HJAR Sep/Oct 2025

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2025 39 Murad Almasri, MD Cardiologist Arkansas Children’s Hospital • The athlete is fully informed and ac- tively involved in the decision. This partnership also opens doors for more open conversations about mental health, identity, and purpose, all of particular importance for adolescents who may view sports as part of who they are. With support, many can safely return to play and feel em- powered, not restricted, by their diagnosis. The Bigger Picture: Physical Activity Matters It’s important to note physical activity is good for the heart, even in people with heart disease. Exercise within safe limits can im- prove overall fitness and quality of life in HCM patients. Completely restricting activity can lead to deconditioning, weight gain, depression, and feelings of isolation, especially in teen- agers. That’s why this shift in thinking is so important. What This Means for Providers in Arkansas While community ties and school sports are deeply valued in Arkansas, HCM is a scary risk. Providers across the state, whether pediatricians, internists, cardiolo- gists, or school nurses, may encounter fami- lies struggling with whether or not a young athlete with HCM should continue playing sports given the risks. Here’s how we can help: • Recognize that not all cardiomyopa- thies are the same; some patients can safely return to sports. • Refer to the cardiology teams ex- perienced in risk assessment and counselling. • Support the shared decision-making model and avoid blanket restrictions. • Educate families and schools about individualized care plans and the importance of safety precautions. • In small towns and rural clinics, a well- informed provider canmake a world of difference in a family’s journey, replac- ing fear with clarity and hope. Ultimately, the goal is not just to protect life but to enhance it. Final Thoughts The decision to let a young person with a heart condition play sports should never be taken lightly. But it should also never be made without them. By embracing shared decision-making, we give patients a voice, honor their values, and respect the full picture of their lives, not just the test results. This care protocol is not just a medical shift. It’s a human one. n REFERENCES 1 Ommen, Steve, et al. “2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Circulation 142, no. 25 (2020). https:// doi.org/10.1161/CIR.0000000000000937. 2 Ommen, Steve, et al. “2024 AHA/ACC/ AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/ American College of Cardiology Joint Committee on Clinical Practice Guidelines.” Circulation 149, no. 23 (2024). https://doi.org/10.1161/ CIR.0000000000001250. 3 Semsarian, Christopher, et al. “Athletic Activity for Patients with Hypertrophic Cardiomyopathy and Other Inherited Cardiovascular Diseases: JACC Focus Seminar 3/4.” Journal of the American College of Cardiology 80, no. 13 (2022): 1268–1283. https://doi.org/10.1016/j. jacc.2022.07.013. 4 Bryde, Robyn, et al. “Exercise Recommendations for Patients with Hypertrophic Cardiomyopathy.” Progress in Cardiovascular Diseases 80 (2023): 53–59. https://doi.org/10.1016/j. pcad.2023.05.004. 5 Masilamani, Mats Steffi Jennifer and Bryan Cannon. “Hypertrophic Cardiomyopathy and Competitive Sports: Let ’em Play?” Current Opinion in Cardiology 39, no. 4 (2024): 308–14. https://doi.org/10.1097/ HCO.0000000000001148. MuradAlmasri,MD, is a cardiologist atArkansas Chil- dren’s Hospital with an interest inmedical education and the genetic aspect of cardiomyopathies.He is an assistant professor of pediatrics at the University of Arkansas for Medical Sciences. The Rise of Shared Decision-Making The newer approach is shared decision- making, which puts the patients and their families at the center of the conversation. Instead of a one-size-fits-all answer, we look at each person’s unique case: • How thick is the heart muscle? • Is there a family history of sudden death? • Are there dangerous heart rhythms seen on testing? • Any previous history of unexplained passing out? • Any concerning findings on imaging modalities? If the patient is low-risk and fully under- stands the possible dangers, we may now support their return to sports, especially if that activity brings meaning, motivation, and well-being to their life. TheAHA/ACC endorsed this approach in a scientific statement and later reflected it in multiple major reviews and studies. Not a Free-for-All but a Thoughtful Partnership To be clear, this is not about giving up safety. Instead, it’s about recognizing there is more to life than avoiding risk. Our job as physicians is to inform, assess, and guide. We use modern tools like cardiac MRI, ex- ercise testing, and rhythmmonitors to help make informed decisions. In this shared model, doctors will not say, “You can’t play.”Nor do they say, “Go ahead, it’s fine.” Instead, they say, “Let’s talk about it together.” We also ensure that: • The athlete is followed closely with regular check-ups. • An emergency plan is in place, includ- ing CPR training and access to anAED. • The team, coaches, and school are aware of the condition.