Cardiac Changes Related to COVID-19 in Athletes: A Brief Review

Abstract

Purpose of Review To describe the cardiac changes related to COVID-19 in athletes, in addition to presenting the current recommendations for cardiac assessment and return to sport after COVID-19 infection. Recent Findings The current state of the art suggests that myocarditis and pericarditis are the main cardiac pathologies related to the COVID-19 infection in athletes even after recovery. The criteria for determining and evaluating cardiac conditions are still discussed, as well as what stage of infection do cardiomyopathies occur. Return to sport should be aligned with cardiovascular risk stratification. Summary Cardiac changes related to COVID-19 infection have drawn the attention in the sports medicine field, while some questions about the course of the disease and its relationship with physical performance in athletes are still under investigation. In addition, feasible assessment techniques for cardiac assessments should be explored in the future.

Individuals with a previous symptomatic COVID-19 infection have altered heart rate and blood pressure variability during acute exercise

“…Along these same lines genetic test and echocardiography performed early in an athlete’s career can lead to improvements the management of genetic conditions such right ventricular arrhythmogenic cardiomyopathy ( Odak et al, 2022 ). Collectively, our data along with previous data demonstrating potential changes to athlete’s hearts who were COVID-19 positive ( de Abreu, 2022 ) suggests the need for improvements in the medical screening process for individuals prior to the initiation exercise or sport. Specifically, this study provides some evidence that previously symptomatic COVID-19 patients have an altered HR and BP response.…”

Return to play of young and adult professional athletes after COVID-19: A scoping review

“…Most studies refer to cardiac diseases, myocarditis, sudden cardiac death (SDC) and main diagnostic tests (particularly, cardiac magnetic resonance imaging - CMRI) for a safe RTP. 15 , 17 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 A further group of studies argues about the low incidence of COVID-19 effects related to cardiac injuries for competitive professional athletes. 15 , 50 , 56 , 57 Current protocols also capture other long-term symptoms such as palpitations, chest pain, breathlessness, as well as fatigue and brain fog.…”

“…59 , 61 Daems et al 52 also suggest imaging techniques such as position emission tomography-computed tomography (PET-CT) with fluorodeossiglucosio (F-FDG), when CMRI demonstrates persistent myocardial oedema with late gadolinium enhancement (LGE). Other scholars 17 , 50 , 51 , 53 , 54 point out to a thorough investigation of the myocarditis in terms of epidemiology, pathophysiology and clinical presentation of COVID-19. In terms of CMRI, multimodal imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of the infection.…”

“…Also, several symptom related classifications are found in the literature terms of ( Table 3 ): asymptomatic/pauci-symptomatic athletes and athletes with ‘mild’ diseases (anosmia, ageusia, headache, sore throat, fever, cough, malaise, mild upper respiratory tract illness, mild gastrointestinal illness); athletes with ‘moderate’ disease or athletes needing hospitalization (persistent fever, chills, myalgia, lethargy, dyspnoea, chest pain, chest tightness); athletes with ‘severe’ and/or ‘critical’ disease (respiratory failure, pneumonia, shock and multiorgan failure). 54 , 87 , 97 According to works considering extended versions of the symptom classification provided by the National Institute of Health (USA), main symptom clusters are as follows ( Table 3 ): Post-acute COVID syndrome (PACS) for persistent symptoms after 3 weeks; Chronic COVID after 12 weeks; Long COVID or Post-Acute Sequelae of SARS-CoV-2 (PASC); Postural tachycardia syndrome (POTS). 47 , 54 , 79 , 84 , 98 , 99 Other studies, instead, consider ‘above neck symptoms’ such as runny/blocked nose or a tickly throat, coughing, sneezing, a sore throat; and ‘below neck symptoms’ such as: high temperature, tight chest, persistent cough, nausea, vomiting, palpitations, malaise, diarrhoea, dyspnoea, muscle aches, joint pains, swollen lymph nodes 8 , 17 , 69 , 96 , 100 , 101 , 102 ( Table 3 ).…”

“… 54 , 87 , 97 According to works considering extended versions of the symptom classification provided by the National Institute of Health (USA), main symptom clusters are as follows ( Table 3 ): Post-acute COVID syndrome (PACS) for persistent symptoms after 3 weeks; Chronic COVID after 12 weeks; Long COVID or Post-Acute Sequelae of SARS-CoV-2 (PASC); Postural tachycardia syndrome (POTS). 47 , 54 , 79 , 84 , 98 , 99 Other studies, instead, consider ‘above neck symptoms’ such as runny/blocked nose or a tickly throat, coughing, sneezing, a sore throat; and ‘below neck symptoms’ such as: high temperature, tight chest, persistent cough, nausea, vomiting, palpitations, malaise, diarrhoea, dyspnoea, muscle aches, joint pains, swollen lymph nodes 8 , 17 , 69 , 96 , 100 , 101 , 102 ( Table 3 ). The study by Hull et al 83 takes into account a symptom-related classification based on: Upper respiratory (UR); Lower respiratory (LR); Cough only; Gastrointestinal (GI); and Non-specific symptoms including, for example, fatigue, headache, or myalgia.…”