Page 7 - Heart Failure Clinical Guidelines

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c. Use of Beta Blockers or ICDs should not be employed for the purpose of permitting
participation in competitive sports

2. Left Ventricular Non-Compaction
a. Competitive sports are allowed in asymptomatic patients who have no ventricular
tachyarrthmias on exercise testing or ambulatory monitor with normal systolic function
b. patients with impaired systolic function and/or significant ventricular or atrial tachyarrthmias
should be restricted from sports

3. Restrictive and Dilated Cardiomyopathy
a. symptomatic patients should not participate in competitive sports

4. Myocarditis
a. before returning to competitive sports, an echocardiogram, Holter monitor and exercise ECG
should be performed
b. return to competitive sports are allowed if all of the following three are met at approximately
three to six months after acute myocarditis
1) ventricular systolic function has returned to normal range
2) biomarkers of myocardial injury and heart failure have normalized
3) no clinically relevant arrhythmias or frequent ventricular or atrial ectopy on Holter
monitor or exercise ECG

5. Arrhtymogenic right ventricular cardiomyopathy
a. patients with probable, borderline and definitive ARVC should not participate in competitive
sports

B. Exercise Training
1. Possible contraindications to exercise
a) decrease in SBP with exercise
b) significant arrhythmias with exercise
c) newly developed NYHA class 4 symptoms
d) current acute myocarditis
e) moderate-severe left sided obstructive lesion
f) evidence of myocardial ischemia on exercise

2. Exercise Training/Recommendations
a) exercise test should be completed prior to initiation
b) exercise recommendations should concentrate on developing sustainable routines
and involve activities that the child enjoys and will likely be sustainable
c) exercise recommendations can consist of aerobic and resistance training, with
activities that keep heart rate around the anaerobic threshold based upon the exercise
test and should be done with involvement with physical therapy and/or Physical
Medicine and Rehabilitation consult