Спортсмены с миокардиальными мостиками и объективными признаками скрытой ишемии миокарда или перенесенным инфарктом миокарда в анамнезе могут быть допущены к занятиям низко интенсивными видами спорта (класс IA).

Спортсмены, перенесшие операцию по рассечению мышечных мостиков или стентирование, могут быть допущены к занятиям низко интенсивными видами спорта на срок не менее 6 месяцев после вмешательства. Асимптомным спортсменам для решения вопроса о допуска к занятиям спотом необходимо проведение нагрузочного теста. В случае нормальной толерантности к физической нагрузке и отсутствии признаков скрытой ишемии миокарда, спортсмены могут быть допущены к занятиям всеми видами спорта.

Список литературы.

1. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovas-cular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcom-mittee on Physical Activity). Circulation 2003;107:3109 –16.

2. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion. Determi-nants of Myocardial Infarction Onset Study Investigators. N Engl J Med 1993;329:1677– 83.

3. Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R. Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med 1993;329:1684 –90.

4. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic characteristics of exertion-related acute myocardial infarction. JAMA 1999;282:1731– 6.

5. Thompson PD, Funk EJ, Carleton RA, Sturner WQ. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 1982;247:2535– 8.

6. Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med 1984;311:874 –7.

7. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000;343:1355– 61.

8. Ragosta M, Crabtree J, Sturner WQ, Thompson PD. Death during recreational exercise in the state of Rhode Island. Med Sci Sports Exerc 1984;16:339 – 42.

9. Black A, Black MM, Gensini G. Exertion and acute coronary artery injury. Angiology 1975;26:759 – 83.

10. Ciampricotti R, Deckers JW, Taverne R, el Gamal M, Relik-van Wely L, Pool J. Characteristics of conditioned and sedentary men with acute coronary syndromes. Am J Cardiol 1994;73:219 –22.

11. Burke AP, Farb A, Malcom GT, Liang Y, Smialek JE, Virmani R. Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 1999;281:921– 6.

12. Maron BJ, Araujo CG, Thompson PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2001;103:327–34.

13. Cheng YJ, Church TS, Kimball TE, et al. Comparison of coronary artery calcium detected by electron beam tomography in patients with to those without symptomatic coronary heart disease. Am J Cardiol 2003;92:498 –503.

14. Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical impli-cations. A statement for health professionals from the American Heart Association Writing Group. Circulation 1996;94:1175–92.

15. O’Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association expert consensus docu-ment on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000;102:126 – 40.

16. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210 –5.

17. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Available at: www.acc.org/clinical/guidelines/exercise/dirIndex.htm. Accessed October 1, 2004. 18. Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S. Circadian variation of exercise capacity in patients with Prinzmetal’s variant angina: role of exercise-induced coronary arterial spasm. Circulation 1979;59:938 – 48.

19. Mark DB, Califf RM, Morris KG, et al. Clinical characteristics and long-term survival of patients with variant angina. Circulation 1984; 69:880 – 8.

20. Gordon JB, Ganz P, Nabel EG, et al. Atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise. J Clin Invest 1989;83:1946 –52.

21. Waters DD, Szlachcic J, Bourassa MG, Scholl JM, Theroux P. Exercise testing in patients with variant angina: results, correlation with clinical and angiographic features and prognostic significance. Circulation 1982;65:265–74.

22. Hamilton KK, Pepine CJ. A renaissance of provocative testing for coronary spasm? J Am Coll Cardiol 2000;35:1857–9.

23. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003;107:149 –58.

24. Shanoudy H, Raggi P, Gasperetti C, et al. Detection of coronary vasospasm by posthyperventilation technetium-99m sestamibi single-photon emission computed tomography imaging in patients with coronary artery disease. Am J Cardiol 1998;81:573–7.

25. Miller LW, Schlant RC, Kobashigawa J, Kubo S, Renlund DG. 24^th Bethesda Conference: cardiac transplantation. Task force 5: compli-cations. J Am Coll Cardiol 1993;22:41–54.

26. Uretsky BF, Kormos RL, Zerbe TR et al. Cardiac events after heart transplantation: incidence and predictive value of coronary arteriogra-phy. J Heart Lung Transplant 1992;11:S45–51.

27. Schroeder JS, Gao SZ, Hunt SA, Stinson EB. Accelerated graft coronary artery disease: diagnosis and prevention. J Heart Lung Transplant 1992;11:S258 – 65.

28. Spes CH, Klauss V, Mudra H, et al. Diagnostic and prognostic value of serial dobutamine stress echocardiography for noninvasive assess-ment of cardiac allograft vasculopathy: a comparison with coronary angiography and intravascular ultrasound. Circulation 1999;100:509 –15.

29. Spes CH, Klauss V, Rieber J, et al. Functional and morphological findings in heart transplant recipients with a normal coronary angio-gram: an analysis by dobutamine stress echocardiography, intracoro-nary Doppler and intravascular ultrasound. J Heart Lung Transplant 1999;18:391– 8.

30. Larsen RL, Applegate PM, Dyar DA, et al. Dobutamine stress echocardiography for assessing coronary artery disease after transplan-tation in children. J Am Coll Cardiol 1998;32:515–20.

31. Akosah KO, McDaniel S, Hanrahan JS, Mohanty PK. Dobutamine stress echocardiography early after heart transplantation predicts development of allograft coronary artery disease and outcome. J Am Coll Cardiol 1998;31:1607–14.

32. Mohlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation 2002;106:2616 –22.

33. Morales AR, Romanelli R, Tate LG, Boucek RJ, de Marchena E. Intramural left anterior descending coronary artery: significance of the depth of the muscular tunnel. Hum Pathol 1993;24:693–701.

34. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes: clinical, demo-graphic, and pathological profiles. JAMA 1996;276:199 –204.

35. Betriu A, Tubau J, Sanz G, Magrina J, Navarro-Lopez F. Relief of angina by periarterial muscle resection of myocardial bridges. Am Heart J 1980;100:223– 6.

36. Hill RC, Chitwood WR Jr., Bashore TM, Sink JD, Cox JL, Wechsler AS. Coronary flow and regional function before and after supraarterial myotomy for myocardial bridging. Ann Thorac Surg 1981;31:176 – 81.