Best Practice Case Studies-Case 116 Asset 2 Athletes With Cardiovascular Abnormalities

Pdf Summary

This AHA/ACC scientific statement updates guidance on competitive sports participation for athletes with cardiovascular abnormalities. It replaces older, more restrictive “disqualification” thinking with a shared decision-making (SDM) model that weighs medical risk, athlete values, sport type, and available expertise.<br /><br />The document is organized into 11 sections covering sports classification, preparticipation screening, ethics, cardiomyopathies, myocarditis/pericarditis, congenital heart disease, aortopathy, arrhythmias/devices/ECG findings, channelopathies, masters athletes, and other conditions such as hypertension, pulmonary embolism, extreme environments, and pregnancy. A key change is that sports are now presented as a continuum of endurance, strength, collision, and impact demands rather than fixed categories.<br /><br />Major updates include:<br />- Preparticipation screening: history/physical remains important, but a resting 12-lead ECG is considered reasonable when expert interpretation and downstream resources are available.<br />- Ethical framework: SDM is described as an ethical imperative, not optional.<br />- Cardiomyopathies: universal restriction is no longer recommended. Competitive participation may be reasonable in selected athletes with hypertrophic, dilated, or arrhythmogenic cardiomyopathies, depending on genotype, phenotype, symptoms, arrhythmia burden, and surveillance.<br />- Myocarditis/pericarditis: return to sport may occur earlier than previously thought in select myocarditis cases if inflammation resolves and testing is reassuring.<br />- Congenital heart disease and aortopathy: decisions depend heavily on anatomy, physiology, aortic size, and exercise/hemodynamic stress, with special caution for high-risk coronary anomalies, aneurysms, and post-dissection patients.<br />- Arrhythmias/channelopathies: many athletes with AF, SVT, WPW, ICDs, long QT syndrome, CPVT, or Brugada syndrome can continue or return to sport under expert care and SDM.<br />- Masters athletes: coronary artery disease becomes the dominant concern, with individualized risk stratification and attention to AF, aortic enlargement, and valvular disease.<br /><br />The statement also emphasizes emergency action plans, CPR/AED readiness, equity in screening, and the need for more prospective data.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 116

Topic Cardiac

Keywords

4th Edition

4th Edition, Case 116

AHA/ACC

competitive sports participation

cardiovascular abnormalities

shared decision-making

preparticipation screening

electrocardiogram

cardiomyopathies

myocarditis

congenital heart disease

arrhythmias

Cardiac