-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathSports_HTN_Overview.html
262 lines (222 loc) · 14 KB
/
Sports_HTN_Overview.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
<!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: Hypertension</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.0000000000000242">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 6: Hypertension</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-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">Pulmonary hypertension 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>Hypertension</b> participate in organized sports?
</section>
</section>
<p class="caveat_description">Note: The decision tree below is a graphic interpretation of the ACC/AHA 2015 guideline,
as perceived by the creator of CardioRef, who was not a part of the expert panel involved in the guideline
creation.
<br> I would strongly recommend that you read the <a href ="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000242">full guideline</a>
for further clarification. <br> Feedback regarding the interpretive figure below is welcome.
</p>
<p>
<b>Before applying the following decision tree, please note the following:* </b><br>
<ul>
<li>"The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels
measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week" (Chobanian 2003)</li>
<li>"People >18 years of age with a BP >140 mm Hg systolic and/or >90 mm Hg diastolic are considered to have hypertension" (Chobanian 2003)</li>
<li>"In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves open to question
when an adult age criterion for hypertension should be applied to the adolescent." (Moyer 2013)</li>
<li>"In determining the level of competitive athletic activity that a hypertensive person may engage in, it is also important to determine the degree of hypertension-related target-organ damage."</li>
<li>"For the general population, increased levels of noncompetitive recreational physical activity are generally regarded as beneficial...
Those who are hypertensive derive protection from both all-cause and cardiovascular mortality by maintaining higher levels of cardiorespiratory fitness." (Church 2001)</li>
<li><a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000242#T1">Guidelines for Clinic/Office BP Measurement</a></li>
<li>"In an adolescent or young adult (ie, < 25 years of age) with stage 2 hypertension, it may be appropriate to refer this person for further evaluation
and therapy to a cardiologist or hypertension specialist. The workup for secondary forms of hypertension and proper pharmacological management is often
outside the scope of general pediatricians and family practitioners who might otherwise be seeing these athletes" </li>
</ul>
<i>*Quotations above are from the <a href = "https://www.ahajournals.org/doi/10.1161/CIR.0000000000000242">ACC/AHA 2015 guidelines</a>. The superscripted citations at the end of each quotation are the citations cited within the guidelines.</i>
</p>
<section id="needtoknow">
<p class="sectiontitle">First, perform appropriate BP assessment</p>
<p>"Before people begin training for competitive athletics, it is reasonable that they undergo careful assessment of BP,
and <b>those with initially high levels (>140 mm Hg systolic or >90 mm Hg diastolic)</b> should have comprehensive <b>out-of-office</b> measurements
to exclude errors in diagnosis. </p><p>Ambulatory BP monitoring with proper cuff and bladder size would be the most precise means of measurement."</p>
<p class="rec_class"> (Class I Recommendation; Level of Evidence B)</p>
</section>
<section id="answer_arrow_section">
<section class="third_invisible">⇙</section>
<section class="twothird_right_invisible"> ⇘</section>
</section>
<section id="answer">
<section class="third_left">
<p class="sectiontitle">Pre-HTN (BP 120-139/80-89)</p>
<p>"Those with prehypertension (BP of 120/80 mm Hg–139/89 mm Hg) should be encouraged to modify their lifestyles
but should not be restricted from physical activity."</p>
</p>
<div class="verdict_ok"><b>No activity restrictions</b></div>
<p class="rec_class"></p>
</section>
<section class="twothird_right">
<p class="sectiontitle">Sustained hypertension (>140/90)</p>
<p>"Those with sustained hypertension should have <b>screening echocardiography</b> performed.
Athletes with LVH beyond that seen with “athlete’s heart” should limit participation
until BP is normalized by appropriate antihypertensive drug therapy."
</p>
<div class="verdict_no">If pathological LVH: Limit sport participation until BP normalized.</div><br>
<div class="verdict_maybe">If no pathological LVH: See below</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence B)</p>
</section>
<section id="answer_arrow_section">
<section class="third_invisible"> </section>
<section class="third_invisible">⇓</section>
<section class="third_invisible">⇓</section>
</section>
<section class="third_left_blank">
<p> </p>
</section>
<section class="third_middle">
<p class="sectiontitle">Stage 1 HTN (BP 140-159/90-99) without target-organ damage</p>
<p>
"It is reasonable that the presence of stage 1 hypertension in the absence of target-organ damage should not
limit the eligibility for any competitive sport. Once having begun a training program,
the hypertensive athlete should have BP measured every 2 to 4 months (or more frequently, if indicated)
to monitor the impact of exercise."
</p>
<div class="verdict_ok"><b>All sports = acceptable, if no LVH or other target-organ damage</b> (with BP checks at least q2-4 months)</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence B)</p>
</section>
<section class="third_right">
<p class="sectiontitle">Stage 2 HTN (SBP > 160, or DBP >100)</p>
<p>
"It is reasonable that athletes with stage 2 hypertension (a systolic BP >160 mm Hg or a diastolic BP >100 mm Hg),
even without evidence of target-organ damage, should be restricted, particularly from high static sports,
such as weight lifting, boxing, and wrestling, until hypertension is controlled by either lifestyle modification or drug therapy."
</p>
<div class="verdict_no">No sports until HTN is controlled</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence B)</p>
</section>
</section>
<hr style="width:50%"><br>
<section id="generalconsider">
<p class="sectiontitle_notrec">General Considerations</p>
<p> "When prescribing antihypertensive drugs, particularly diuretic agents, for competitive athletes, it is reasonable for clinicians to
use drugs already registered with appropriate governing bodies
and if necessary obtain a therapeutic exemption."</p>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence B)</p>
<p>"When hypertension coexists with another cardiovascular disease, it is reasonable that eligibility for participation in
competitive athletics is based on the type and severity of the associated condition."
</p>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<hr style="width:50%"><br>
<p class="foot">
<b>References:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000242"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities. Task Force 6: Hypertension.
A Scientific Statement From the AHA and ACC.</i></a> <i>Circulation 2015</i>
<ul>
<li>Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ; National High Blood Pressure Education Program Coordinating Committee. JNC 7: complete report: seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.Hypertension. 2003; 42:1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2.</li>
<li>Church TS, Kampert JB, Gibbons LW, Barlow CE, Blair SN.Usefulness of cardiorespiratory fitness as a predictor of all-cause and cardiovascular disease mortality in men with systemic hypertension.Am J Cardiol. 2001; 88:651–656.</li>
<li>Moyer VA; U.S. Preventive Services Task Force. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement.Pediatrics. 2013; 132:907–914. doi: 10.1542/peds.2013-2864.</li>
</ul>
<p class="foot"><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> HTN = hypertension, BP = blood pressure, SBP = systolic BP, DBP = diastolic BP
</p>
</section>
<script>
function goThere(){
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';
}
}
function toggle_table() {
var x = document.getElementById("elaboration");
if (x.style.display === "block") {
x.style.display = "none";
} else {
x.style.display = "block";
}
}
</script>
</html>