Sudden cardiac death in seemingly healthy young people during exertion has led to preparticipation assessment of athletes. Typically, cardiac evaluation is limited to auscultation by a primary care provider. Screening electrocardiography is controversial. The value of limited echocardiography is unknown. High school athletes undergoing preparticipation evaluation for organized athletics completed a medical history questionnaire and were examined with standardized history and physical, 12-lead electrocardiogram, and a limited two-dimensional echocardiogram. The studies were interpreted by cardiologists. Of 95 subjects recruited, there were 55 females and 40 males. There were 10 abnormalities detected requiring further evaluation, two by electrocardiogram and eight by echocardiography. Only one abnormality was found with screening physical examination. Abnormalities occurred with similar frequency (13% vs. 9%) in those with and without cardiovascular symptoms. Screening echocardiography and electrocardiography are of benefit in identification of cardiac anomalies not appreciated on routine physical examinations. Further study of these screening modalities is warranted.