Post-COVID heart concerns in young athletes: When is more testing and rest needed?

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CHICAGO (WGN) – Doctors are seeing heart problems in older COVID-19 patients hospitalized with the virus. But what about young athletes?

When a University of Florida basketball player collapsed months after a reported COVID-19 infection, the case reignited concerns among parents and fellow athletes.

Sarah Barbosa was a three-sport athlete in high school, and she kept up her rigorous exercise routine in college. 

“My entire life since I could walk, I’ve been super active,” she said. “I was going to cardio hip hop classes. I would be working out most days of the week running the treadmill, running outside, I was doing the machines.”

But in early November, she came down with COVID-19.

“I woke up with a 102 fever and this crazy pressure in my head and throughout my neck and back,” she said. “I had my fever for four days straight, I couldn’t break it. I had the cough, the runny nose.” 

When she returned home weeks later for the holidays, her mother Kathy Barbosa, said there were signs the fit 18-year-old was still struggling. 

“She was bringing up her laundry basket, maybe five, six stairs and her heart was racing,” she said. “She was out of breath and winded from bringing a laundry basket up. … So for me that’s when it became a little more concerning.”

The Barbosas aren’t alone. NorthShore University HealthSystem cardiologist Dr Jason Robin said that he and his colleagues saw 75 to 100 high school and college athletes during winter break for concerns about post-COVID myocarditis – inflammation of the heart muscle.

“We’ve certainly seen an uptick in calls since the University of Florida basketball player collapsed,” he said.

He said the risk for myocarditis does appear to be linked to severity of infection. 

“For the most part, what we’ve seen to this point is asymptomatic and mildly symptomatic young people do very, very well, and there is really no concern for clinically relevant myocarditis,” he said. 

But for those who had more than mild symptoms Robin said some more evaluation could be needed.

“When you are talking about athletes who have had any sort of cardiac or pulmonary symptoms – chest pains, shortness of breath or they’ve had persistent fevers or significant muscle aches, that is the group that should be evaluated before they return to sports,” he said.

The recommended heart tests are an electrocardiogram, also known as an EKG, to look at electrical activity; a troponin blood test (a marker of inflammation), and an echocardiogram or ultrasound. If there is evidence of myocarditis, Robin recommends more rest.

“We recommend that the athlete does not participate in any strenuous activity for typically six months,” he said. 

“I didn’t want her to be one of those kids who just all of a sudden something happened to,” Kathy Barbosa said.

“When there is inflammation of the left ventricle, that is when we are concerned there could be arrhythmias of the heart, really fast heart rates, really slow heart rates or the heart could dilate and become abnormal over time,” Robin said. 

Sarah Barbosa’s heart looked healthy. Still, doctors dug deeper looking for damage at the cellular level.

“If we see abnormalities, that points us in the direction that there could be early myocarditis and the need for further testing,” Robin said.

For now, she is all clear.

“It does make me feel at ease,” Sarah Barbosa said. “Obviously it was super concerning because I had never had any problems before.” 

“He said if two to three months down the road we’re still having some questions or issues then come back,” Kathy Barbosa said. “But right now he gave her from his standpoint a clean bill of health, it’s just a waiting game now.” 

“We should still continue to watch them because this is still a new virus and we still don’t know how they might look two or three weeks after they recover,” Robin said. “So we shouldn’t completely close the door on a heart issue.” 

Robin said the majority of patients who develop viral myocarditis go on to make a full recovery  but about 25 percent can have long-term cardiac malfunction. Early diagnosis and the proper medications are key.

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