This state-of-the-art review provides a primary reference for the cardiovascular care of pediatric athletes (<18 years old), detailing preparticipation screening and management of cardiac conditions.
This review serves as a primary reference for the cardiovascular care of pediatric athletes, emphasizing that adult sports cardiology principles do not fully generalize to pediatrics.
Sports cardiology broadly encompasses the cardiovascular care of individuals who place a high premium on habitual exercise, sports performance, and/or sports competition. Some of the essential aspects within sports cardiology include the preparticipation cardiac evaluation and the management of cardiac diseases in athletes. Although most sports cardiology practitioners are trained in adult cardiology, a significant number of individuals who participate in sports are pediatric-aged, <18 years old. Up to two-thirds of children in middle and high school participate in organized sports or are involved in nonorganized recreational sports. The cardiovascular care of pediatric-aged athletes can be challenging because many of the classic tenets and principles in adult sports cardiology do not fully generalize to pediatrics, and there is a lack of the evidence base that may be present for adult athletes. The epidemiology, presentation, and progression of cardiovascular diseases can be significantly different between pediatric and adult athletes. The evaluation of potential diseases and management considerations may also differ between pediatric and adult athletes. Similar to adults, there are "gray zones" where it is difficult to differentiate between normal exercise-induced cardiac remodeling and true cardiac pathology, but the additional lack of normative standards further complicates assessments in pediatric athletes. Management decisions for pediatric athletes are generally based on limited data but carry substantial short- and long-term implications. Thus, shared decision-making as part of the determination of clinical management strategies and for sports participation is critical and requires the participation of the parents or guardian(s). In this state-of-the-art review, key differences between pediatric and adult-aged athletes are highlighted. Specifically, how to define the "pediatric athlete," consider cardiovascular adaptations observed among pediatric athletes, determine preparticipation screening options and optimal symptom-driven evaluations in children, and consider best practices for pediatric athletes with several key cardiac conditions are detailed. The purpose of this document is to represent the first primary reference available to providers who care for pediatric athletes with cardiovascular concerns.
“We don't know as much for the younger age groups, but we do know that the same phenotype at a younger age may represent a different risk. HCM is an evolving disease and gets worse through adolescence. When applying the adult risk criteria to pediatrics, I worry that the 12-year-old who is manifesting a 25 mm septum is different than the adult with a 25 mm septum, not only on proportion to body surface area and z scores, but more so because this is a more malignant phenotype by showing up early.”
Dean et al. (Tue,) conducted a review in Cardiovascular care of pediatric athletes. This state-of-the-art review provides a primary reference for the cardiovascular care of pediatric athletes (<18 years old), detailing preparticipation screening and management of cardiac conditions.