<p>Despite being recognized for over a century, the athlete's heart (AH) a result of intense and regular physical training remains a topic of clinical debate. This physiological cardiac remodelling involves structural, electrical, and functional changes that can resemble pathological conditions. In some cases, sudden cardiac death may be the first sign of underlying disease. Accurate diagnosis is crucial, but a knowledge gap often exists regarding the normal features of an athlete’s heart. Clinical evaluation, including physical examination, personal and family history, and 12-lead electrocardiogram (ECG) findings, plays a key role in identifying conditions such as hypertrophic cardiomyopathy. However, distinguishing between physiological and pathological ECG changes is challenging, potentially leading to either missed diagnoses or unnecessary disqualification. This review outlines the cardiovascular adaptations to training across different athlete groups and emphasizes critical factors in assessing young competitive athletes to ensure safe participation without compromising clinical vigilance.</p> Graphical Abstract <p></p>