[Hypertrophic cardiomyopathy and sports activities]

What advice should be given today to a patient with hypertrophic cardiomyopathy who wishes to participate in sports? The Bethesda recommendations of 1994 strictly contraindicate competition in sports for any subject with hypertrophic cardiomyopathy, outside of a few activities with a very low level of energy expenditure. Nothing today suggests a change in these recommendations. Even if genetic knowledge of hypertrophic cardiomyopathy has progressed considerably, it is still not possible to determine precisely which forms are specific to a risk of sudden death linked to effort. Some forms of hypertrophic cardiomyopathy can be classified as high risk based on history-taking (familial antecedents of sudden death, syncope) and/or on genetic study, and/or on the results of complementary examinations (lack of blood pressure adaptation on exertion test, ventricular rhythm disorders, etc.) and in such cases extreme prudence should be recommended with regard to physical activity. On the other hand, if results indicate that the patient is at low risk, limited, submaximal physical activity can be envisioned, taking into account the results of the exertion test and Holter readings made during physical activity. Periodic re-evaluation of tolerance to exertion is then indispensable.