During the pandemic, several professional and collegiate sports leagues have canceled major events and seasons, in part to slow the spread of COVID-19, but also due to alarming reports of athletes developing a syndrome called myocarditis (inflammation of the heart muscle) after a stroke. COVID-19 infection.
After two years of investigation, the Guide published by the American College of Cardiology Tuesday that states the incidence of heart inflammation among athletes after COVID-19 is lower than originally thought, but still suggests a step-by-step plan to help competitive athletes and weekend warriors who It will help you return to your activities safely.
“For athletes recovering from COVID-19 with ongoing cardiopulmonary symptoms…further evaluation should be performed before resuming exercise,” states the ACC Expert Consensus Decision Pathway, which was published in the Journal of the American College of Cardiology. “For all others who are asymptomatic or with symptoms less suggestive of a cardiopulmonary etiology… further cardiac testing is not recommended.”
evolving science
Doctors were doing “very rigorous testing for myocarditis” early in the pandemic, Dr. Tamanna Singh, co-director of the Cleveland Clinic Center for Sports Cardiology, who was not involved in the new guidance, told ABC News, noting that, at the time, they were concerned that the incidence of myocarditis “was going to be much higher than it actually was.”
In September 2020, when much was still unknown about COVID-19, Ohio State University researchers tested 26 athletes after a mild COVID-19 infection that did not require hospitalization. Myocarditis was found in 15% of the athletes, while 30% had developed scarring of the heart, leading to a sense of uncertainty around the safety of athletes returning to play after infection.
“While data on cardiomyopathy are preliminary and incomplete, the uncertain risk was unacceptable at this time,” Big Ten Commissioner Kevin Warren wrote in a statement. Open letter from August 2020 on the decision to cancel the 2020-2021 college conference fall sports season.
But over time, it was discovered that the incidence appears to be much lower than previously thought.
“A lot of conferences, including the Big Ten, were doing cardiac MRIs on all athletes who have recovered from COVID, and what they found was that the incidence of serious MRI abnormalities was very low, on the order of 1 to 2 percent.” said Dr. Nicole Bhave, a cardiologist and echocardiographer at the University of Michigan and co-chair of the committee that published this new guideline.
Typical rates of myocarditis involvement in athletes are “very low, with rates typically ranging from 0.6 percent to 0.7 percent,” Singh said.
While expert understanding of COVID-19 is evolving, it is clear that many patients continue to have symptoms, obvious or subtle, after infection. And while not every athlete with COVID-19 will experience myocarditis, it’s dangerous enough for doctors to notice.
“Myocarditis is a very rare but serious complication of COVID,” Bhave said. “Patients with COVID myocarditis really should be managed in a high-level center [with the proper equipment]because these patients can go south quickly.
orientation for athletes
New ACC guidance suggests it’s safe for athletes without COVID-19 symptoms to return to exercise three days after self-isolation. For those with mild symptoms that don’t involve the heart or lungs, it’s safe to return to exercise once symptoms resolve.
Athletes who suffer from persistent chest pain, palpitations, or fainting require further cardiac testing. If the findings are of concern for myocarditis, the ACC recommends abstinence from exercise for three to six months.
“We don’t think a routine MRI is needed for everyone who has had COVID before starting to exercise again,” Bhave said.
If an athlete has persistent symptoms, Bhave said, “one of the recommendations we make in the document is that people do exercises lying down, so instead of trying to walk, do something where they’re actually sitting, so that intolerance orthostatic [the inability to tolerate quick movements] it is not a big thing”.
For athletes experiencing long-lasting COVID-19 symptoms, the recovery process can be frustrating.
“You’re basically looking at someone who has had a decade and a half, maybe even two decades, of unrestricted sports participation and unlimited exercise capacity who is now severely limited,” Singh said. “They’re losing not only their physical connection to themselves, but also their social connection to their community, which can be really mentally devastating.”
Singh and Bhave said reintroducing exercise after infection should be gradual, starting with small amounts and increasing the frequency, duration and intensity as tolerated.
“It’s important as doctors to say, ‘Hey, I’m here with you and I know you’re not back to where you were yet. I share your frustration and I’m not going to abandon you,'” Bhave said. . “We still have a lot to learn, and I think that’s a very helpful message for patients who are feeling frustrated.”
Nicholas P. Kondoleon, MD, is an internal medicine resident at the Cleveland Clinic and a contributor to the ABC News Medical Unit.
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