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Sports_Coarct_Overview.html
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<!DOCTYPE html>
<html lang="en">
<!-- defines the default zoom for mobile devices -->
<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Coarctation of the Aorta</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
-webkit-margin-after:0;
-webkit-margin-start:0;
-webkit-margin-end:0;
}
</style>
</head>
<body>
<div class="topbar">
<a href="index.html">Pedi CardioRef</a>
<div class="guidelinebar">
<a target="_blank" rel="noopener noreferrer" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000240">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 4: Congenital Heart Disease</a>
</div>
</div>
<section style="margin:10px">
<p class="topspace"></p>
<label><b>By the ACC/AHA 2015 guidelines, should my patient with</label>
<select name="disease" id="dz" class="InputBox" onChange="goThere();">
<option value="">*Select Disease*</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HCM">Hypertrophic Cardiomyopathy </option>
<option value="LVNC">Left Ventricular Non-Compaction </option>
<option value="DilRestr">Dilated or Restrictive Cardiomyopathy </option>
<option value="ARVC">Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) </option>
<option value="Myo">Myocarditis </option>
<option value="Peri">Pericarditis </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="ASDVSDPDA">ASD, VSD, or PDA </option>
<option value="PS">Pulmonic Stenosis </option>
<option value="AS">Aortic Stenosis </option>
<option value="Coarct">Coarctation </option>
<option value="Cyan">Cyanotic Heart Disease, unrepaired or with palliative shunt </option>
<option value="TOF">Tetralogy of Fallot, s/p repair </option>
<option value="TGA_Must">d-TGA, s/p atrial switch (Mustard/Senning)</option>
<option value="TGA_Art">d-TGA, s/p arterial switch </option>
<option value="CCTGA">Congenitally-corrected TGA </option>
<option value="Fontan">Fontan </option>
<option value="Ebstein">Ebstein Anomaly </option>
<option value="AnomCoronary">Anomalous Coronary Artery Origin</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="PVR">Elevated PVR in CHD </option>
<option value="VentricularDysfxn">Ventricular Dysfunction s/p CHD Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Valve_AS">Aortic Stenosis</option>
<option value="Valve_AR">Aortic Regurgitation </option>
<option value="Valve_MS">Mitral Stenosis</option>
<option value="Valve_MR">Mitral Regurgitation </option>
<option value="Valve_Hx">History of Mitral or Aortic Valve Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HTN">Hypertension </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="AoDiseases_and_Marfan">Aortic Diseases and Marfan Syndrome</option>
<option value="BAV">Bicuspid Aortic Valve</option>
<option value="Marfan">Marfan Syndrome</option>
<option value="TAA">Thoracic Aortic Aneurysm, familial or unexplained</option>
<option value="LoeysDietz_EhlersDanlos">Loeys-Dietz or vascular Ehlers-Danlos</option>
<option value="AoEnlarge">Enlarged Aorta, non-syndrome non-familial</option>
<option value="Ao_Surgery">S/p Surgery for Aortic Enlargement/Dissection</option>
<option value="Chronic_AoDissection">Chronic Aortic Dissection or Branch Aneurysm</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="CoronaryOverview">Coronary Artery Disease </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Syncope">Syncope </option>
<option value="Arrhythmia">Arrhythmias (SVT, PVC, Vtach, etc.) </option>
<option value="ConductionDefect">Conduction Defects (AV block, brady, pacemaker, RBBB/LBBB)</option>
<option value="Channelopathies">Channelopathies (LQTS, CPVT, Brugada, etc.) </option>
<option value="ICD">Implantable Cardioverter-Defibrillator (ICD) </option>
</select>
<span>participate in organized sports?</span></b>
<br><br>
<section id="question">
Should my patient with <b>coarctation of the aorta</b> participate in organized sports?
</section>
</section>
<br>
<div class="multi">
<ul class="tabs">
<li class="tab">
<input type="radio" name="tabs" checked="checked" id="tab1" />
<label for="tab1">Coarctation, unrepaired</label>
<div id="tab-content1" class="content">
<h1>Coarctation, unrepaired</h1>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Ascending aorta dilation?</li>
<li>Exercise-induced hypertension?</li>
<li>Coarctation gradient</li>
</ul>
<br>
</section>
<section id="answer">
<section id="answer_arrow_section">
<section class="half_left_invisible">⬋</section>
<section class="half_right_invisible">⬊</section>
</section>
<section class="half_left">
<p class="sectiontitle">No ascending aorta dilation, normal exercise test, < 20mmHg gradient</p>
<p>"Athletes with coarctation and without significant ascending aortic dilation (z score ≤3.0; a score of 3.0 equals
3 standard deviations from the mean for patient size)
with a normal exercise test and a resting systolic blood pressure gradient < 20 mm Hg between the upper and lower limbs and a
peak systolic blood pressure not exceeding the 95th percentile of predicted with exercise can participate
in all competitive sports."
</p>
<div class="verdict_ok"><b>All sports are likely acceptable, if the above conditions are met.</b></div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="half_right">
<p class="sectiontitle">Ascending aorta dilation, exercise-induced hypertension, or > 20mmHg gradient</p>
<p>
"Athletes with a systolic blood pressure arm/leg gradient >20 mm Hg or exercise-induced hypertension (a peak systolic blood pressure
exceeding the 95th percentile of predicted with exercise) or with significant ascending
aortic dilation (z score >3.0) may be considered for participation only in low-intensity class IA sports."
</p>
<div class="verdict_maybe"><b>May only consider low-intensity class IA sports </b>(bowling, cricket, curling, golf, riflery, yoga)</div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
</li>
<li class="tab">
<input type="radio" name="tabs" id="tab2" />
<label for="tab2">Coarctation, repaired</label>
<div id="tab-content2" class="content">
<h1>Coarctation, treated by surgery or balloon and stent</h1>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>How long since repair</li>
<li>Residual gradient</li>
<li>Exercise test results</li>
<li>Ascending aorta dilation</li>
<li>Repair-site aneurysm</li>
<li>Aortic valve disease?</li>
</ul>
<br>
</section>
<section id="answer">
<section id="answer_arrow_section">
<section class="half_left_invisible">⬋</section>
<section class="half_right_invisible">⬊</section>
</section>
<section class="half_left">
<p class="sectiontitle">Greater than 3 months post op, < 20mmHg gradient, and all other conditions above normal</p>
<p>"Athletes who are >3 months past surgical repair or stent placement with < 20 mm Hg arm/leg blood pressure gradient at rest,
as well as (1) a normal exercise test with no significant dilation of the ascending aorta (z score < 3.0),
(2) no aneurysm at the site of coarctation intervention, and (3) no significant concomitant aortic valve disease,
may be considered for participation in competitive sports, but with the exception of high-intensity
static exercise (classes IIIA, IIIB, and IIIC), as well as sports that pose a danger of bodily collision."
</p>
<div class="verdict_maybe"><b>May consider sports <u>except</u> high-intensity static exercise</b> (IIIA, IIIB, IIIC) and <b>those where danger of collision</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="half_right">
<p class="sectiontitle">Aortic dilation or aneurysm</p>
<p>
"Athletes with evidence of significant aortic dilation or aneurysm formation (not yet at a size to need surgical repair)
may be considered for participation only in low-intensity (classes IA and IB) sports."
</p>
<div class="verdict_maybe"><b>If not yet requiring additional surgical repair, may consider Class IA sports </b>(Bowling, Cricket, Curling, Golf, Riflery, Yoga) or
<b>IB sports </b>(Baseball/softball, Fencing, Table tennis, Volleyball)</div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
</li>
</ul>
</div>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000240"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 4: Congenital Heart Disease.
A Scientific Statement From the AHA and ACC.</i></a> <i>Circulation 2015</i>
<br><br><b>Disclaimer:</b> This website is derived from published guidelines, but does not constitute medical advice nor does it replace clinical judgement. Only the text in quotation marks are direct quotations from the original guidelines. Text not in quotations as well as the method of information display are all that of the website creator and are not part of the original published guidelines. Please consult a physician to discuss any patient-specific matters.
</p>
<section class="key">
<p><b>Key:</b> coarctation = coarctation of the aorta
</p>
</section>
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var disease = document.getElementById("dz").value;
location.href= disease+'_Overview.html';
}
function getState() {
var disease = document.getElementById("dz").value;
var sport = document.getElementById("spt").value;
if(disease && sport) {
console.log(disease);
console.log(sport);
console.log(disease+sport);
combo=disease+sport;
location.href = combo+'.html';
}
}
</script>
</html>