By: Shreya Pal
Among the hundred other complications that worry millions of people, athletes are the most concerned for mostly one, heart disease. For instance, the Redwoods Lacrosse athlete, Jules Heningburg had been cautioned to leave training after his doctors said that tests showed he was at high risk for cardiac arrest with high-intensity training. He had been sprinting up hills and playing pick-up basketball for a month after being diagnosed with COVID-19 and with proper recovery. Additionally, Early halts of national sport championships were primarily due to the fear of developing sports-related sudden cardiac death. This raises the question, is there a strong relation between developing heart complications and post-COVID-19 recovery?
Initial studies for determining the correlation between heart complications and COVID-19 recovery were relatively small and the cardiac findings were alarmingly common, occurring in ≈40% of athletes. However these studies had been conducted with the absence of control athletes, small sample sizes, lack of previous baseline imaging, and uncertain pretest likelihood for myocardial involvement in patients with COVID-19 infection contributed to uncertainty in estimating myocarditis risk.
In October 2020, the American College of Cardiology's (ACC) Sports & Exercise Cardiology Council published revised consensus recommendations regarding return-to-play (RTP) for athletes after the COVID-19 infection. At that time, clinical outcomes of especially myocarditis (inflammation of heart) prevalence in athletes were still unknown. RTP recommendations remained purely consensus-based.
However, over the last year, robust prevalence data pertaining to myocardial involvement after COVID-19 infection in athletes were published. Recent evidence suggests true COVID-19 myocarditis may in fact be uncommon, presenting pathologically in <5% of patients undergoing autopsy or referred for myocardial biopsies in a recent case series. Furthermore, the last iteration of RTP recommendation suggests that the likelihood of developing myocarditis is 0.6 - 0.7%. Subsequent studies of athletes recovering from COVID-19 have since demonstrated much lower rates of myocardial involvement than earlier studies, ranging from 0.6% to 3%, despite similar proportions of symptomatic athletes.
Current data suggest competitive athletes recovering from COVID-19 with mild, non-cardiopulmonary symptoms are unlikely to have myocarditis and clinically significant myocardial involvement. Rather, the presence of cardiopulmonary symptoms are of greater relevance when assessing the probability of clinically-important myocardial disease. Only athletes recovering from COVID-19 with cardiopulmonary symptoms concerning myocarditis or myocardial involvement (chest pain or tightness, dyspnea, palpitations, lightheadedness, or syncope) should further cardiac evaluation be performed prior to RTP. For all others who are asymptomatic or with non-cardiopulmonary symptoms (includes fever [temperature ≥100.4°F], chills, lethargy, myalgias, upper respiratory tract, gastrointestinal, anosmia, ageusia, headache), cardiac testing is not recommended prior to RTP.
Even with all of these registries, to-date, there have been no adverse cardiac outcomes reported as a direct consequence of COVID-19 and regardless of the inclusion of cardiac MRI in the screening process. Finally, regardless of how severe you think your complications are post COVID-recovery, you should immediately consult a doctor. Afterall, there is always more to discover about COVID-19 and any preventative measures should be of utmost priority.
References:
A Closer Look at Covid-19 and Heart Complications among Athletes. www.heart.org. (2020, October 30). Retrieved March 16, 2022, from https://www.heart.org/en/news/2020/09/11/a-closer-look-at-covid-19-and-heart-complications-among-athletes
Covid-19 and the athletic heart: Key updates from the American College of Cardiology Sports & Exercise Leadership Council. American College of Cardiology. (n.d.). Retrieved March 16, 2022, from https://www.acc.org/Membership/Sections-and-Councils/Sports-and-Exercise-Cardiology-Section/Section-Updates/2022/01/24/19/52/COVID-19-and-the-Athletic-Heart
Martinez MW, Tucker AM, Bloom OJ, et al. Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol. 2021;6(7):745. https://doi.org/10.1001/jamacardio.2021.0565
Sarma, S., Everett, B. M., & Post, W. S. (2021). Cardiac involvement in athletes recovering from covid-19: A reason for hope. Circulation, 144(4), 267–270. https://doi.org/10.1161/circulationaha.121.054957