Despite the documented health benefits of physical exercise, there is a paradoxical, but small, risk of sudden cardiac arrest (SCA) and/or death (SCD) associated with exercise. Cardiovascular causes account for 75% of sportrelated deaths in young athletes, with SCA/SCD rates varying according to athlete age, gender, intensity of activity, race, and ethnicity. True risk for American athletes is dif fi cult to assess owing to the lack of a national registry with well-de fi ned numerators and denominators, and a consensus on metrics. Although exercise-related syncope and/or chest pain are considered the most ominous prodromal complaints, the true predictive value of symptoms is not known in athletic populations. The comparative effectiveness of various screening methodologies (e.g. history and physical alone versus history and physical plus electrocardiogram) with regard to athlete outcomes has not been determined. To address these issues in American athletes, and to coordinate a nation-wide multidisciplinary approach to athlete cardiovascular care, the American College of Cardiology Sports and Exercise Cardiology Section convened the " Think Tank to Protect the Heart of the American Athlete and Exercising Individual " on October 18, 2012, in Washington, DC. Think Tank participants (representing athletic trainers; primary care professional societies; cardiovascular specialty, subspecialty, and imaging societies; government agencies; industry; sports governing bodies; and patient advocacy groups) identifi ed 92 quality gaps, and created an action plan to address the most urgent of these gaps: 1) Defining sports cardiology outcome metrics and conducting highquality epidemiologic research; 2) Educating providers in the optimal use of existing clinical athlete cardiovascular care tools; 3) Promoting and conducting research to de fi ne normative values for cardiac tests in large numbers of American athletes and developing datadriven management algorithms; and 4) Coordinating athlete advocacy efforts by creating athlete cardiovascular care state-wide task forces. The Think Tank plans to convene every 2 years to monitor progress.