The pathological causes of sudden death during athletics varies with the age of the competitor. Congenital abnormalities are the predominant cause of exercise-related deaths in subjects under age 30 yr whereas atherosclerotic coronary artery disease is the primary cause of such deaths in adults. Cardiovascular screening programs designed to reduce the incidence of exercise deaths are limited by the rarity of exercise events, the poor predictive value of the tests, and the cost of testing. Nevertheless, we recommend that young athletes be examined to detect conditions associated with exercise complications and that new symptoms in young and old athletes be carefully evaluated.