Sudden cardiac death (SCD) is the leading cause of death during exercise in young athletes. Preparticipation physical examinations were developed to maintain the health and safety of athletes, including the prompt identification of those at risk for SCD. The use of medical history and physical examinations, electrocardiography, and echocardiography, or some combination thereof, is the source of continued debate. This article provides an overview of the etiology of SCD and reviews literature relating to preparticipation echocardiography, with a focus on its evolution, utility, and effectiveness. The limited echocardiogram is a potentially viable screening option yet to be thoroughly explored by experts and policymakers in the sports medicine community.