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ESC Congress 2004

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Lisa Salberg Find out more about Lisa Salberg
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  • ESC Congress 2004

    ESC Congress 2004: Competitive sport and cardiomyopathy
    The recommendations of the study group of sports cardiology of the ESC
    __________________________________________________ ________

    The rationale for offering recommendations concerning the participation in
    competitive sport in athletes with cardiovascular disease is based on the
    widely accepted clinical perception, substantiated by scientific evidence 1,
    that individuals with underlying (even clinically silent) cardiovascular
    disease have an increased risk for sudden cardiac death, or worsen cardiac
    outcome (in comparison with normal individuals), because of regular exercise
    training and sport participation. The aim of the recommendations is to
    provide careful directions to physicians and consultant cardiologists,
    suggesting the type and intensity of sport activity that can be safely
    performed by the candidate with cardiovascular abnormality.

    The particular interest for sport is dictated by the awareness that
    competitive athletes (in particular, elite and professional athletes)
    represent a special subset of our society not only for their outstanding
    performances, but also for the substantial economic benefit they gather, as
    well as the intense pressure they are exposed by sponsors, athletic
    associations and media.

    Nature of the Recommendations

    The Recommendations for Competitive Sport Participation represents the
    consensus document of an international panel of experts appointed by the
    European Society of Cardiology, including clinical cardiovascular
    specialists with experience in exercise physiology, sport medicine and
    clinical cardiovascular medicine. The present recommendations are based on
    published scientific evidence where available, and on personal experience
    and consensus of experts. The aim of the panel was to formulated indications
    which represent a reasonable balance between the risks and the benefits
    inherent with competitive sport participation, and not simply restrict sport
    activity that could be associated with increased risk. The recommendations
    represent, therefore, a prudent, contemporary, and practical document for
    advising competitive sport activity in patients with cardiovascular disease.

    Implementation of the Recommendations within the European countries

    At present, a large heterogeneity (or lack) of regulations exist in the
    European countries, with only a few (such as Italy) requiring a medical
    clearance of competitive athletes and, in individuals with cardiovascular
    disease, having implemented Guidelines (COCIS) which are considered the
    standard of medical care 2.

    The panel believes that a common, unbiased management of competitive
    athletes with cardiovascular disease is now needed, in consideration of the
    unlimited opportunity for professional athletes to move across EU countries.
    A unique and appropriate consensus document will be of relevant medical (and
    legal) value for physicians and cardiologists when evaluating athletes with
    cardiovascular disease. In the absence of binding requirements established
    by law, the panel recommends that the present Recommendations represent the
    standard of medical care for evaluation of competitive athletes with
    cardiovascular disease across Europe. Adherence to these recommendations
    will have substantial and cost-effective impact on medical care, by
    enhancing the safety of athletic activities and reducing the legal
    controversies related to different (or lack of) regulations.

    The role of the Examining Physician

    Should the physician be the ultimate authority determining whether or not an
    athlete with cardiovascular disease can participate in competitive sport ?
    Or alternatively, can the athlete with cardiovascular disease just sign an
    informed consent and be engaged in a risky and potentially life-threatening
    sport activity ?

    Due to the unique structure and pressures of competitive sports, individuals
    with heart disease may not always use proper independent judgment in
    assessing the overall risk associated with a competitive sport career. The
    panel believes that the examining physician (and consultant cardiologist)
    have the ethical, medical and legal obligation to inform exhaustively the
    candidate of the risks inherent with competitive athletic lifestyle and,
    when the cardiovascular risk appears to be unreasonably high, the physician
    should be responsible for the final decision, with the aim to prevent
    adverse clinical events and/or reduce risk for disease progression.

    Protecting the athlete's health and physical well-being of the athlete is
    the paramount objective of the physician, regardless other non-medical
    considerations, such as the potential antagonistic positions of the sponsor
    or the athletic association, which may be economically dependent on the
    athlete's competitive activity. These recommendations are intended,
    therefore, to support the physician's decision in such difficult instances
    and to offer a medical protection to the athlete from the unsustainable
    hazard of competitive sport activity.

    Recommendations for Competitive Sport and Cardiomyopathies

    Cardiomyopathies represent a spectrum of primary myocardial diseases, mostly
    on genetic basis, which are characterized by cardiac hypertrophy
    (hypertrophic cardiomyopathy), or dilatation (dilated cardiomiopathy), or
    right ventricular abnormalities (right ventricular
    cardiomyopathy/dysplasia). Prevalence of cardiomyopathies in the general
    population is greater than previously expected, and about 0.2% for
    hypertrophic cardiomyopathy.

    Clinical relevance of cardiomyopathies is based on the recognition that they
    represent the most common cause of sudden and unexpected cardiac death in
    association with exercise in young patients, including competitive athletes.
    The diagnosis of cardiomyopathies is based on accurate evaluation of the
    distinctive morphologic abnormalities and differentiation from physiologic
    cardiac changes associated with chronic athletic conditioning (i.e., the
    athlete's heart). A varied spectrum of symptoms may be present in patients
    with cardiomyopathies, such as palpitations, syncope (mostly on arrhythmic
    basis) dyspnea and fatigability. However, a substantial proportion of
    patients and athletes engaged in competitive activities, present only mild
    (or no) symptoms. Treatment of cardiomyopathies is focused on preventing the
    risk of sudden cardiac death (by controlling incidence of arrhythmias) and
    includes withdrawn of the patient from regular training and intensive
    athletic activities.

    The Recommendations for Competitive Sport Participation provide directions
    for evaluating athletes with cardiomyopathies, suggesting the diagnostic
    testing needed for confirming the diagnosis (such as echocardiography,
    12-lead ECG) and risk stratification (such as exercise testing and Holter
    ECG monitoring, or additional diagnostic testing according the individual
    case). In most instances, definite diagnosis of a cardiomyopathy precludes
    the candidate from participation in competitive sport, with the aim to
    reduce the risk for death or disease progression associated with athletic
    lifestyle.
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

  • #2
    Re: ESC Congress 2004

    Quote
    Should the physician be the ultimate authority determining whether or not an athlete with cardiovascular disease can participate in competitive sport? Or alternatively, can the athlete with cardiovascular disease just sign an informed consent and be engaged in a risky and potentially life-threatening sport activity?

    Quote
    The panel believes that the examining physician (and consultant cardiologist) have the ethical, medical and legal obligation to inform exhaustively the candidate of the risks inherent with competitive athletic lifestyle and, when the cardiovascular risk appears to be unreasonably high, the physician should be responsible for the final decision, with the aim to prevent adverse clinical events and/or reduce risk for disease progression.

    Quote
    In most instances, definite diagnosis of a cardiomyopathy precludes the candidate from participation in competitive sport, with the aim to reduce the risk for death or disease progression associated with athletic lifestyle.


    Yes sir – I am a doctor – You’re G-d and keeper. I will decide for you what you can and can not do in life. You have nothing to say about it. It is totally MY decision. Sieg Heil!!!

    G-d, save us from those who will protect us right out of our lives.

    I believe it is foolish to risk one’s life unnecessarily, but I strongly believe a person has the right to make his or her own decisions in life, without some third party stealing that right from us.
    Burt

    Comment


    • #3
      Re: ESC Congress 2004

      Here we go again. Holy Manaschevitz pass the wine , the horse has come back again!!!
      Dx @ 47 with HOCM & HF:11/00
      Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
      Lead failure,replaced 12/06.
      SF lead recall:07,extracted leads and new device 2012
      [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
      Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
      Genetic mutation 4/09, mother(d), brother, son, gene+
      Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

      Comment


      • #4
        Re: ESC Congress 2004

        Hi Pam,
        I am deeply offended by people and/or institutions who want to steal my, or anybody’s freedom – for our own good. I guess my passion shows. Actually I would like nothing better then to bury this dead horse, but somebody is always out there trying to subjugate us for one reason or another. This horse has more lives then ten thousand cats.

        If the Germans stood up to Heir Schickelgruber when he first usurped power, there never would have been a second world war, with the attendant loss of millions of lives and uncounted billions of dollars, not to mention the mountains of pain and suffering.

        Sorry hon, but whenever I see someone trying to steal the rights of others I just have to stand up and be counted. I am truly sorry if this offends anyone, but I can’t help myself. I value freedom much too highly.

        I suspect the medical lobby will soon have their authority over us enacted into law, and we will all be diminished to a greater extent then we are now, - and American law will follow the European rule like the tail on a puppy. I am saddened and frustrated.
        Burt

        Comment


        • #5
          Re: ESC Congress 2004

          I know Burton, truly I respect your and any others opinion here, just could not resist bring up the dead horse . Heck somebody had to raise him from the dead . Oh Darren , Darren it is your turn. LOL. I know this is a serious subject , I am just trying to add levity. Carry on.
          Dx @ 47 with HOCM & HF:11/00
          Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
          Lead failure,replaced 12/06.
          SF lead recall:07,extracted leads and new device 2012
          [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
          Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
          Genetic mutation 4/09, mother(d), brother, son, gene+
          Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

          Comment


          • #6
            Re: ESC Congress 2004

            Well Pam dear heart,
            I guess we all know where we each stand by this time. I hope by now that old horse can lie down and go back to sleep. I guess there has been enough rehash of this to last everybody for awhile now. I hope you didn’t think my remarks were reflecting my feelings for anybody on these boards. That is definitely not the case. I truly appreciate knowing each of you, and hope it continues for a long, long time. Take care my friend.
            Burt

            Comment


            • #7
              Re: ESC Congress 2004

              Due to the unique structure and pressures of competitive sports, individuals with heart disease may not always use proper independent judgment in assessing the overall risk associated with a competitive sport career.
              Did i miss something, or does this basically say (albeit very nicely) that the athletes themselves are too stupid to decide for themselves what is best? I've now read the freakin thing three different times, and that is still what i come up with. Must have been a heck of a meeting. Perhaps after everyone was done patting each other on the back for their brilliance, and the coffee and donuts had run out, somebody figured out that they had in fact still not made any actual recommendations yet, and just scribbled down on a napkin...

              "Oh bother... just let their physicians decide."

              Jim
              "Some days you're the dog... some days you're the hydrant."

              Comment


              • #8
                Re: ESC Congress 2004

                Yes Jim,
                We who know what idiots they can be, will soon be bound by law to follow what they decide is best for us – as we obviously can’t decide for ourselves. Heck, after all, it’s for our own good. AAAAhhhhh!!!
                Burt

                Comment


                • #9
                  Re: ESC Congress 2004

                  Please be aware this is in Europe, not the good old USA.

                  I am sure there will be lots of debate about this issue before any mandation is made by our government. Choice is what our fore fathers insisted upon.

                  It will be a great day when everyone can pronouce, "hypertrophic cardiomyopathy."

                  Comment


                  • #10
                    Re: ESC Congress 2004

                    Originally posted by Pam Alexson
                    Here we go again. Holy Manaschevitz pass the wine , the horse has come back again!!!
                    LOL. I thought it was kind of funny myself, Pam.

                    "Some days you're the dog... some days you're the hydrant."

                    Comment


                    • #11
                      Re: ESC Congress 2004

                      Sharon I love you,
                      Such a good heart and mind. I hope you are absolutely right on that score, but I am fearful that Europe will succumb to this treachery, as Italy has already done. I am also fearful that once it is made the law in Europe, the United States’ athletes will be affected in international competitions, and it will soon thereafter become law here too.

                      The doctor’s are saying having HCM reduces you to the classification of second class citizen, without the right to make your own choices in life. I am absolutely outraged.
                      Burt

                      Comment


                      • #12
                        Re: ESC Congress 2004

                        Burt,
                        I have to say I do not agree with some of your posts on this topic. HCM is not bringing anyone to the level of 2nd class citizen. Statements like this are highly misleading and may give people a completely wrong understanding of the base facts we are dealing with.

                        Pre-Participation physicals are done for a purpose - that purpose it to detirmine if a person is in the proper health to particiapte in a given sport. This is the standard of care in the USA and throughout the world. Those who are found to have medical problem that may not be suitable for participation are not granted clearance to play.

                        I am all for civil liberties - I am also well aware of liability. I have seen many kids be 'approved' to participate when there were clear indications that there were problems - these children died. I can think of one here in NJ his B/P was a bit high and his heart rate was also a bit high (both over "normals") -2 weeks later he died from Marfans Disease when his aorta ruptured on the football field. Did this child have a "right" to participate in sports - did he have a "right" to live - did his family have a "right" to file a large law suit - you can answer those questions yourself.

                        This is a complex issue and I assure you these committees do not publish such documents without careful evaluation of all medical data. I happen to know 2 people who participated in this document - they are very caring and educated professionals who care about patients - the whole patient - mind and body.

                        Sincerely,
                        Lisa
                        Knowledge is power ... Stay informed!
                        YOU can make a difference - all you have to do is try!

                        Dx age 12 current age 46 and counting!
                        lost: 5 family members to HCM (SCD, Stroke, CHF)
                        Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
                        Therapy - ICD (implanted 97, 01, 04 and 11, medication
                        Currently not obstructed
                        Complications - unnecessary pacemaker and stroke (unrelated to each other)

                        Comment


                        • #13
                          Re: ESC Congress 2004

                          Lisa,
                          Dearheart, I think you missed my whole point.
                          I am all for the testing –
                          I am all for the identification –
                          I am all for the advising of the dangers –
                          I am all for spelling out the risks –
                          I am all for the protection of minors and those not able to make an informed decision, and I am all for at least a half dozen other preventative measures.

                          I am adamantly apposed to giving any doctor or politician the RIGHT to say – You CAN’T do that – I WILL NOT ALLOW IT!

                          It is the removal of our right to make our own informed decisions in life that makes us less then a first class citizen – not the fact that we have or do not have a particular condition, or if our informed decision seems wrong to somebody else.
                          Burt

                          Comment

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