BACKGROUND: Customary preparticipation screening strategies to detect heart disease in professional athletes have not been examined systematically. OBJECTIVE: To describe the current preparticipation cardiovascular screening process for professional athletes. DESIGN: Screening practices surveyed by questionnaire. SETTING: The 122 major professional sports teams in North America. PARTICIPANTS: Athletic trainers and team physicians. MEASUREMENTS: League recommendations for history taking and physical examination and noninvasive testing were compared with screening recommendations from an American Heart Association consensus panel. RESULTS: All 122 teams have team physicians perform annual screening, including family and personal history taking (100%), physical examination (100%), and lipid panels (108 of 122 [89%]). Diagnostic testing by using electrocardiography was substantially more common (112 of 122 [92%]) than exercise testing and stress echocardiography (21 of 122 [17%]) or echocardiography (16 of 122 [13%]). League recommendations for history taking and physical examination were most complete for Major League Baseball and the National Hockey League, meeting 10 of 12 and 8 of 12 American Heart Association recommendations, respectively. The most comprehensive cardiovascular screening using echocardiography is confined to selected, elite professional basketball players. LIMITATIONS: Data were self-reported by team representatives. CONCLUSIONS: A variety of nonstandardized preparticipation screening strategies for the detection of cardiovascular disease, varying considerably in scope, constitute customary practice among professional sports teams.