The benefits of regular moderate exercise to improve health are undisputed. However, in individuals harboring underlying cardiac disorders, there is an increased risk of adverse cardiac events during exertion, including sudden cardiac death (SCD). Subclinical cardiomyopathies are amongst the most common causes of SCD in young athletes and, importantly, SCD may be the initial presentation of a cardiomyopathy. While these tragic events are rare, the emotional effect on the athlete’s family and the community at large is profound and devastating. Therefore, pre-participation screening programs to detect silent cardiac disorders are in place in many countries. However, the optimal structure of such programs, particularly whether or not a 12-lead ECG should be included as an initial screening test, is an area of controversy. This review discusses the most recent insights and latest guidelines regarding pre-participation screening to detect cardiomyopathies in athletes.