Throughout the pandemic, some professional and college sports leagues have not only delayed the spread of COVID-19, but also due to the alarming reports of athletes developing a syndrome called myocarditis (myocarditis). In addition, we have canceled major events and seasons. COVID-19 infection.
After two years of research, the American Heart Association released guidance on Tuesday stating that athletes have a lower incidence of cardiac inflammation after COVID-19 than originally thought, but still competitive athletes. And similar warriors who are proposing a step-by-step plan to support the weekend and will help them safely return to their activities.
“Athletes recovering from COVID-19 with advanced cardiopulmonary symptoms need further assessment before resuming exercise,” said ACC Expert Consensus Decision Pathway in the Journal of the American College of Cardiology. .. “Additional heart tests are not recommended for all others who are asymptomatic or have few symptoms suggestive of cardiopulmonary etiology.”
Evolving science
Doctors were doing “a very rigorous test to look for myocarditis” early in the pandemic, Dr. Tamannasin, co-director of the Cleveland Clinic Sports Heart Disease Center, told ABC News that he was not involved in the new guidance. .. At that time, they were worried that the incidence of myocarditis would be “much higher than it really is.”
In September 2020, when much was not known about COVID-19, researchers at Ohio State University examined 26 athletes after mild COVID-19 infection that did not require hospitalization. Myocarditis is found in 15% of athletes and 30% has scars on the heart, increasing the anxiety surrounding the safety of athletes returning to competition after infection.
“Data on cardiomyopathy are preliminary and incomplete, but uncertain risks were not accepted at this time,” Big Ten Commissioner Kevin Warren said in a public letter in August 2020 at the University Conference 2020-2021. I wrote about the decision to cancel the sports season in the fall of the year.
However, over time, it was discovered that the incidence appeared to be much lower than initially thought.
“Many conferences, including Big Ten, performed echocardiography on all athletes who recovered from COVID. They found that the incidence of serious MRI abnormalities was on the order of 1-2%. “It was low,” said Nicole Barb, a cardiologist and echocardiologist at the University of Michigan and co-chairman of the committee who announced this new guidance.
The typical rate of myocarditis involvement in athletes is “very low, usually around 0.6-0.7%,” Shin said.
Although expert understanding of COVID-19 is evolving, it is clear that many patients continue to show obvious or subtle symptoms after infection. Also, not all athletes with COVID-19 experience myocarditis, but it is dangerous to alert a doctor.
“Myocarditis is very rare, but it is a serious complication of COVID,” Bhave said. “Patients with COVID myocarditis should be managed in a really high level center [with the proper equipment]Because these patients can go south faster. “
Guidance for athletes
The new ACC guidance suggests that COVID-19 asymptomatic athletes are safe to return to exercise after 3 days of self-isolation. People with mild symptoms that do not involve the heart or lungs are safe to return to exercise once the symptoms have disappeared.
Athletes suffering from persistent chest pain, palpitations, or fainting should undergo additional heart tests. If the findings are related to myocarditis, the ACC recommends abstinence from exercise for 3-6 months.
“I don’t think everyone with a COVID needs a regular MRI before they can start exercising again,” Bhave said.
If the athlete has persistent symptoms, Bhave said: “One of the things we recommend in this document is for people to lie down. Orthostatic intolerance. [the inability to tolerate quick movements] It’s not a big deal. “
The recovery process can be frustrating for athletes experiencing long-distance COVID-19 symptoms.
“Basically, for 10 and a half years, and in some cases 20 years, I’ve seen people with unlimited sports participation and unlimited athletic performance, and now with strict restrictions,” Shin said. “They have lost not only their physical connection to themselves, but also their social connection to the community. This can be truly psychologically devastating.”
Both Singh and Bhave said that reintroduction of exercise after infection should be started in small doses and gradually, increasing the frequency, duration and intensity allowed.
“As a doctor,’Hey, I’m with you. I know you haven’t returned to where you were. I’ll share your frustration and I’m not going to abandon you.'” That’s important, “Barb said. .. “I still have a lot to learn. I think it’s a very useful message for frustrated patients.”
Nicholas P. Kondoleon, MD, is a Resident of Internal Medicine at Cleveland Clinic and a contributor to the ABC News Medical Unit.
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