TY - JOUR T1 - Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review JF - British Journal of Sports Medicine JO - Br J Sports Med SP - 1041 LP - 1048 DO - 10.1136/bjsports-2020-102921 VL - 55 IS - 18 AU - Jonathan A Drezner AU - Aneil Malhotra AU - Jordan M Prutkin AU - Michael Papadakis AU - Kimberly G Harmon AU - Irfan M Asif AU - David S Owens AU - Joseph C Marek AU - Sanjay Sharma Y1 - 2021/09/01 UR - http://bjsm.bmj.com/content/55/18/1041.abstract N2 - The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree. ER -