Skip to main content
SpringerLink
Log in

Cardiac Issues in Football

  • Chapter
  • First Online:
Football Injuries

  • 554 Accesses

Abstract

Although relatively rare, sudden cardiac death (SCD) is the most common medical cause of death in football athletes. There are advantages and disadvantages to the various screening strategies used to identify those at risk. Screening strategies can include a combination of history, physical examination, 12-lead electrocardiogram (ECG), echocardiography, and exercise testing. Secondary prevention strategies start with an emergency action plan (EAP). Specific etiologies of cardiac morbidity in football players including hypertrophic cardiomyopathy (HCM), aortic diseases, coronary artery anomalies/coronary artery disease (CAD), Wolff-Parkinson-White (WPW) syndrome, long QT syndrome (LQTS), hypertension (HTN), and myocarditis are discussed. The increasing recognition of cardiac conditions in athletes combined with increased appreciation for patient autonomy has led to an evolving concept of shared decision making, which will be discussed in this chapter in addition to legal precedents involving the cardiac care of athletes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Harmon K, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association Athletes: a decade in review. Circulation. 2015;132(1):10–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Holst AG, Winkel BG, Theilade J, Kristensen IB, Thomsen JL, Ottesen GL, et al. Incidence and etiology of sports-related sudden cardiac death in Denmark – implications for preparticipation screening. Heart Rhythm. 2010;7(10):1365–71.

    Article  PubMed  Google Scholar 

  3. Risgaard B, Winkel BG, Jabbari R, Glinge C, Ingemann-Hansen O, Thomsen JL, et al. Sports-related sudden cardiac death in a competitive and a noncompetitive athlete population aged 12 to 49 years: data from an unselected nationwide study in Denmark. Heart Rhythm. 2014;11(10):1673–81.

    Article  PubMed  Google Scholar 

  4. Drezner JA, Harmon KG, Marek JC. Incidence of sudden cardiac arrest in Minnesota high school student athletes: the limitations of catastrophic insurance claims. J Am Coll Cardiol. 2014;63(14):1455–6.

    Article  PubMed  Google Scholar 

  5. Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011;123(15):1594–600.

    Article  PubMed  Google Scholar 

  6. Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S. Incidence and causes of sudden death in u.s. College athletes. J Am Coll Cardiol. 2014;63(16):1636–43.

    Article  PubMed  Google Scholar 

  7. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence and etiology of sudden cardiac arrest and death in high school athletes in the United States. Mayo Clin Proc. 2016;91(11):1493–502.

    Article  PubMed  Google Scholar 

  8. Drezner JA, Peterson DF, Siebert DM, Thomas LC, Lopez-Anderson M, Suchsland MZ, et al. Survival after exercise-related sudden cardiac arrest in young athletes: can we do better? Sports Health. 2019;11(1):91–8.

    Article  PubMed  Google Scholar 

  9. Harmon KG, Drezner JA, Klossner D, Asif IM. Sickle cell trait associated with a RR of death of 37 times in National Collegiate Athletic Association football athletes: a database with 2 million athlete-years as the denominator. Br J Sports Med. 2012;46(5):325–30.

    Article  PubMed  Google Scholar 

  10. Peterson DF, Siebert DM, Kucera KL, Thomas LC, Maleszewski JJ, Lopez-Anderson M, et al. Etiology of sudden cardiac arrest and death in US competitive athletes: a 2-year prospective surveillance study. Clin J Sport Med. 2020;30(4):305–14.

    PubMed  Google Scholar 

  11. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes. Analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009;119:1085–92.

    Article  PubMed  Google Scholar 

  12. Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of sudden death in sports: insights from a United Kingdom regional registry. J Am Coll Cardiol. 2016;67(18):2108–15.

    Article  PubMed  Google Scholar 

  13. Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, et al. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation. 1996;94(4):850–6.

    Article  CAS  PubMed  Google Scholar 

  14. Drezner JA, Owens DS, Prutkin JM, Salerno JC, Harmon KG, Prosise S, et al. Electrocardiographic screening in National Collegiate Athletic Association Athletes. Am J Cardiol. 2016;118(5):754–9.

    Article  PubMed  Google Scholar 

  15. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2014;64(14):1479–514.

    Article  PubMed  Google Scholar 

  16. American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy Of Sports Medicine. The preparticipation physical evaluation. 5th ed. Elk Grove: American Academy of Pediatrics; 2019.

    Google Scholar 

  17. Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007;115(12):1643–455.

    Article  PubMed  Google Scholar 

  18. Drezner JA, O’Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med. 2017;51(3):153–67.

    Article  PubMed  Google Scholar 

  19. Hainline B, Drezner J, Baggish A, Harmon KG, Emery MS, Myerburg RJ, et al. Interassociation consensus statement on cardiovascular care of college student-athletes. Br J Sports Med. 2017;51(2):74–85.

    Article  PubMed  Google Scholar 

  20. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996;276(3):199–204.

    Article  CAS  PubMed  Google Scholar 

  21. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329–38.

    Article  PubMed  Google Scholar 

  22. Fudge J, Harmon KG, Owens DS, Prutkin JM, Salerno JC, Asif IM, et al. Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. Br J Sports Med. 2014;48(15):1172–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Madsen NL, Drezner JA, Salerno JC. Sudden cardiac death screening in adolescent athletes: an evaluation of compliance with national guidelines. Br J Sports Med. 2013;47(3):172–7.

    Article  PubMed  Google Scholar 

  24. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593–601.

    Article  CAS  PubMed  Google Scholar 

  25. Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(5):516–24.

    Article  PubMed  Google Scholar 

  26. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69(8):1057–75.

    Article  PubMed  Google Scholar 

  27. Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, et al. Outcomes of cardiac screening in adolescent soccer players. N Engl J Med. 2018;379(6):524–34.

    Article  PubMed  Google Scholar 

  28. Miars CW, Stamatis A, Morgan GB, Drezner JA. Cardiovascular screening practices and attitudes from the NCAA autonomous “power” 5 conferences. Sports Health. 2018;10(6):547–51.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Allen G, Edenfield K, Fitch R, Hainline B, Altman J, Pitts N, Clugston J. Trends in pre-participation cardiac screening among NCAA division 1 autonomy five institutions. Clin J Sport Med. 2020;30(2):130.

    Google Scholar 

  30. Sharma S, Merghani A, Gati S. Cardiac screening of young athletes prior to participation in sports: difficulties in detecting the fatally flawed among the fabulously fit. JAMA Intern Med. 2015;175(1):125–7.

    Article  PubMed  Google Scholar 

  31. Yim ES, Basilico F, Corrado G. Early screening for cardiovascular abnormalities with preparticipation echocardiography: utility of focused physician-operated echocardiography in preparticipation screening of athletes. J Ultrasound Med. 2014;33(2):307–13.

    Article  PubMed  Google Scholar 

  32. Edenfield K, Reifsteck F, Carek S, Harmon K, Asken B, Dillon M, et al. Echocardiographic measurements of left ventricular end-diastolic diameter and interventricular septal diameter in collegiate football athletes at preparticipation evaluation referenced to body surface area. BMJ Open Sport Exerc Med. 2019;5:e000488.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Reifsteck F, Clugston J, Carek S, Harmon K, Asken B, Dillon M, et al. Echocardiographic measurements of aortic root diameter (ARD) in collegiate football Athletes at pre-participation evaluation. BMJ Open Sport Exerc Med. 2019;5:e000546.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993;22(11):1652–8.

    Article  CAS  PubMed  Google Scholar 

  35. Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: long-term results of a prospective multinational registry. Circulation. 2017;135(23):2310–2.

    Article  PubMed  Google Scholar 

  36. Maron BJ, Harris KM, Thompson PD, Eichner ER, Steinberg MH. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 14: sickle cell trait: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2444–6.

    Article  PubMed  Google Scholar 

  37. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013;381(9862):242–55.

    Article  PubMed  Google Scholar 

  38. Cooper RM, Raphael CE, Liebregts M, Anavekar NS, Veselka J. New developments in hypertrophic cardiomyopathy. Can J Cardiol. 2017;33(10):1254–65.

    Article  PubMed  Google Scholar 

  39. Semsarian C, Ingles J, Maron MS, Maron BJ. New perspectives on the prevalence of hypertrophic cardiomyopathy. J Am Coll Cardiol. 2015;65(12):1249–54.

    Article  PubMed  Google Scholar 

  40. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002;287(10):1308–20.

    Article  PubMed  Google Scholar 

  41. Alcalai R, Seidman JG, Seidman CE. Genetic basis of hypertrophic cardiomyopathy: from bench to the clinics. J Cardiovasc Electrophysiol. 2008;19(1):104–10.

    PubMed  Google Scholar 

  42. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2362–71.

    Article  PubMed  Google Scholar 

  43. Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International criteria for electrocardiographic interpretation in athletes. Br J Sports Med. 2017;51(9):704–31.

    Article  PubMed  Google Scholar 

  44. Schnell F, Riding N, O’Hanlon R, Axel Lentz P, Donal E, Kervio G, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation. 2015;131(2):165–73.

    Article  PubMed  Google Scholar 

  45. Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. 2008;358(2):152–61.

    Article  CAS  PubMed  Google Scholar 

  46. Afonso L, Kondur A, Simegn M, Niraj A, Hari P, Kaur R, et al. Two-dimensional strain profiles in patients with physiological and pathological hypertrophy and preserved left ventricular systolic function: a comparative analyses. BMJ Open. 2012;2(4):e001390.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wasfy MM, Weiner RB. Differentiating the athlete’s heart from hypertrophic cardiomyopathy. Curr Opin Cardiol. 2015;30(5):500–5.

    Article  PubMed  Google Scholar 

  48. Basavarajaiah S, Wilson M, Junagde S, Jackson G, Whyte G, Sharma S, et al. Physiological left ventricular hypertrophy or hypertrophic cardiomyopathy in an elite adolescent athlete: role of detraining in resolving the clinical dilemma. Br J Sports Med. 2006;40(8):727–9; discussion 9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Weiner RB, Wang F, Berkstresser B, Kim J, Wang TJ, Lewis GD, et al. Regression of “gray zone” exercise-induced concentric left ventricular hypertrophy during prescribed detraining. J Am Coll Cardiol. 2012;59(22):1992–4.

    Article  PubMed  Google Scholar 

  50. Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2350–5.

    Article  PubMed  Google Scholar 

  51. Ammash NM, Sundt TM, Connolly HM. Marfan syndrome-diagnosis and management. Curr Probl Cardiol. 2008;33(1):7–39.

    Article  PubMed  Google Scholar 

  52. Loeys BL, Dietz HC, Braverman AC, Callewaert BL, De Backer J, Devereux RB, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet. 2010;47(7):476–85.

    Article  CAS  PubMed  Google Scholar 

  53. Braverman AC, Harris KM, Kovacs RJ, Maron BJ, American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology CoCDiY, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. Circulation. 2015;132(22):e303–9.

    Article  PubMed  Google Scholar 

  54. Radke RM, Baumgartner H. Diagnosis and treatment of Marfan syndrome: an update. Heart. 2014;100(17):1382–91.

    Article  PubMed  Google Scholar 

  55. Basso C, Boschello M, Perrone C, Mecenero A, Cera A, Bicego D, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol. 2004;93(5):661–3.

    Article  PubMed  Google Scholar 

  56. Braverman AC. Aortic involvement in patients with a bicuspid aortic valve. Heart. 2011;97(6):506–13.

    Article  PubMed  Google Scholar 

  57. Yim ES. Aortic root disease in athletes: aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan’s syndrome. Sports Med. 2013;43(8):721–32.

    Article  PubMed  Google Scholar 

  58. Gentry JL, Carruthers D, Joshi PH, Maroules CD, Ayers CR, de Lemos JA, et al. Ascending aortic dimensions in Former National Football League Athletes. Circ Cardiovasc Imaging. 2017;10(11):e006852.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2398–405.

    Article  PubMed  Google Scholar 

  60. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35(6):1493–501.

    Article  CAS  PubMed  Google Scholar 

  61. Van Hare GF, Ackerman MJ, Evangelista JK, Kovacs RJ, Myerburg RJ, Shafer KM, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2372–84.

    Article  PubMed  Google Scholar 

  62. Hoyt WJ, Dean PN, Schneider DS, Conaway MR, Kramer CM, Battle RW. Coronary artery evaluation by screening echocardiogram in intercollegiate athletes. Med Sci Sports Exerc. 2017;49(5):863–9.

    Article  PubMed  Google Scholar 

  63. Tucker AM, Vogel RA, Lincoln AE, Dunn RE, Ahrensfield DC, Allen TW, et al. Prevalence of cardiovascular disease risk factors among National Football League players. JAMA. 2009;301(20):2111–9.

    Article  CAS  PubMed  Google Scholar 

  64. Baron SL, Hein MJ, Lehman E, Gersic CM. Body mass index, playing position, race, and the cardiovascular mortality of retired professional football players. Am J Cardiol. 2012;109(6):889–96.

    Article  PubMed  Google Scholar 

  65. Chang AY, FitzGerald SJ, Cannaday J, Zhang S, Patel A, Palmer MD, et al. Cardiovascular risk factors and coronary atherosclerosis in retired National Football League players. Am J Cardiol. 2009;104(6):805–11.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Basra SS, Pokharel Y, Hira RS, Bandeali SJ, Nambi V, Deswal A, et al. Relation between playing position and coronary artery calcium scores in retired National Football League players. Am J Cardiol. 2014;114(12):1836–40.

    Article  CAS  PubMed  Google Scholar 

  67. Thompson PD, Myerburg RJ, Levine BD, Udelson JE, Kovacs RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 8: coronary artery disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2406–11.

    Article  PubMed  Google Scholar 

  68. Rao AL, Salerno JC, Asif IM, Drezner JA. Evaluation and management of Wolff-Parkinson-White in athletes. Sports Health. 2014;6(4):326–32.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, et al. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm. 2012;9(6):1006–24.

    Article  PubMed  Google Scholar 

  70. Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):976–81.

    Article  PubMed  Google Scholar 

  71. Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NAM. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2412–23.

    Article  PubMed  Google Scholar 

  72. Calvo N, Brugada J, Sitges M, Mont L. Atrial fibrillation and atrial flutter in athletes. Br J Sports Med. 2012;46(Suppl 1):i37–43.

    Article  PubMed  Google Scholar 

  73. Raju H, Kalman JM. Management of Atrial Fibrillation in the athlete. Heart Lung Circ. 2018;27(9):1086–92.

    Article  PubMed  Google Scholar 

  74. Flannery MD, Kalman JM, Sanders P, La Gerche A. State of the art review: atrial fibrillation in athletes. Heart Lung Circ. 2017;26(9):983–9.

    Article  PubMed  Google Scholar 

  75. Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, et al. Lifestyle and risk factor modification for reduction of atrial fibrillation: a scientific statement From the American Heart Association. Circulation. 2020. https://doi.org/10.1161/CIR.0000000000000748.

  76. Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10(1):15–20.

    Article  PubMed  Google Scholar 

  77. Gomez AT, Prutkin JM, Rao AL. Evaluation and management of athletes with Long QT syndrome. Sports Health. 2016;8(6):527–35.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Schnell F, Behar N, Carré F. Long-QT syndrome and competitive sports. Arrhythm Electrophysiol Rev. 2018;7(3):187–92.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, et al. Prevalence of the congenital long-QT syndrome. Circulation. 2009;120(18):1761–7.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001;103(1):89–95.

    Article  CAS  PubMed  Google Scholar 

  81. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10(12):1932–63.

    Article  PubMed  Google Scholar 

  82. Ackerman MJ, Zipes DP, Kovacs RJ, Maron BJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 10: the cardiac channelopathies: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2424–8.

    Article  PubMed  Google Scholar 

  83. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):e127–248.

    Article  PubMed  Google Scholar 

  84. Weiner RB, DeLuca JR, Wang F, Lin J, Wasfy MM, Berkstresser B, et al. Exercise-induced left ventricular remodeling among competitive athletes: a phasic phenomenon. Circ Cardiovasc Imaging. 2015;8(12):e003651.

    Article  PubMed  Google Scholar 

  85. Lin J, Wang F, Weiner RB, DeLuca J, Wasfy MM, Berkstresser B, et al. Blood pressure and left ventricular remodeling among American Style Football Players. JACC Cardiovasc Imaging. 2016;9(12):1367–76.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Pelto H. Hypertensive medications in competitive athletes. Curr Sports Med Rep. 2017;16(1):45–9.

    Article  PubMed  Google Scholar 

  87. Niebauer J, Börjesson M, Carre F, Caselli S, Palatini P, Quattrini F, et al. Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2018;39(40):3664–71.

    Article  PubMed  Google Scholar 

  88. Black HR, Sica D, Ferdinand K, White WB. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 6: hypertension: a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2393–7.

    Article  PubMed  Google Scholar 

  89. Basso C, Carturan E, Corrado D, Thiene G. Myocarditis and dilated cardiomyopathy in athletes: diagnosis, management, and recommendations for sport activity. Cardiol Clin. 2007;25(3):423–9, vi.

    Article  PubMed  Google Scholar 

  90. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636–48, 48a–48d.

    Article  PubMed  Google Scholar 

  91. Bonow RO, Nishimura RA, Thompson PD, Udelson JE. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 5: valvular heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2385–92.

    Article  PubMed  Google Scholar 

  92. Estes NAM, Kovacs RJ, Baggish AL, Myerburg RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 11: drugs and performance-enhancing substances: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2429–33.

    Article  PubMed  Google Scholar 

  93. Link MS, Myerburg RJ, Estes NAM. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 12: emergency action plans, resuscitation, cardiopulmonary resuscitation, and automated external defibrillators: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2434–8.

    Article  PubMed  Google Scholar 

  94. Link MS, Estes NAM, Maron BJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 13: commotio cordis: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2439–43.

    Article  PubMed  Google Scholar 

  95. Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2356–61.

    Article  PubMed  Google Scholar 

  96. Mitten MJ, Zipes DP, Maron BJ, Bryant WJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 15: legal aspects of medical eligibility and disqualification recommendations: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2447–50.

    Article  PubMed  Google Scholar 

  97. Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol. 2005;45(8):1318–21.

    Article  PubMed  Google Scholar 

  98. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol. 2017;24(1):41–69.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA

    Katherine M. Edenfield

  2. Departments of Family Medicine and Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA

    Kimberly G. Harmon

Authors
  1. Katherine M. Edenfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly G. Harmon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine M. Edenfield .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, University of Florida, Gainesville, FL, USA

    Kevin W. Farmer

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Edenfield, K.M., Harmon, K.G. (2021). Cardiac Issues in Football. In: Farmer, K.W. (eds) Football Injuries. Springer, Cham. https://doi.org/10.1007/978-3-030-54875-9_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-54875-9_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54874-2

  • Online ISBN: 978-3-030-54875-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation