It has been past 60 years since the School Health Law, the Enforcement Ordinance of the School Health Law, and Enforcement Regulation of the School Health Law were established to mandate health check-ups to screen for cardiovascular diseases and abnormalities when entering school and selecting the conduction of additional clinical examinations for those suspected to have heart disease to find it in 1958. However, systematic heart disease screening has been performed since 1995 after the Enforcement Regulation of the School Health Law was revised to mandate that all students in the first year of elementary school, junior high school, and senior high school undergo an ECG test. Sudden death in school has dramatically decreased because of the increase in the installation proportion of automated external defibrillators (AEDs) in schools, and also the propagation of the education on cardiopulmonary resuscitation for school teachers. However, some high risk heart diseases have still been overlooked, and we are confronted with other problems that we have no guidelines to determine to what extent we can allow exercise for already known patients who might have a risk of sudden death during sporting events if the patient wants to participate. Universities, colleges, and vocational schools need to establish their own system because there is no heart disease screening system after graduation from high school. University students from overseas sometimes have severe heart disease that was not managed or treated in their home country. The main topic of this symposium is the problems and assignment of the Japanese heart disease screening system.