Reports have indicated that COVID-19 may cause heart damage in hospitalized patients with severe cases of the disease, but it's unclear whether cardiac injury also occurs in infected patients who are asymptomatic or experience only mild symptoms.
This question is of particular concern for athletes because myocarditis--inflammation in the heart usually caused by a viral infection--can cause sudden cardiac death during exercise.
In a special report published in JAMA Cardiology, a group led by sports cardiologists at Massachusetts General Hospital (MGH) and Emory University School of Medicine offers guidance for athletes' return to play after they have recovered from COVID-19.
The article addresses the most common questions posed by the media, in clinics and athletic training rooms, and during discussions among cardiologists who care for athletes. With consideration of evolving data, it represents a reassessment of a previous consensus statement by the American College of Cardiology that was published in May.
Baggish and his colleagues have observed that athletes infected with COVID-19 who experienced no or mild symptoms did not exhibit signs of heart injury. For such athletes, they do not recommend detailed cardiac screening.
The prevalence of cardiac injury in athletes who were infected with COVID-19 is still unknown, however, and the team believes it's prudent to screen for heart damage in athletes with moderate to severe symptoms.
The experts also note that despite recent small studies showing that cardiac magnetic resonance imaging has detected potential cardiac abnormalities in individuals who have recovered from COVID-19, they feel that current evidence doesn't justify its use as a universal screening tool for athletes' return to play.
"We hope the recommendations put forth in the document will assist practitioners in sports medicine, sports cardiology and general cardiology in the evaluation of athletes for return to play after COVID-19 infection," said lead author Jonathan Kim, MD, MSc, chief of Cardiology Sports at Emory University School of Medicine.
"These recommendations are intended to guide the process of determining who requires more detailed cardiac screening and ensure that all athletes post-COVID-19 infection should have a slow and gradual return to training with close monitoring of persistent symptoms, regardless of the severity of the infection."