Criteria and considerations relative to safe participation in sport for athletes with cardiac abnormalities

This chapter describes the criteria for advising safe participation in competitive sport in individuals with underlying (or even silent) cardiovascular (CV) diseases. The rationale for advising sport participation in patients with CV diseases is based on the broad clinical perception, substantiated by scientific evidence, that such individuals are exposed to an increased risk of sudden cardiac death/cardiac arrest (SCD/CA), or progression of the underlying disease, in association with intensive exercise training and sport participation. However, modification of the type/intensity of sport, or abstinence from competition in selected cases, may reduce the risk. Competitive athletes, especially professionals, with clinically silent CV abnormalities are usually driven by the will to accept possible future risks, but achieve the immediate benefits associated with a lucrative athletic career including (but not limited to) the economic, societal, and visibility correlates. In this context, the role of the physician is to identify the pathological cardiac condition and approriately advise the athlete regarding the benefits and risk associated with participation in sport. This chapter suggests the approach that the physician can adopt, based on the best scientific knowledge of the CV disease and keeping in mind the primary aim of safeguarding the athlete’s health. The present recommendations are the framework for a protocol of evaluation and management of athletes with CV disease, based on the available scientific evidence and expert opinion. Currently, in the absence of robust evidence, these recommendations cannot be considered as legally binding. Therefore, individual physicians may also practise outside the remit of these recommendations, based on their scientific and professional experience in sports cardiology. Implementation of these recommendations may achieve a relevant medical approach to safeguarding the health of athletes, and provide a uniform method of managing elite and professional athletes as they compete globally.