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Sports_Coronary_Bridging_Overview.html
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Sports_Coronary_Bridging_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: Myocardial Bridging</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.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">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" class="active">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>Myocardial Bridging</h2>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Stress test results</li>
<li>Evidence of myocardial ischemia?</li>
<li>History of coronary surgery or stenting</li>
</ul>
</section>
<section id="answer_arrow_section">
<section class="third_invisible">⇙</section>
<section class="third_invisible">⇓</section>
<section class="third_invisible">⇘</section>
</section>
<section id="answer">
<section class="third_left">
<p class="sectiontitle">No ischemia with adequate stress test</p>
<p>"It is reasonable for athletes with myocardial bridging and no evidence of myocardial ischemia during adequate stress testing
to participate in all competitive sports."
</p>
<div class="verdict_ok"><b>All sports = reasonable</b></div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="third_middle">
<p class="sectiontitle">Evidence of ischemia, or prior MI</p>
<p>
"It is reasonable to restrict athletes with myocardial bridging of an epicardial coronary artery
and objective evidence of myocardial ischemia or prior myocardial infarction to sports with low to moderate dynamic
and low to moderate static demands."
</p>
<div class="verdict_maybe"><b>Low to moderate dynamic & low to moderate static sports = reasonable</b></div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="third_right">
<p class="sectiontitle">Surgical resection or stenting</p>
<p>
"It is reasonable to restrict athletes who have undergone surgical resection of the myocardial bridge
or stenting of the bridge to low-intensity sports for 6 months after the procedure.
If such athletes have no subsequent evidence of ischemia, they may participate in all competitive sports ."
</p>
<div class="verdict_maybe"><b>First 6 months after procedure: Restrict to low-intensity sports</b></div>
<p style="font-size:30px; font-weight: bold; text-align:center; margin:0">⇩</p>
<div class="verdict_ok">If no evidence of ischemia >6 months after procedure: <b>All sports = reasonable</b></div>
<p class=rec_class>(Class IIa 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> LVEF = LV ejection fraction, MI = myocardial infarction
</p>
</section>
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