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Guidelines Cardiological Guidelines for Competitive Sports Eligibility

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Guidelines Cardiological Guidelines for Competitive Sports Eligibility Guidelines Cardiological guidelines for competitive sports eligibility Consensus Document by Italian Society of Sports Cardiology (SIC Sport), Italian Association of Out-of-Hospital Cardiologists (ANCE), Italian Association of Hospital Cardiologists (ANMCO), Italian Federation of Sports Medicine (FMSI) Pietro Delise, Umberto Guiducci, Paolo Zeppilli, Luigi D’Andrea*, Cesare Proto*, Roberto Bettini**, Alessandro Villella**, Giovanni Caselli***, Franco Giada***, Antonio Pelliccia***, Maria Penco§, Gaetano Thiene§, Antonio Notaristefano§§, Antonio Spataro§§ SIC Sport, *ANCE, **ANMCO, ***FMSI, §SIC, §§COCIS Secretary General Consultant Experts of this Document Paolo Alboni, Deodato Assanelli, Domenico Attinà, Enrico Ballardini, Umberto Berrettini, Alessandro Biffi, Michele Brignole, Raffaele Calabrò, Armando Calzolari, Pier Luigi Colonna, Domenico Corrado, Daniele D’Este, Antonio Dal Monte, Ernesto Di Cesare, Marcello Faina, Pier Luigi Fiorella, Francesco Furlanello, Giorgio Galanti, Pietro Gallo, Paolo Garavoglia, Maurizio Lunati, Paolo Marconi, Carlo Menozzi, Lucio Mos, Franco Naccarella, Paolo Palatini, Massimo Pantaleoni, Sergio Pede, Fernando Picchio, Silvia G. Priori, Antonio Raviele, Jorge Salerno, Nicola Sanna, Berardo Sarubbi, Gabriele Vignati (Ital Heart J 2005; 6 (8): 661-702) Address: Preface ................................................... 662 Sports activity in patients with an Dr. Pietro Delise PRACTICAL AND MEDICAL-LEGAL ASPECTS implantable cardioverter-defibrillator .... 676 Divisione di Cardiologia Medical-legal aspects ............................. 662 References .............................................. 676 Ospedale Civile Accreditation in Medicine and Sports CONGENITAL AND ACQUIRED VALVULAR Via Brigata Bisagno, 4 Cardiology.............................................. 664 HEART DISEASES ...................................... 31015 Conegliano (TV) E-mail: [email protected] SPORTS CLASSIFICATION BASED ON Congenital heart diseases ....................... 682 CARDIOVASCULAR INVOLVEMENT ............ Preface................................................ 682 Introduction ............................................ 665 Patent ductus arteriosus ...................... 683 Classification .......................................... 665 Atrial septal defects............................ 683 ARRHYTHMIAS AND POTENTIALLY Anomalous pulmonary venous return 684 ARRHYTHMOGENIC CONDITIONS ............. Atrioventricular septal defects............ 684 Preface.................................................... 667 Ventricular septal defects.................... 684 Symptoms of possible arrhythmic origin 668 Aortic coarctation............................... 685 Syncope .............................................. 668 Aortic stenosis .................................... 685 Palpitations ......................................... 669 Pulmonary stenosis............................. 686 Arrhythmias............................................ 670 Tetralogy of Fallot .............................. 686 Bradycardias and conduction defects 670 Transposition of the great arteries ...... 687 Premature beats .................................. 671 Acquired valvular heart diseases and Supraventricular tachycardias ............ 671 mitral valve prolapse .............................. 687 Ventricular tachycardias ..................... 673 Mitral stenosis .................................... 687 Potentially arrhythmogenic conditions ... 674 Mitral regurgitation ............................ 687 Mitral valve prolapse.......................... 674 Aortic stenosis .................................... 688 The Brugada syndrome ...................... 674 Aortic regurgitation ............................ 688 Arrhythmogenic right ventricular Valve prosthesis.................................. 688 cardiomyopathy.................................. 675 Mitral valve prolapse.......................... 688 Long QT syndrome ............................ 675 References .............................................. 689 Short PR interval (Lown-Ganong-Levine CARDIOMYOPATHIES, MYOCARDITIS syndrome)........................................... 675 AND PERICARDITIS................................... Indications to catheter ablation in athletes 675 Cardiomyopathies................................... 691 Return to sports activity after Hypertrophic cardiomyopathy................ 691 transcatheter ablation.......................... 675 Diagnosis............................................ 691 Sports activity in subjects with a Risk assessment.................................. 692 pacemaker............................................... 675 Indications .......................................... 692 661 Ital Heart J Vol 6 August 2005 Dilated cardiomyopathy ......................... 692 Blood pressure measurement.................. 696 Diagnosis............................................ 692 Etiology and target organ damage.......... 697 Risk assessment.................................. 693 Sports eligibility ..................................... 698 Indications .......................................... 693 Antihypertensive treatment Arrhythmogenic right ventricular and sports activity................................... 699 cardiomyopathy...................................... 693 Physical activity for the prevention Diagnosis............................................ 693 and treatment of hypertension ................ 699 Indications .......................................... 694 References .............................................. 699 Other cardiomyopathies ......................... 694 CORONARY ARTERY DISEASE................... Myocarditis............................................. 694 Introduction ............................................ 700 Diagnosis............................................ 694 Sports eligibility in subjects with Indications .......................................... 694 known coronary artery disease ............... 700 Pericarditis.............................................. 694 Sports eligibility in subjects with silent Diagnosis............................................ 695 coronary artery disease........................... 700 Indications .......................................... 695 Coronary artery disease and exercise References .............................................. 695 in a gym setting ...................................... 701 SYSTEMIC HYPERTENSION....................... References .............................................. 701 Definition and classification................... 696 Appendix ................................................ 702 Preface easily refer to (that is the reason why references were omitted and are published only in the scientific jour- Working out guidelines and protocols for healthcare nals). On one hand, the first part devoted to the med- professionals has always characterized the fruitful ac- ical-legal aspects was simplified, taking their knowl- tivity of any Scientific Society. It entails a long-lasting edge for granted, and on the other a short paragraph planning phase mainly devoted to choose the task force was added dealing with accreditation of Centers and members which is not an easy task due to the coexis- sports physicians in order to bring this issue to the at- tence of indolence, excessive tolerance or irritability tention of colleagues and institutions. The Committee among experts as well as to a sound antagonism among members and the consulted experts who were outstand- the different schools of thinking. ing representatives of the major Italian cardiological The cardiological protocols for sports eligibility, and sports medicine associations, deemed unanimous- nowadays better known as “COCIS Protocols” (from ly that an improvement in healthcare quality (health de- the Italian Organizing Cardiological Committee on fense of athletes and people of any age practicing sport) Sports Eligibility), are not an exception to this rule and represents a key step toward the definite establishment this new edition, which follows the two previous ones of Medicine and Sports Cardiology in our country. published in 1989 and 1995, has had to cope with many difficulties. However, at the end of the working process, all those who participated in the protocol drafting felt PRACTICAL AND MEDICAL-LEGAL ASPECTS as if they had made “something good” by preparing useful guidelines for daily clinical practice of their col- Medical-legal aspects leagues in cardiology and sports medicine. These guidelines present with novelty and new approaches as Sports medicine practitioners are high-trained pro- a result of the dramatic advances in scientific knowl- fessionals engaged in prevention, treatment and reha- edge and are based on the extraordinary scientific and bilitation programs aimed to provide care for individu- cultural experience of the last 20 years of the Italian So- als who engage in sports and thus they are legally re- ciety of Sports Cardiology (SIC Sport) that promoted sponsible for their delivery of care, either in case of this initiative. The management of this initiative was abuse or neglect, and are subjected to the duties and li- rendered easier by the thorough interaction of the CO- abilities pertaining to all healthcare professionals of CIS Committee members, the majority of whom, be- any specialty field. sides being members of the SIC Sport and the Italian With reference to competence (the duty of good Federation of Sports Medicine, were joining from oth- practice), sports medicine
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