Growing evidence suggests that the coronavirus can damage the hearts of even young and physically fit people.
A study published Friday in JAMA Cardiology magazine found that 4 out of 26 college athletes had signs of a heart condition called myocarditis after recovering from COVID-19.
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The results were hinted at in late August when Dr. Wayne Sebastianelli, the director of sports medicine at Penn State, said during a discussion with members of the school board that 30 percent of Big Ten athletes who have had COVID-1
Scott Gilbert, a Penn State Health spokesman, told NBC News that Sebastianelli misrepresented the results at the time and apologized for any confusion. Gilbert added that Penn State was not involved in the research and that there were no cases of myocarditis in COVID-19 positive athletes at the school.
In fact, the new study was conducted by doctors at Ohio State University’s Wexner Medical Center who were considering the safest way to send athletes back in the fall. Ultimately, the Big Ten Conference, which includes both Ohio State and Penn State, decided against this fall.
“We were asked this question, what would be the safest way to get them back into competitive play,” said study co-author Dr. Saurabh Rajpal, a cardiologist in the state of Ohio. “We decided, in our own group, to do a cardiac MRI in addition to the usual recommendations that were a clinical exam and looking for symptoms to get more information and see what the virus was doing does the hearts of athletes. “
The study included both male and female athletes in basketball, lacrosse, athletics, soccer, and soccer. It was confirmed that all had recovered from COVID-19 and none required hospital or specific treatments. Twelve of the athletes reported mild COVID-19 symptoms, including a sore throat and shortness of breath or fever, while the remaining 14 were asymptomatic.
To study the effects of the virus on the heart, the athletes had several tests, as well as a cardiac MRI scan to map the heart.
The MRI found that four athletes – all men with no previous medical history – had signs of myocarditis. Two reported mild COVID-19 symptoms; The other two were asymptomatic.
It was surprising that not all athletes with myocarditis had symptoms of COVID-19, said Dr. Brett Toresdahl, sports medicine specialist at the New York City Specialty Surgery Hospital. This was because myocarditis was originally detected in patients hospitalized with COVID-19.
“What this study shows is that myocarditis can occur even after less severe and even asymptomatic cases of COVID-19,” said Torsedahl, who was not involved in the research. “Therefore, an athlete’s risk of myocarditis may not be related to the severity of their symptoms.”
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Another eight athletes also had signs of heart scars, but it’s unclear whether this is related to COVID-19 or normal heart adjustment.
While the disease often goes away on its own, in rare cases it can lead to sudden death from cardiac arrest.
Rajpal warned that the study was small and further investigation was needed to confirm whether COVID-19 was contributing to athletes’ myocarditis.
In fact, athletes’ hearts usually change as they adapt to high-intensity exercise, which allows their heart to work more efficiently. Dr. However, Ali Nsair, director of exercise cardiology at UCLA, said the results were abnormal even for an athlete.
Based on what is known about the virus, it is likely that the heart disease is related to COVID-19, Rajpal said. In fact, previous research found evidence of heart inflammation in recovered COVID-19 patients.
However, the athlete’s MRIs were the only evidence of heart damage. None of the athletes had abnormalities on the other tests, including an EKG, which measures the heart’s rhythm, or a blood test for troponin levels, a protein that indicates damage to the heart.
Nsair, who was also not involved in the research, said the issue was that abnormalities were only found on MRIs and not on blood tests or EKGs. It begs the question of whether an athlete who tests positive for the coronavirus should have an MRI of his heart before being cleared for competitive play, he said.
In the state of Ohio, Rajpal said this is the current protocol for recovered COVID-19 athletes before returning to strenuous activity.
Rajpal added that athletes with myocarditis are advised to rest for three months before playing again, according to guidelines from the American Heart Association. And when they return, they should be careful about symptoms, especially if they experience unusual shortness of breath or chest pain.
Others agreed that rest is essential.
“If we see a patient, professional athlete, or anything else with that amount of inflammation, we would definitely advise against any exercise until it is found out,” said Nsair.
Toresdahl told an athlete with signs of myocarditis, “Right now it would be to rest just because we don’t know the risk of sudden cardiac arrest from COVID-19 myocarditis.”
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