14 Jun 2020 ESC guidelines on sports cardiology part 2
How exercise professionals can use the 2020 ESC guidelines: myocardial bridging, anomalous origins of coronaries, heart failure, heart transplant and valve diseases
This is part two of a five part series on the 2020 European Society of cardiology guidelines on sports cardiology. Myocardial bridging is usually a harmless condition in which one or more of the coronary arteries goes through the heart muscle instead of lying on its surface. Most bridges don’t seem to cause symptoms. However, some people with myocardial bridging can experience and angina-like pain or chest pain. Competitive sports are not recommended in individuals with myocardial bridging +/- persistent ischaemia +/- complex cardiac arrhythmias seen during exercise stress testing. Prticipation in competitive and leisure time sport should be considered in asymptomatic individuals with myocardial bridging who don’t have inducible ischaemia or ventricular arrhythmias recorded during stress testing.
In the next part of my video, I’ve provided some diagrams and some explanations around anomalous origins of coronary arteries. The ESC recommends AGAINST participation in most competitive sports for exercise in young people with anomalous origins of primary arteries; similarly the ESC recommends AGAINST exercise and physical activity at moderate and particularly high cardiovascular demands in these individuals.
The next part of the video is on recommendations for exercise prescription in heart failure with reduced or mid-range ejection fractions. Exercise is recommended based on an individualised exercise prescription in pretty much all individuals with heart failure. Exercise-based cardiac rehabilitation is recommended in all stable individuals to improve exercise capacity, quality of life, and to reduce the frequency of hospital readmissions. High intensity interval training or HIIT may be considered in low risk patients who want to return to high intensity aerobic and or endurance sports.
For patients who have undergone heart transplant, regular exercise through cardiac rehabilitation combining moderate intensity aerobic and resistance exercise is recommended to reverse pathophysiology, and to improve function and fitness to at least pre-transplant levels. Exercise will also help to reduce cardiovascular risk induced by post-transplantation medical treatments and to improve clinical outcomes. Low intensity recreational sports participation should being considered and encouraged for stable asymptomatic individuals after heart transplant and therapy optimisation. Eligibility for competitive sport involving low and moderate intensity exercise maybe considered in selected asymptomatic individuals with an uncomplicated follow up.
I have already made many videos and provided to several blog posts here on aortic stenosis and so I will not repeat them here. For individuals with aortic regurgitation, the recommendation is that participation in moderate or high intensity recreational exercise is not recommended for severe and obviously critical disease, but is pretty much unencumbered for those individuals with normal left ventricular function and mild to moderate aortic regurgitation. Look for further details on this condition in the video. Similarly, for individuals with mitral valve regurgitation, I have provided some information on the ESC guidelines in the video. There is generally less restrictions on exercise for patients with mitral valve disease compared to aortic valve disease.