OBJECTIVE: Concern regarding the risk of sudden unexpected cardiac death has fueled interest in athletes who experience chest pain, syncope, or palpitations during training and competition. This review examines the etiology and evaluation of these symptoms in young athletes. DATA SOURCES/SYNTHESIS: Previously published reports that have provided a base of expert opinion were examined to define the optimal means of assessment before returning athletes to play. RESULTS: A well-defined differential diagnosis must be considered to rule out heart disease and define noncardiac causes of these symptoms. CONCLUSIONS: Athletes who experience symptoms such as chest pain, syncope, and palpitations during competition and training can be safely returned to play only after the evaluation is completed.