How does taking warfarin affect Exercise Regimen? By Dr.*~LoOKTaO ~* ÿ

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1 How does taking warfarin affect Exercise Regimen? By Dr.*~LoOKTaO ~* ÿ

2 no consistent recommendations available regarding safety of certain sports & exercise any sports w/ high risk of trauma, especially head trauma, should be avoided wear helmet

3 Why is this important to divers? bleeding from injury, ear, sinus & pulm barotrauma decompression can cause relative thrombocytopenia that may aggravate any bleeding believed to result from platelet consumption by adherence to bubbles post-mortem findings of decompression sickness include haemorrhage in spinal cord

4 Guidance Max depth limit of 20 metres No stop diving using tables rather than dive computers Frequent INR checks & INR measured within 7 days of diving Using self monitoring devices where available (similar to diabetic monitoring)

5 Management of VHD who are involved in leisure-time physical activities or competitive sports European Journal of Cardiovascular Prevention and Rehabilitation 2008 By Dr.*~LoOKTaO ~* ÿ

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8 Mitral valve stenosis Classification ÿ Mild = MVA > 1.5 cm2. Moderate = MVA cm2. Severe = MVA < 1.0 cm2

9 Recommendations NSR& mild MS can participate in all types of sport, excluding high dynamic ± high static in combination Mod/severe MS & NSR/AF should only participate in low dynamic & low static types of sport. Should undergo further cardiac evaluation & appropriate med Rx ± PTMC / Sx.

10 Pt whom anticoagulation Rx should not participate in any type of sport that is associated w/ a high probability of injury

11 Mitral valve regurgitation mild-to-mod MR, NSR, normal ET, w/ normal LV size and function may participate in all types of sport mild-to-mod MR, NSR, mild LV dilatation (LVEDD<60mm) & normal resting LV f n may participate in low & mod isometric & dynamic

12 mild-to-moderate MR & LVEDD>60mm or resting LV dysfunction (EF<50%) should not participate in sports, should undergo further evaluation. severe MVR should avoid any type of competitive sports AF must receive anticoagulation Rx & should not participate in sports associated w/ bodily contact (combatant sport)

13 Aortic valve stenosis Classification Mild = AVA >1.5 cm 2, mean gradient 20mmHg Moderate = AVA cm 2, mean gradient mmhg Severe =AVA <1.0 cm 2, mean gradient 50mmHg.

14 Recommendations Asymptomatic w/ mild AS may take low mod dynamic & low mod static sport as long as LV f n & size is normal, normal response to exercise at the level performed & no arrhythmias. Hx of syncope, angina pectoris or dizziness, even if only mild AS should undergo further evaluation & should not participate in competitive sports.

15 Asymptomatic w/ mod AS should only take low dynamic and static Mod AS & LV dysfunction or marked LVH (>15 mm) / severe AS / relevant ascending aorta dilatation should not participate in sports. Symptomatic w/ sig AS require further assessment for Sx & should not perform any athletic exercises.

16 Aortic valve regurgitation Recommendations mild AR, w/ normal LVEDD & systolic f n can participate in all types of sport. asymptomatic mod AR & progressive LV dilatation, sports of dynamic group A and static group I may be carried out.

17 mild/mod AR & sig ventricular arrhythmia at rest/during exercise should not participate in competitive sports. severe AR should not participate in competitive sports, irrespective of LV f n & should be evaluated for valve Sx. AR & marked dilatation of ascending aorta (>50 mm) should not participate in competitive sports.

18 Tricuspid valve stenosis Recommendations asymptomatic, w/ normal ET & normal LV & RV f n & mild-to-mod stenosis can participate in lowmod dynamic and static sport

19 Tricuspid valve regurgitation Recommendations mild TR can take part in all sports. mod TR may take low mod dynamic & low mod static any degree of TR associated w/ AR pressure 20mmHg should avoid competitive sports.

20 Multivalvular disease Recommendations Recommendations should be based on the haemodynamically most relevant defect.

21 Percutaneous mitral valvuloplasty Recommendations Based on residual degree of valve stenosis/valve regurgitation present after the procedure. EST, including stress echo, should be carried out to the level of sport. Residual gradients at rest & during exercise, valve area, PA pressure & LV f n determine the eligibility for sports activities.

22 Mitral valve prolapse Accompanying complications are respected. Unexplained syncope, family Hx of SCD, complex supraventricular or ventricular arrhythmias, long QT interval or severe MR, no sport should be performed. Absence of earlier cited circumstance, all sports are permitted.

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