Potential COVID-related heart issues raise concerns for athletes across sports

Even if they recover in the short-term, there is a growing concern that athletes who have contracted COVID-19 might face potentially greater long-term health effects.

Recent studies have shown an alarming number of cases of myocarditis, or inflammation of the heart muscle, in people who previously tested positive for coronavirus but no longer have symptoms. The Journal of the American Medical Association recently published results from a study of 100 patients who had recovered from COVID-19. Heart imaging showed "cardiac involvement" in 78% of the patients and 60% "ongoing myocardial inflammation" among the participants.

NCAA Chief Medical Officer Dr. Brian Hainline said Thursday during a media briefing hosted by the Infectious Diseases Society of America that of the 1%-2% of athletes at NCAA institutions who have tested positive for COVID-19, at least a dozen have been later found to have myocarditis.

"We know that if you have active cardiac involvement from a virus, this virus seems to do it more often than any other virus we’ve ever seen," Matthew Martinez, consulting cardiologist for the NBA Players Association, recently told USA TODAY Sports.

Left undiagnosed and untreated, myocarditis can cause heart damage and sudden cardiac arrest, which can be fatal. As a result, medical experts have urged cardiac screening for athletes returning to play after contracting the virus.

One MLB player lost his entire 2020 season after being diagnosed with myocarditis.

Boston Red Sox pitcher Eduardo Rodriguez tested positive for coronavirus before the team began its summer workouts. 

“I’ve never been that sick in my life, and I don’t want to get that sick again," Rodriguez said. 

Left-hander Eduardo Rodriguez won 19 games for the Boston Red Sox in 2019 and was expected to lead their rotation this season until he developed complications related to COVID-19 that will keep him from pitching in 2020. (Photo: Dan Hamilton, USA TODAY Sports)

Doctors then found he had developed myocarditis during his recovery from COVID-19, and the Red Sox shut him down for the season. 

The NBA added cardiac screening to its list of requirements for players who test positive before they are able to return to action inside the league's bubble near Orlando, Florida.

“That extension now is with COVID-19 because initial reports said this had a high prevalence of involving hospitalized patients," Martinez said. "Those were sicker patients, and about 30% were reported to have cardiac involvement. That was what really tipped things off.”

Even NBA players who have not tested positive but have had symptoms associated with COVID-19 within the past three months must undergo a cardiac evaluation.

While athletes in top shape are believed to be able to combat the virus better than the average person, MLB and the NBA have resources and the medical expertise available to make sure their players receive the highest standard of care. That might not always be the case for amateur athletes. 

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Earlier this month, a freshman offensive lineman at Indiana University, Brady Feeney, had his mother describe his struggles with COVID-19 in an emotional post to Facebook.

“After 14 days of hell battling the horrible virus, his school did additional testing on all those that were positive,” Deborah Rucker wrote. “My son even received extra tests because he was one of the worst cases. Now we are dealing with possible heart issues! He is still experiencing additional symptoms and his blood work is indicating additional problems.

“Bottom line, even if your son’s schools do everything right to protect them, they CAN’T PROTECT THEM!!”

Last month, the NCAA issued COVID-19-related recommendations to schools that include daily self-help checks and testing within 72 hours of competition. However, the organization last revised its guidelines on cardiac testing in 2016, encouraging screening for athletes who are at risk for heart problems but not requiring them for participation. 

"There are things about this virus that we have not seen before with other viruses," said Dr. Jonathan Kim, the chief of sports cardiology at Emory University, during a media briefing. "I do think that just with some of these reports that have publicly noted that they've had myocarditis, it affirms the need that a conservative approach still remains an appropriate plan."

Among the major pro sports: 

► The NHL mirrors the NBA's heart-related measures in its Phase 4 (Return to Play) protocols. Players are required to undergo an ECG, echocardiogram and a high-sensitivity test for troponins, which can help flag possible heart problems. And all players must be cleared by a cardiologist, as well as a team physician, before they're allowed to return to game activity.

► The NFL also requires a cardiac screening for all players who have tested positive for COVID-19 and recovered or who have tested positive for COVID antibodies.

“I think they’re important," Allen Sills, the NFL's chief medical officer, told reporters Wednesday on a conference call, adding the league wants to have "ongoing conversations when players have tested positive about what those screening tests mean and what’s the best way to rule out any of those complications.”

► MLB lists an optional cardiac evaluation "at the discretion of the team physician" for players who have tested positive.

While athletes might have greater access to testing and treatment for the novel coronavirus — which has been responsible for more than 5 million COVID-19 cases and over 163,000 deaths in the United States, according to the Centers for Disease Control and Prevention — the potential long-term cardiac effects are cause for concern.

While there have only been a few documented cases of myocarditis in high-level athletes so far, doctors are concerned about the impact of resuming activity if there is any heart damage.

"We know that if you exercise when you have active inflammation or a cardiac injury that is a known cause of sudden death, we have to screen for this," Martinez said.

"Because this disease is so new, we are literally learning more about it every month."

Contributing: Aria Gerson, Michael Middlehurst-Schwartz, Dan Wolken, Jeff Zillgitt

Follow Gardner on Twitter @SteveAGardner.

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