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Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualific...

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Autores principales: Drezner, Jonathan A, Malhotra, Aneil, Prutkin, Jordan M, Papadakis, Michael, Harmon, Kimberly G, Asif, Irfan M, Owens, David S, Marek, Joseph C, Sharma, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408577/
https://www.ncbi.nlm.nih.gov/pubmed/33472848
http://dx.doi.org/10.1136/bjsports-2020-102921
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author Drezner, Jonathan A
Malhotra, Aneil
Prutkin, Jordan M
Papadakis, Michael
Harmon, Kimberly G
Asif, Irfan M
Owens, David S
Marek, Joseph C
Sharma, Sanjay
author_facet Drezner, Jonathan A
Malhotra, Aneil
Prutkin, Jordan M
Papadakis, Michael
Harmon, Kimberly G
Asif, Irfan M
Owens, David S
Marek, Joseph C
Sharma, Sanjay
author_sort Drezner, Jonathan A
collection PubMed
description The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.
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spelling pubmed-84085772021-09-16 Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review Drezner, Jonathan A Malhotra, Aneil Prutkin, Jordan M Papadakis, Michael Harmon, Kimberly G Asif, Irfan M Owens, David S Marek, Joseph C Sharma, Sanjay Br J Sports Med Review The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree. BMJ Publishing Group 2021-09 2021-01-20 /pmc/articles/PMC8408577/ /pubmed/33472848 http://dx.doi.org/10.1136/bjsports-2020-102921 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Drezner, Jonathan A
Malhotra, Aneil
Prutkin, Jordan M
Papadakis, Michael
Harmon, Kimberly G
Asif, Irfan M
Owens, David S
Marek, Joseph C
Sharma, Sanjay
Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title_full Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title_fullStr Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title_full_unstemmed Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title_short Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
title_sort return to play with hypertrophic cardiomyopathy: are we moving too fast? a critical review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408577/
https://www.ncbi.nlm.nih.gov/pubmed/33472848
http://dx.doi.org/10.1136/bjsports-2020-102921
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