Can patients with congenital heart disease participate in athletics?

In general, yes. However, as no formal guidelines are available, recommendations are based on the judgments of individual physicians. The risks of athletic activity vary with the type of disease, functional cardiac status of the patient, and type of activities. The intensity and duration of exercise, risk of body collision or trauma, conditioning required, and the risk of injury (to both the athlete and spectators) if the athlete develops syncope are also factors in assessing risk.

Recommendations for Athletic Participation in Persons with Congenital Heart Disease

Is congenital heart disease a contraindication to pregnancy?

The most common congenital malformation in women surviving to childbearing age are atrial septal defect (secundum), patent ductus arteriosus, pulmonary valvular stenosis, aortic coarctation, aortic valve disease, and tetralogy of Fallot. Few congenital heart lesions interfere with the initiation of pregnancy. Maternal mortality is related to functional class and varies from 0.4% for New York Heart Association Classes I and II to 6.8% for Classes III and IV. Fetal mortality varies from essentially 0% in Class I to 30% for Class IV.

The effects of pregnancy on common congenital defects also relate to clinical status. Asymptomatic atrial septal defects, bicuspid aortic valves, and aortic coarctation require special attention to risks of embolism and endocarditis but have little effect on mortality. In contrast, elevations of pulmonary vascular resistance significantly increase the risks of pregnancy, and Eisenmenger’s complex is associated with cumulative maternal death rates of 30-70% during and after pregnancy. Risks of pregnancy are lower in patients with surgically corrected disease but are still determined by the degree of cardiac and vascular reserve and the residual defects after surgery. The major risks to the fetus stem from functional class of the mother, presence of maternal cyanosis, and use of anticoagulants (especially with prosthetic heart valves).

Is ischemic heart disease a problem in women?

Yes. Ischemic heart disease causes 250,000 deaths/year in women in the U.S. This represents 23% of all deaths in women, making ischemic heart disease the leading cause of death in women over age 50.

What are the risk factors for coronary artery disease (CAD) in women?

The effects of risk factors are not well studied, but age, smoking, hypertension, lipoprotein profile, obesity, diabetes, and family history do predict CAD in women. Also, oral contraceptives and menopause increase the risk, while postmenopausal hormonal replacement decreases the risk.

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