Practice Guidelines

Cardiomyopathy and Myocarditis in Competitive Athletes: Recommendations from the AHA/ACC


Key Points for Practice

• Asymptomatic persons who are positive for the HCM genotype can reasonably partake in competitive sports in the absence of left ventricular hypertrophy.

• Patients with myocarditis can resume training and competition if ventricular systolic function and serum markers of myocardial injury, inflammation, and heart failure are normal and if no arrhythmias are seen on monitoring.

• Persons in the acute phase of pericarditis should not play competitive sports and should return to play only if there is no evidence of active disease.

From the AFP Editors

The American Heart Association (AHA) and American College of Cardiology (ACC) have provided recommendations regarding eligibility and disqualification of competitive athletes with cardiovascular abnormalities. The full guidelines can be found at This summary focuses on cardiomyopathy and myocarditis.



Hypertrophic cardiomyopathy (HCM), which occurs in one in 500 persons, is a common nontraumatic cause of sudden death in young persons. For persons who are positive for the HCM genotype, competing in competitive athletics is reasonable if no symptoms or evidence of left ventricular hypertrophy on echocardiography or cardiac magnetic resonance imaging are present, and especially if there is also no family history of related sudden death. Persons who likely have HCM with clinical manifestations such as ventricular hypertrophy should not participate in most competitive sports, except low-intensity class 1A versions as described in the classification of sports in the full guidelines. Providing medication such as beta blockers to persons with cardiac-related symptoms or ventricular tachyarrhythmia and placing a prophylactic implantable cardioverter-defibrillator (ICD) in persons with HCM are not recommended if the only reason for doing so is to allow participation in high-intensity sports. These medications may

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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Aug 15, 2017

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