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Sports_Valve_AR_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: ____</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.0000000000000241">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 5: Valvular 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-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>Aortic Regurgitation</b> participate in organized sports?
</section>
</section>
<br>
<section id="needtoknow">
<p class="sectiontitle">Need to perform:</p>
<ul>
<li>Annual evaluation</li>
<li>Exercise testing</li>
</ul>
<p>"Athletes with AR should be evaluated annually to determine whether
sports participation can continue."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
<p>"Exercise testing to at least the level of activity achieved in competition and the training regimen
is helpful in confirming asymptomatic status in athletes with AR
and assessing blood pressure responses."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</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">Mild-Mod AR, normal LVEF, no/mild LV dilatation, normal exercise test</p>
<p>"Athletes with mild to moderate degrees of AR (stage B) with
normal LV ejection fraction and no or mild LV dilatation
can participate in all competitive sports if they have normal exercise tolerance on exercise testing."
</p>
<div class="verdict_ok"><b>All sports, if normal exercise test (see conditions above)</b></div>
<p class="rec_class"> (Class I Recommendation; <br> Level of Evidence C)</p>
<br><br><br><br><br><br>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">Mild-mod AR, normal LVEF, mod LV dilatation</p>
<p>
"Athletes with mild to moderate degrees of AR with normal LV ejection fraction and moderate LV dilatation
(LVESD < 50 mm [men], < 40 mm [women], or < 25 mm/m2 [either sex]) can reasonably participate in
all competitive sports if they have normal exercise tolerance on exercise testing."
</p>
<div class="verdict_maybe"><b>All sports, if normal exercise test</b> (see conditions above)</div>
<p class="rec_class">(Class IIa Recommendation; <br> Level of Evidence C)</p>
<br><br><br><br>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Severe AR, LVEF ≥50%, LVESD < parameters below, normal exercise, no progession of AR severity, no progression of LV dilatation</p>
<p>
"It may be reasonable for athletes with severe AR, LV ejection fraction ≥50% (stage C1),
and LVESD < 50 mm (men), < 40 mm (women), or < 25 mm/m2 (either sex) to participate in
all competitive sports if they have normal exercise tolerance,
and Doppler echocardiography indicates no progression of AR severity or severity of LV dilatation."
</p>
<div class="verdict_maybe"><b>All sports, if normal exercise test, and no progression of AR or LV dilatation</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Severe AR, symptoms, LVEF < 50%, large LVESD or increase in LVEDD</p>
<p>
"Athletes with severe AR and symptoms (stage D), LV systolic dysfunction with ejection fraction < 50% (stage C2),
LVESD >50 mm or >25 mm/m2 (stage C2), or severe increase in LVEDD (>70 mm or ≥35.3 mm/m2 [men], >65 mm or ≥40.8 mm/m2 [women])
should not participate in competitive sports."
</p>
<div class="verdict_no">Sports participation is inadvisable</div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
</section>
</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="threefourths_left">
<p class="sectiontitle">Aortic dimensions 41-45mm</p>
<p>"It may be reasonable for athletes with AR and aortic dimensions of 41 to 45 mm
to participate in sports with low risk of bodily contact."
</p>
<div class="verdict_maybe"><b>If low risk of bodily contact, may be reasonable</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
</section>
<br><br>
<button id="showtable" onclick="toggle_table()">Grading AR Severity (2017 JASE Guideline) -- Click to show table</button>
<div id="elaboration" class='hidden'>
<a href ="https://www.onlinejase.com/action/showFullTableHTML?isHtml=true&tableId=tbl11&pii=S0894-7317%2817%2930007-X">JASE 2017 AR Severity Table</a>
<br>
<p>Full text:</p><a href="https://pubmed.ncbi.nlm.nih.gov/28314623/">Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance </a>
<img src="_" alt="AR Severity, 2017 JASE Guidelines" style="width:80%">
</div>
<br><br><br>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000241"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 5: Valvular 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> AR = aortic regurgitation, LVEDD = left ventricle end diastolic diameter, LVESD = left ventricle end systolic diameter
</p>
</section>
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combo=disease+sport;
location.href = combo+'.html';
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