The majority of sudden deaths during physical activity is due to cardiac diseases. In younger persons (< 25 years) the hypertrophic cardiomyopathy is most often involved, followed by infectious cardiac diseases (myocarditis). Already in persons up to 40 years the incidence of coronary arteriosclerosis markedly increases. Although the acute risk of sudden cardiac death is enhanced during sport activity, regular physical training results in an overall cardioprotective effect. Demands on the sports medical examination are discussed in the light of the prevention of sudden cardiac death as well as the long-term health care. Based on a careful anamnesis and clinical examination the ECG as well as the echocardiography present non-invasive methods with high informational value. An exercise-ECG is especially recommended to evaluate the eligibility for physical exercise in persons > 35-40 years and in subjects with risk factors for cardiovascular diseases.