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Sports_Valve_AS_Overview.html
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Sports_Valve_AS_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: Aortic Stenosis</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
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<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 Stenosis</b> participate in organized sports?
</section>
</section>
<br>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Symptoms</li>
<li>Aortic stenosis severity</li>
<li>Exercise test results</li>
</ul>
<p>"Athletes with AS should be <b>evaluated yearly</b> to determine whether sports participation can continue."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section id="answer">
<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 class="quarter_left">
<p class="sectiontitle">Asymptomatic, mild AS, normal exercise test</p>
<p>"Athletes with mild AS (stage B) and a normal maximal exercise response can participate in
all sports."
</p>
<div class="verdict_ok"><b>All sports = likely reasonable</b></div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">Asymptomatic, moderate AS, normal exercise test</p>
<p>
"Athletes with moderate AS (stage B) can participate in low and moderate static or
low and moderate dynamic competitive sports (classes IA, IB, and IIA) if exercise tolerance testing
to at least the level of activity achieved in competition and the training regimen demonstrates satisfactory
exercise capacity without symptoms, ST-segment depression, or ventricular tachyarrhythmias, and
with a normal blood pressure response."
</p>
<div class="verdict_ok"><b>Class IA, IB, and IIA = likely reasonable</b> (if conditions above met)</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Asymptomatic, severe AS</p>
<p>"Asymptomatic athletes with severe AS (stage C) should not participate in competitive sports,
with the possible exception of low-intensity (class IA) sports."
</p>
<div class="verdict_no">Participation in competitve sports is inadvisable. Possible exception for Class IA sports.</div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Symptomatic AS</p>
<p>
"Symptomatic patients with AS (stage D) should not participate in
competitive sports."
</p>
<div class="verdict_no">Participation in competitive sports is inadvisable.</div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
</section>
</section>
<p></p>
<button id="showtable" onclick="toggle_table()">AS Stages (2014 AHA/ACC Guideline) -- Click to show table</button>
<div id="elaboration" class='hidden'>
<img src="Table_AS_stages.png" alt="AS Stages, 2014 AHA/ACC Guidelines" style="width:80%">
</div>
<p></p>
<p></p>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000236"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities.
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> AS = aortic valve stenosis
</p>
</section>
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