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Volume: 38
Number: 4
Index: December 2010
Clinical Focus:Respiratory Care
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December 2010
Clinical Focus: Respiratory Medicine
  • Asthma and the athlete
    • Vocal cord dysfunction
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    • Exercise-induced bronchospasm
  • COPD
    • Obesity and COPD
    • Relationship between COPD and nutrition intake
  • Treatment options for steroid-induced osteoporosis in men
  • Treatments for asthma
    • Bronchodilators, anticholinergics
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    • Metered-dose vs other types of inhalers
  • Respiratory infections in winter sports athletes
  • Asthma in elite athletes
  • Pulmonary rehabilitation and physical activity
  • Fitness and long-term oxygen therapy/lung transplantation
  • Airflow function and the metabolic syndrome
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doi: 10.3810/PSM.2009.04.1686
The Physician and Sportsmedicine: Volume 37: No.1
Return-to-Play Decisions in Athletes with Cardiac Conditions
Christine E. Lawless, MD, MBA, FACC, FACSM, ABCL
Abstract: Many sets of guidelines written by experts in their fields can assist sports medicine physicians to make return-to-play decisions for athletes with known or suspected cardiac conditions. These guidelines can be divided into preparticipation screening guidelines, such as the 2007 American Heart Association (AHA) 12-element screening examination, and specific recommendations for those with heart disease or symptoms. Several important documents fall into the latter category. Among these are the 36th Bethesda Guidelines, the European Society of Cardiology Guidelines, the AHA Consensus Document for Young People with Genetic Conditions, the Heart Rhythm Society Guidelines, and the Guidelines for Masters Athletes. Guidelines are designed to enhance the sports medicine physician’s probability of detecting heart disease and making wise participation and return-to-play decisions in athletes with highrisk cardiac conditions, such as hypertrophic cardiomyopathy, anomalous coronary artery, myocarditis, and valvular heart disease. Guidelines also aid in writing exercise prescriptions for those deemed too high risk for sports participation. Because the guidelines may not be entirely consistent on all topics, or based on opinion rather than research evidence, many cases require additional input from a cardiologist or electrophysiologist. Guidelines address not only specific disease entities, but also how corrective surgery, ablations, implantable defibrillators, or drug therapy can influence return-to-play decisions. They are updated as new studies become available to provide physicians with the most up-to-date information.

Keywords: return-to-play guidelines; athletes with cardiac conditions; preparticipation screening; heart disease


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