Care of the Athletic Heart is an American College of Cardiology (ACC) course in which experts in the field of sports cardiology meet and discuss the frontiers of clinical decision-making within this dynamic and growing field. This expert analysis presents take-home points from this year's meeting.

Updated Guidelines

• The ACC Sports and Exercise Cardiology Leadership Council chair, Dr. Jonathan Kim, provided an overview of the updated sports cardiology guidelines,¹ highlighting how the new recommendations differ from prior iterations. Spurred by emerging data on the safety of competitive sport participation in athletes with heart disease, these guidelines also include new sections dedicated to the masters athlete and shared decision-making (SDM), emphasizing the growing awareness of these domains in the field.

Electrocardiogram Interpretation in the Athlete

• This session's speakers highlighted the 2025 International Summit on ECG Interpretation in Athletes (which convened on Sept. 25-26, 2025), a highly anticipated meeting to review and update the International Criteria for ECG Interpretation in Athletes. Topics of interest included addressing interpretation of QRS fractionation, low QRS voltage, and T-wave inversions in female athletes.

"How to" From the Experts: Building a Sports Cardiology Career

• This session provided a nuts-and-bolts overview of the logistics of not only building a sports cardiology program but also emphasizing the specialized skills that sports cardiologists provide. Beyond expertise in exercise physiology, sports cardiologists possess the skill of nuanced risk stratification for guiding sports participation, often integrating assessments from several domains (e.g., noninvasive and invasive imaging, exercise testing, genetic testing) in these complex decisions.
• An important pillar of building a program is community engagement; suggested ways to become involved included participating in community athletic events, developing emergency action plans for local teams, and proactively seeking opportunities to speak with recreational athletes in the community.

SDM in Sports Cardiology

• Consensus guidelines have evolved over time to allow athletes with a wider array of conditions to be able to return to play, and specific guidance on SDM was a key update to the new sports cardiology guidelines.¹ Often, these decisions involve uncertainty and limited evidence. The roles of a sports cardiologist include recognizing and defining these limitations and communicating them to athletes with the aim of empowering them to make a well-informed return-to-play decision.
• This year's session featured an interview with National Basketball Association (NBA) player Jared Butler, who shared his experience of being diagnosed with hypertrophic cardiomyopathy (HCM). When sharing his bewildering journey navigating this diagnosis, Mr. Butler highlighted the importance of clear and open communication from his sports cardiologists to himself and his family as they made the shared decision to continue playing basketball.

NBA Point Guard Jared Butler shared his story as an athlete diagnosed with HCM and his perspective of the process required to continue his professional journey and the pivotal role played by his care team in advocating for his opportunity to pursue his lifelong dream of becoming a professional athlete.

Dr. Matt Martinez interviews NBA player Jared Butler during the 2025 ACC Care of the Athletic Heart session on SDM.

Cardiovascular Considerations for Exercise in the Extremes

• A new topic discussed this year was iron deficiency, which is common but often underdiagnosed among athletes, particularly female athletes, and which should be considered in the evaluation of the symptomatic athlete. Treatment with oral replacement or intravenous infusion is safe and cost-effective, and serial monitoring of iron levels should be performed for athletes even after replenishment.

Arrhythmia in the Athlete

• Anticoagulation for young competitive athletes with atrial fibrillation should be guided by standard risk algorithms. However, in those who require anticoagulation, bleeding risk may outweigh benefit for certain activities involving collision or impact, as highlighted in the updated guidelines.¹
• Supported by emerging evidence from studies such as the LIVE-LQTS (Lifestyle and Exercise in the Long QT Syndrome) study and one by Martinez et al., athletes with long QT syndrome who are asymptomatic or previously symptomatic and under expert assessment and supervision can return to competitive sports participation following appropriate risk evaluation and SDM.^2,3

Cardiovascular Care of the Masters Athlete

• Traditional risk factors for cardiovascular disease are common among masters athletes and should be specifically screened for to guide risk stratification. Although commonly used risk scores are helpful, they likely overestimate risk in athletic populations.
• Increased physical activity does not attenuate the association of coronary artery calcification with cardiac events, although increased levels of physical activity are still associated with a lower overall mortality.⁴

Watch sessions from Care of the Athletic Heart 2025, available on-demand on ACC Anywhere. Log in or subscribe to ACC Anywhere to watch the full video series and thousands of other videos from cardiology's top meetings!

References

1. Kim JH, Baggish AL, Levine BD, et al. Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2025;85(10):1059-1108. doi:10.1016/j.jacc.2024.12.025
2. Lampert R, Day S, Ainsworth B, et al. Vigorous exercise in patients with congenital long QT syndrome: results of the prospective, observational, multinational LIVE-LQTS study. Circulation. 2024;150(7):516-530. doi:10.1161/CIRCULATIONAHA.123.067590
3. Martinez KA, Bos JM, Baggish AL, et al. Return-to-play for elite athletes with genetic heart diseases predisposing to sudden cardiac death. J Am Coll Cardiol. 2023;82(8):661-670. doi:10.1016/j.jacc.2023.05.059
4. Berry JD, Zabad N, Kyrouac D, et al. High-volume physical activity and clinical coronary artery disease outcomes: findings from the Cooper Center longitudinal study. Circulation. 2025;151(18):1299-1308. doi:10.1161/CIRCULATIONAHA.124.070335