Sports Medicine: Just the Facts

b. To assess functional capacity and to aid in the

prognosis of patients with known CAD

c. To evaluate the prognosis and functional capacity

of patients with known CAD soon after an uncom-

plicated myocardial infarction(MI)

d. To evaluate patients with symptoms consistent with

recurrent, exercise-induced cardiac arrhythmias

CLASSII

• Conditions which are frequently used but in which
  there is a divergence of opinion regarding medical
  effectiveness of EST
  a. To evaluate asymptomatic males >45 years (females

  
  

  55 years) with special occupations
  b. To evaluate asymptomatic males >45 years (females
  55 years) with two or more cardiac risk factors.
  c. To evaluate asymptomatic males >45 years (females
  55 years) who plan to enter a vigorous exercise
  program
  d. To assist in the diagnosis of CAD in adult patients
  with a high or low pretest probability of disease
  e. To evaluate patients with a class I indication who
  have baseline electrocardiogram(EKG) changes

  
  

  
  

CLASSIII

• Conditions for which there is general agreement the
  EST is of little to no value, inappropriate, or con-
  traindicated
  a. To assist in the diagnosis of CAD in patients with
  left bundle-branch-block (LBBB) or Wo l ff
  Parkinson White(WPW) on a resting EKG
  b. To evaluate patients with simple premature ven-
  tricular complexes(PVCs) on a resting EKG with
  no other evidence for CAD
  c. To evaluate men or women with chest discomfort
  not thought to be cardiac


• The above classes group the indications based on risk
  according to ACSM guidelines. Patients are catego-
  rized into low, moderate, and high-risk groups prior to
  beginning an exercise program. Risk stratification is
  based on age, sex, presence of CAD risk factors,
  major symptoms of disease, or known heart disease
  (NECP, 2001; American College of Sports Medicine,
  2000 a) (see Tables 20-1 and 20-2).


• Low risk:Asymptomatic younger individuals (men <
  age45 years; women <age 55 years) and no more
  than 1 risk factor from Table 20-1.

120 SECTION 2 • EVALUATION OF THE INJURED ATHLETE

TABLE 20-1 Coronary Artery Risk Factors Used for Risk Stratification

Positive Factors
Family History 1. Myocardial infarction or

2. Coronary revascularization or


3. Sudden death
   (History of above occurring in male first-degree relative
   before age 55 years; history of above occurring before
   age 65 in female first-degree relatives)

Cigarette Smoking 1. Current smoker or

2. Those who quit smoking in previous six months

Hypertension 1. Currently on antihypertensive medication or

2. Systolic blood pressure ≥140 mm Hg.* or


3. Diastolic blood pressure ≤90 mm Hg.
   (confirmed on two separate occasions)

Hypercholesterolemia 1. Total serum cholesterol >200 mg/dl or

2. High-density lipoprotein cholesterol <40 mg/dl or


3. Low-density lipoprotein cholesterol >100 mg/dl if CHD
   or CHD risk equivalent
   ≥130 mg/dl if ≥2 risk factors
   ≥160 mg/dl if 0-1 risk factors

Impaired Fasting Glucose Fasting blood glucose ≥110 mg/dl

Obesity 1. Waist girth >102 cm (men) or >88 cm (women)

Sedentary Lifestyle 1. Persons not participating in regular exercise program or

2. Not meeting the minimal physical activity
   recommendations from the U.S. Surgeon General’s report

Negative Factors
High Serum High-Density >60 mg/dL
Lipoprotein Cholesterol

SOURCE: Expert Panel, on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Summary
of the third report of the national Cholesterol Education Program (NCP) expert panel on detection, evaluation,
and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA285:2486–2497, 2001.
ABBREVIATION: CHD = Coronary heart disease.