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Sports_PVC_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: Premature Ventricular Contractions (PVCs)</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
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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/10.1161/CIR.0000000000000245">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015)
Task Force 9</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">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>PVCs</b> participate in organized sports?
</section>
</section>
<!-- End of 10px margin section. Consider changing template. -->
<br>
<!-- navigation bar for disease sub-categories -->
<nav>
<a href="Sports_Afib_Overview.html" >Atrial Fibrillation</a>
<a href="Sports_Aflutter_Overview.html">Atrial Flutter</a>
<a href="Sports_SVT_Overview.html">EAT, AVNRT, AVRT, & WPW</a>
<a href="Sports_PVC_Overview.html" class="active">PVCs</a>
<a href="Sports_NSVT_Overview.html">Non-sustained ventricular tachycardia (NSVT)</a>
<a href="Sports_VT_mono_Overview.html">Monomorphic VT, sustained</a>
<a href="Sports_VT_poly_Overview.html">Polymorphic VT or VF, sustained</a>
</nav>
<div class="largeanswerbox">
<h2 align=center>Premature Ventricular Contractions (PVCs)</h2>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Exercise test results</li>
</ul>
</section>
<section id="answer_arrow_section">
<section class="quarter_invisible">⇙</section>
<section class="quarter_invisible">⇙</section>
<section class="quarter_invisible">⇘</section>
<section class="quarter_invisible">⇘</section>
</section>
<section id="answer">
<section class="quarter_left">
<p class="sectiontitle">Single PVCs, no greater than couplets (rest/exercise), no structural heart disease</p>
<p>"Athletes with single PVCs and complex forms no greater than couplets at rest and
during exercise testing without structural heart disease can participate in all competitive sports.
</p><p>The exercise testing protocol should be based on maximal performance rather than achieving 80% to 100%
of the target heart rate to come as close as possible to the level of exertion achieved during their
competitive sport."
</p>
<div class="verdict_ok"><b>All sports = acceptable</b> (if conditions met)</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">PVCs increase in frequency w/ exercise</p>
<p>"Athletes with PVCs at rest that increase in frequency during exercise or exercise testing
and convert to repetitive forms should have further evaluation by appropriate imaging or monitoring strategies
before clearance for participation in high-intensity sports. </p>
<p>If uncontrollable exercise-induced arrhythmias produce symptoms of lightheadedness or near-syncope,
fatigue, or dyspnea, the athlete should be limited to competitive sports below the level
at which marked frequency increase or symptoms evolved during testing."
</p>
<div class="verdict_maybe">If PVCs increase in frequency w/ exercise and convert to repetitive form: <b>Imaging/monitoring</b></div><br>
<div class="verdict_maybe">If symptomatic, uncontrollable exercise-induced arrhythmias: <b>Limit sports below level at which PVCs increased / symptoms occurred</b></div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Structural heart disease and high risk</p>
<p>"Athletes with defined structural heart disease who are considered high risk based on the specific heart disease and
who have PVCs with or without treatment should be limited to low-intensity class IA competitive sports.
This statement applies whether or not PVCs in this setting are suppressed by drug therapy.
Some degree of risk can still be present during class IA sports, however, depending on the nature of the heart disease."
</p>
<div class="verdict_maybe"><b>Class IA sports only.</b> Note: Some risk possible even with IA sports.</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Symptomatic, frequent PVCs resistant to medical therapy</p>
<p>"Ablation of PVCs may be considered in symptomatic patients with
frequent PVCs resistant to medical therapy."
</p>
<div class="verdict_maybe"><b>Can consider ablation</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000245"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9.</a>
A Scientific Statement From the AHA and ACC. 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> PVC = premature ventricular contractions
</p>
</section>
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