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Sports_HCM_Overview.html
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<!DOCTYPE html>
<html lang="en">
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<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Hypertrophic Cardiomyopathy</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
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</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/full/10.1161/cir.0000000000000239">Reference: ACC/AHA Sports Participation Recommendations, Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic RV Cardiomyopathy and other Cardiomyopathies, and Myocarditis (Circulation 2015)</a>
</div>
</div>
<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-transposition (d-TGA), s/p atrial switch (Mustard/Senning)</option>
<option value="TGA_Art">d-transposition (d-TGA), s/p arterial switch </option>
<option value="CCTGA">Congenitally-corrected TGA (CC-TGA, L-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>Hypertrophic Cardiomyopathy</b> participate in organized sports?
</section>
<br>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Symptoms</li>
<li>Clinical manifestations (LVH on echo or MRI)</li>
<li>Family history of HCM-related sudden death</li>
</ul>
</section>
<section id="answer_arrow_section">
<section class="half_left_invisible">⬋</section>
<section class="half_right_invisible">⬊</section>
</section>
<section id="answer">
<section class="half_left">
<p class="sectiontitle">With LV Hypertrophy</p>
<p>"Athletes with a probable or unequivocal clinical expression and diagnosis of HCM (ie, with the disease
phenotype of <u>LV hypertrophy</u>) should <em><u>not</u></em> participate in most competitive sports,
with the exception of those of low intensity (class IA sports)"
</p><p>"This recommendation is independent of age, sex, magnitude of LV hypertrophy,
particular sarcomere mutation, presence or absence of LV outflow obstruction (at rest or with physiological exercise),
absence of prior cardiac symptoms, presence or absence of late gadolinium enhancement (fibrosis) on CMR,
and whether major interventions such as surgical myectomy or alcohol ablation have been performed previously."
<div class="verdict_no">Non-Class IA = Inadvisable</div>
</p>
<hr>
<div class="verdict_ok"><b>Class IA sports: </b>Bowling, Cricket, Curling, Golf, Riflery, Yoga = <b>Acceptable</b></div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
</section>
<section class="half_right">
<p class="sectiontitle">Without LV Hypertrophy</p>
<p>
"Participation in competitive athletics for <u>asymptomatic</u>, genotype-positive HCM patients
<u>without evidence of LV hypertrophy</u> by 2-dimensional echocardiography and CMR is <em>reasonable</em>,
particularly in the <u>absence of a family history of HCM-related sudden death</u> ."
</p>
<div class="verdict_maybe">Non-Class IA = Maybe (see conditions above)</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
</section>
<hr style="width:50%"><br>
<section id="notrecommend">
<p class="sectiontitle_notrec">Not Recommended</p>
<p>The following are NOT recommended:</p>
<span class="sectiontitle">Beta Blocker for sport:</span>
Pharmacologic agents to control cardiac-related symptoms or ventricular tachyarrhythmias should NOT be administered for the <u>sole</u> purpose of permitting participation in high-intensity sports. Notably, such drugs may also be inconsistent with maximal physical performance in most sports
<br><br>
<span class="sectiontitle">Prophylactic ICD:</span>
Should not be placed in athletes with HCM for the <u>sole</u> or primary purpose of permitting participation in high-intensity sports competition because of the possibility of device-related complications. ICD indications for competitive athletes with HCM should not differ from those in nonathlete patients with HCM.
</section>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000239"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis.
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> LV = left ventricle, LVH = left ventricular hypertrophy,
HCM = hypertrophic cardiomyopathy,
ICD = implantable cardio defibrilator,
echo = echocardiogram, CMR = cardiac MRI
</p>
</section>
</body>
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