Cardiovascular signs and symptoms in young people are common and usually represent variants of normal physiology. However, these signs and symptoms can also indicate the presence of important cardiovascular disorders. Innocent heart murmurs can be distinguished from pathologic murmurs by the lack of associated symptoms, as well as their loudness, timing and location. Although most chest pain in this age group is of musculoskeletal or psychogenic origin, cardiac causes can include pericarditis, aortic stenosis and coronary anomalies. Syncope is usually vasovagal in origin and has a benign prognosis. Sinus arrhythmia and isolated extrasystoles are the most common causes of irregular cardiac rhythms in the young. Multiform premature ventricular contractions, couplets and ventricular tachycardia may indicate underlying cardiac disease.