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Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review
- Source :
- British Journal of Sports Medicine
- Publication Year :
- 2021
- Publisher :
- BMJ, 2021.
-
Abstract
- 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.
- Subjects :
- Male
Gerontology
medicine.medical_specialty
Basketball
Adolescent
Heart disease
Decision Making
American football
Physical Therapy, Sports Therapy and Rehabilitation
Review
heart disease
Disease
Sudden cardiac death
Young Adult
prevention
death
Epidemiology
medicine
Humans
Orthopedics and Sports Medicine
cardiovascular diseases
biology
Athletes
business.industry
cardiovascular
Hypertrophic cardiomyopathy
General Medicine
Cardiomyopathy, Hypertrophic
biology.organism_classification
medicine.disease
Return to Sport
Death, Sudden, Cardiac
cardiovascular system
sport
business
human activities
Sports
Subjects
Details
- ISSN :
- 14730480 and 03063674
- Volume :
- 55
- Database :
- OpenAIRE
- Journal :
- British Journal of Sports Medicine
- Accession number :
- edsair.doi.dedup.....c6766b96c5e7ac7cd9557b85f13308e5