Specific Cardiovascular Diseases and Competitive Sports Participation: Congenital Heart Disease

Abstract

Most patients with congenital heart disease (CHD) have reduced exercise capacity due to multiple factors associated with their abnormality as well as the consequences of previous interventions with residual abnormalities. Exercise restrictions or lacking recommendation from medical doctors, together with overprotection by the parents, still exacerbate this condition. However, physical activity (PA), exercise and sport participation are also important for CHD patients in view of the health benefits that can be achieved. This applies not only to physical but also to psychosocial areas, in order not to exclude the affected child from their physically active friends. Therefore, every patient must sufficiently be encouraged to perform regular PA and exercise. Because of increasing participation in sport, a growing number of patients encounter competitive sports, thus exposing them to a higher risk of adverse events. An initial medical examination that should at least involve comprehensive medical history, resting ECG, echocardiography and cardiopulmonary exercise testing is therefore mandatory. Based on the latter, it is important that patients receive individually tailored advice on the intensity of exercise and the adequate type of sports, considering the nature and severity of their particular type of CHD. The final decision should be shared by all involved parties: doctors, exercise physiologists, parents, trainers and of course the patients. While advice was rather restrictive in the past, it is becoming increasingly clear that exercise training, as well as participation in organized recreational and competitive sports, can overall be performed safely. It is important to identify those with an increased risk and to reassure and encourage the large majority with very low risk to participate in sporting activities of all kind.

Review

1.1 Questions

• 1. During preparticipation screening a 20-year old male soccer player with repaired coarctation of the Aorta develops slight ST segment depression during a cardiopulmonary exercise test. Would you initiate further examinations, or would you basically disqualify him from exercising, with this information in mind?

• 2. Why is chronotropic insufficiency often observed in patients with CHD?

• 3. Which factors play a role in the observed exercise intolerance of patients with CHD?

1.2 Answers

• 1. Mild ST depressions can frequently be observed during physical stress in patients with coarctation of the Aorta; they do not require further diagnostics. Therefore, at this point there is no reason to prohibit exercise. However, this finding should nonetheless be monitored regularly.

• 2. Chronotropic incompetence is often caused by surgical scars around the right atria, sinus node dysfunction and/or delayed electric conduction.

• 3. The function of the respiratory, cardiovascular and musculoskeletal system are the most important factors. Musculoskeletal abnormalities can also play a role (e.g. scoliosis). Moreover, deconditioning is also an important factor contributing to reduced exercise capacity.