The 18th FIFA Soccer World Cup 2006 in Germany enthused millions of people worldwide, but only little is known about the association of such an event with cardiovascular events. Modest physical activity is known to reduce the cardiovascular risk significantly. On the other hand, vigorous physical activity and emotional strain increase the cardiovascular risk and the incidence of cardiovascular events likely due to an increased sympathetic tone with consecutive catecholamine stimulation of the heart. Few reviews and case-reports are dealing with the risk of physical activity in cardiovascular high-risk patients or athletes with congenital heart diseases (e.g. hypertrophic obstructive cardiomyopathy), but the impact of highly competitive events on cardiovascular events, especially in spectators were rarely addressed. Thus, the increased risk of cardiovascular events in players and spectators were addressed in this review with respect to various soccer matches and tournaments, such as the FIFA World Cup.