Myocardial ischemia, be it silent or asymptomatic, is defined as an objective documentation of myocardial ischemia, in the absence of angina or its equivalents. Among the subjects who can be asymptomatic coronary heart disease carriers, athletes also come into this category, i.e. individuals who regularly practice and compete in sports events at highly competitive athletic levels. Most of the patients with silent myocardial ischemia due to coronary artery disease are athletes.Silent myocardial ischemia is not the same as silent coronary artery disease. Symptomatic angina is the tip of the ischemic iceberg and in athletes is smaller than non -athletes. Athletes are normally considered individuals in good if not great health, thus when one of them is struck by sudden death, it creates uproar and consternation. However, just as what happens among the population on a whole, athletes can harbour unrecognized cardiac.For this reason the preparticipation screening program of athletes has the goal of of the early identification of previously unsuspected cardiovascular disease in the hope that these strategies will reduce the incidence of sudden cardiac death.