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Sports_Coronary_Athero_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: Coronary Atherosclerosis</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.0000000000000244">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 8: Coronary Artery 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-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>Coronary Artery Disease</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_Coronary_Athero_Overview.html" class = "active">Atherosclerotic Coronary Disease</a>
<a href="Sports_Coronary_Spasm_Overview.html">Coronary Spasm</a>
<a href="Sports_Coronary_Dissection_Overview.html">Coronary Artery Dissection</a>
<a href="Sports_Coronary_Bridging_Overview.html">Myocardial Bridging</a>
<a href="Sports_Coronary_Kawasaki_Overview.html">Kawasaki</a>
<a href="Sports_Coronary_Vasculitis_Overview.html">Coronary Vasculitis</a>
<a href="Sports_Coronary_Transplant_Overview.html">Transplant Coronary Vasculopathy</a>
</nav>
<div class="largeanswerbox">
<h2 align=center>Atherosclerotic Coronary Artery Disease (ASCAD)</h2>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Should perform/prescribe:</p>
<ul>
<li>Maximal exercise testing</li>
<li>Evaluate LV function</li>
</ul>
<p>"Athletes with ASCAD should undergo maximal exercise testing to evaluate exercise tolerance,
the presence of inducible ischemia, and the presence of exercise-induced electrical instability.
Testing should be performed on the subject’s standard medical regimen,
including β-adrenergic blocking medications."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
<p>"Athletes with ASCAD should undergo an evaluation of left ventricular function."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section id="answer_arrow_section">
<section class="single_invisible">⇓</section>
</section>
<section class="single_center">
<p class="sectiontitle">All patients with ASCAD:</p>
<p>"Once informed of the results of the evaluations contained in recommendations 1 and 2,
adult patients with ASCAD should <b>participate in the decision</b> as to whether the health and psychological benefits
of exercise for them outweigh the risk."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
<hr>
<p>"Athletes with ASCAD should undergo aggressive risk factor reduction with <b>high-intensity statin therapy</b>
to reduce the chance of plaque disruption."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence A)</p>
</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">Clinically concealed ASCAD, LVEF >50%</p>
<p>"It is reasonable for athletes with clinically concealed ASCAD to participate in
all competitive activities if their resting left ventricular ejection fraction is >50%
and they have no inducible ischemia or electrical instability."
(Recommendation 5)
</p>
<div class="verdict_ok"><b>All sports = reasonable</b>, if resting LVEF >50%.</div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">Clinically manifest ASCAD, LVEF >50%, asymptomatic, no ischemia or electrical instability</p>
<p>"It is reasonable for patients with clinically manifest ASCAD to participate in all competitive activities
if their resting left ventricular ejection fraction is >50%, they are asymptomatic,
and they have no inducible ischemia or electrical instability." (Recommendation 6)
</p>
<div class="verdict_ok"><b>All sports = reasonable</b>, if above criteria met.</div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Clinically manifest ASCAD, not meet criteria</p>
<p>
"It is reasonable to restrict patients with clinically manifest ASCAD that does not fulfill the criteria
in recommendation 6 to sports with low dynamic and low to moderate static demands." (Recommendation 7)
</p>
<div class="verdict_maybe"><b>Low dynamic and low-moderate static sports = acceptable</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Clinically manifest ASCAD, recent AMI or revascularization, worsening ischemia</p>
<p>
"It is reasonable to prohibit patients with clinically manifest ASCAD from competitive sport participation:
<ul>
<li>For at least 3 months after an AMI or coronary revascularization procedure;</li>
<li>If they have increasing frequency or worsening symptoms of myocardial ischemia."</li>
</ul>
</p>
<div class="verdict_no">No sports</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.0000000000000244"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 8: Coronary Artery Disease.</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> ASCAD = atherosclerotic coronary artery disease, LVEF = LV ejection fraction, AMI = acute myocardial infarction
</p>
</section>
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