What is it?

Congenital coronary anomalies (CCA), though uncommon, are the second leading cause of Sudden Cardiac Death (SCD). They are caused by problems with the flow of oxygen and nutrients to the heart. These disorders are most often related to certain coronary arteries, but they can also include variations in the size and shape of the affected blood vessels.

The broad classification of congenital heart disease occurs in 8 per 10,000 live births, and anomalies of coronary arteries accounts for roughly 17% of SCD in the United States. The risk of death with this condition is due to obstructed blood flow (myocardial ischemia) during periods of increased cardiac demand, such as exercise.

Symptoms/Risks

Symptoms can vary depending on the artery disorder and can include chest pain, palpitations, dyspnea, arrhythmia and sudden death can occur and must be evaluated.

As an individual ages, increasing levels of vigorous training/ sport will cause more cardiac oxygen/blood demand. In an individual with CCA, this often leads to blood flow problems within the heart and can cause these symptoms.

Sports Medicine Evaluation & Treatment

Despite being an uncommon condition, physician must consider these abnormalities when patients have these symptoms. Sport medicine professionals must remember to perform the appropriate pre-participation cardiac screening on all athletes. This should include an in-depth family and personal history, a proper physical examinations and potentially a resting EKG or echocardiogram.

With recent medical advances, CCA can be identified using computed tomography (CT) scans and cardiac magnetic resonance (CMR). The gold standard for finding the abnormal course is coronary angiography. However, this is invasive and costly, and the cost versus risk must be considered.

Injury Prevention

Recognition of CCA can be difficult, but it must be considered when evaluating athletes. Occasional evaluation of athletes should also take place to assess for changes in their history and symptoms. Due to this condition’s rare and unpredictable nature, no current research suggests appropriate guidelines for monitoring athletes.

Return to Play

When making return to play recommendations, a physician must consider the training and competitive aspects of the sport, as well as the patient’s status and surgical history. Athletes with known CCAs should have their participation status evaluated with a team approach between the athlete, their sports medicine physician and cardiologist. Return to play will likely be limited by the symptoms they show to prevent significant risk to their health.

The treatment of choice for a CCA is surgical repair. Returning to sports can be considered after a thorough risk versus benefit discussion with the athlete and the appropriate medical professional, with total clearance happing after about six months after the defect is surgically corrected.

AMSSM Member Authors
Jesse Shaw, DO and David Braun, MD

References
Van Hare GF, Ackerman MJ, Evangelista JK, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease. Circulation. 2015;132:e281-291
Bend X, Huang P, Chen W, et al. An incidental encounter of a rare high take-off right coronary artery. Medicine. 2017;96:45(e8614)
Villa ADM, Sammut E, Nair A, et al. Coronary artery anomalies overview: the normal and the abnormal. World J Radiol. 2016;8(6):537-555
Schmied C, Bojesson M. Sudden cardiac death in athletes. J Intern Med. 2014;275:93-103
Angelini P, Vidovich MI, Lawless CE. Peventing sudden cardiac death in athletes. Tex Heart Inst J. 2013;40(2):148-155