The cardiovascular system experiences the greatest overload, morphological and functional changes inelite sport, which in a number of athletes undergoes nonadaptive (pathological) remodeling both functional and morphological. The latter is characterized by certain objective features, including echocardiography indicators, which occupies a special place in sports cardiology. Structural and functional changes beyond the generally accepted norm (pronounced cardiac hypertrophy or dilatation, high arterial hypertension) can be associated with systolic or diastolic myocardial dysfunction and impaired electrical properties, some of which are predictors of severe complications up to sudden cardiac death and pose a serious problem regarding the admission of athletes to training and competition. This review is devoted to summarizing the views of authoritative specialists in the field of sports medicine on the criteria of pathological remodeling of the heart muscle, the role of echocardiography in its diagnosis, the discussion of the limits of the norm of response to blood pressure load, the analysis of the main causes of sudden cardiac death of athletes, the realities and prospects of genetic selection in sports.