Cardiovascular disease is the most frequent cause of death among Americans today and unfortunately is not limited to the elderly and those with various comorbidities, but also takes the lives of young, seemingly healthy individuals, including elite athletes. Because of the tremendous social and psychologic impact that these albeit rare events entail, there has been a drive in recent years to develop preventive strategies so that such tragedies may be avoided. It is also imperative that recommendations be made for those older individuals with existing disease who wish to remain active and healthy. If such individuals are to engage in such activities they must know the risks involved. This review defines the spectrum of cardiac disease commonly affecting athletes and presents the most current diagnostic strategies as well as recommendations for disqualification from sport. In addition, it is important to recognize the benefits of regular physical activity even in those older patients at risk because of existing heart disease and provide them with adequate information regarding the extent to which they may participate in physical activity.