Members of the ACC Sports and Exercise Cardiology Section Leadership Council offer a closer look at common exercise-induced cardiovascular adaptations and review the importance of a shared decision-making approach to caring for athletes, in a new state-of-the-art review paper published Sept. 27 in the Journal of the American College of Cardiology.

With the role of the sports cardiologist having evolved "into an essential component of the medical care of athletes," Matthew W. Martinez, MD, FACC; Jonathan H. Kim, MD, MSc, FACC, and colleagues review the effects of exercise on the "athlete's heart" and dive into specific clinical scenarios germane to sports cardiology.

Among the specific highlights, the authors note that athletes "may develop physiological adaptations found on ECG and imaging that may overlap with pathological conditions." They also stress that "ECG and imaging findings must be integrated with both the clinical history and other diagnostic testing to determine expected adaptions vs. pathological abnormality." For those athletes with asymptomatic and symptomatic cardiovascular disease, the paper urges risk stratification be considered before return to competitive sports play.

Patient-centered shared decision-making is also a focal point of the paper, with the authors noting such an approach "has become the accepted paradigm of treatment option discussions with patients." According to Martinez et al., the five pillars of knowledge, humility, respect, teamwork and communication should be used by providers in discussions with the patients. With the ultimate goal of reaching a clinical decision that is then followed up by ongoing risk discussions, athlete surveillance and exercise prescription.

"[Shared decision-making] should not be a 'rubber-stamp' allowance to continue with sports participation for all athletes," write Martinez, et al. "Risk stratification of the athlete with consultation by experts in sports cardiology and other disciplines is mandatory. Along with the risk of sudden cardiac death, the focus of [shared decision-making] must include the potential negative psychological, social, and overall health impacts of sports restriction."

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias, Exercise

Keywords: Cardiovascular Diseases, Cardiologists, Adaptation, Physiological, Exercise, Sports, Athletes, Death, Sudden, Cardiac, Cardiology, Electrocardiography, Risk Assessment, Diagnostic Techniques and Procedures, Patient-Centered Care, Prescriptions

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