In brief: Sudden cardiac death in high school and college athletes is uncommon. When it does occur, its most common causes include hypertrophic cardiomyopathy, aortic rupture associated with Marian's syndrome, congenital coronary artery anomalies, and atherosclerotic coronary artery disease. A screening cardiovascular examination may help identify athletes who are at risk for sudden death. Echocardiography can be a useful tool for identifying previously undetected cardiovascular disease in young athletes, However, including it routinely in preparticipation evaluations is financially, logistically, and legally impractical. A brief but thorough screening history and physical examination should identify individuals who would benefit from a more extensive evaluation, which might include an echocardiogram and other tests. The authors discuss typical findings in individuals who should be evaluated further.