Best Practice Case Studies-Cardiac Concerns: Participation in Sport

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The AHA/ACC Scientific Statement highlights hypertrophic cardiomyopathy (HCM) as the leading cause of sudden death among young competitive athletes in the United States. It is identified as a genetic disorder affecting approximately 1 in 500 individuals. The condition is associated with 1500 mutations across 11 major genes impacting cardiac sarcomere, Z disk, and calcium handling proteins. Sudden death in HCM patients is primarily due to ventricular tachyarrhythmias. High-intensity sports exacerbate these risks, making athletic participation a modifiable risk factor.<br /><br />The document outlines strategies for risk stratification, emphasizing that some HCM cases may not present conventional risk markers. It recommends a cautious approach to sports eligibility, balancing the risk of sudden death with the benefits of exercise. The guidelines suggest that athletes with HCM generally avoid competitive sports, except for low-intensity activities.<br /><br />For genotype-positive but phenotype-negative individuals (those carrying the genetic markers without the clinical expression), sports participation is deemed reasonable in the absence of LV hypertrophy and a family history of sudden death.<br /><br />The statement also addresses other cardiomyopathies and myocarditis. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is another focus, particularly prevalent in Italy but less so in the U.S. The guidelines recommend against participation in most competitive sports for individuals diagnosed with ARVC, due to the risk of ventricular arrhythmias and sudden death during exertion.<br /><br />For myocarditis, the document advises against sports participation during active inflammation. An athlete's return to sports requires a normal ECG, absent arrhythmias, and normal ventricular function following a defined recovery period.<br /><br />Overall, the recommendations stress individualized assessment and decisions made in consultation with healthcare providers, considering each athlete's unique health profile and risks. These guidelines aim to mitigate sudden cardiac death risk in athletes with cardiovascular conditions while allowing safe participation in physical activities where possible.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 03

Topic Cardiac

Keywords

2nd Edition, CASE 03

2nd Edition

Cardiac

hypertrophic cardiomyopathy

sudden death

competitive athletes

genetic disorder

risk stratification

sports eligibility

ventricular tachyarrhythmias

arrhythmogenic right ventricular cardiomyopathy

myocarditis

individualized assessment