Focal Myocarditis after Mild COVID-19 Infection in Athletes

Ivana P Nedeljkovic,Olga Nedeljkovic-Arsenovic,Nenad Dikic,Milan Dobric,Marina Ostojic,Ruzica Maksimovic,Vojislav Giga,Ivan Nikolic,Branko Beleslin,Tamara Stojmenovic,Nebojsa Mujovic,Ana Djordjevic-Dikic

doi:10.3390/diagnostics11081519

Ivana P Nedeljkovic, Olga Nedeljkovic-Arsenovic + Show 10 more

Open Access

https://doi.org/10.3390/diagnostics11081519

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Abstract

COVID-19 infection in athletes usually has a milder course, but in the case of complications, myocarditis and even sudden cardiac death may occur. We examined an athlete who felt symptoms upon returning to training after asymptomatic COVID-19 infection. Physical, laboratory, and echocardiography findings were normal. The cardiopulmonary exercise test was interrupted at submaximal effort due to severe dyspnea in the presence of reduced functional capacity in comparison to previous tests. Cardiac magnetic resonance (CMR) detected the focal myocarditis. After three months of recovery, CMR still revealed the presence of focal myocarditis and the persistence of decreased functional capacity. This case raises the question of screening athletes even after asymptomatic forms of COVID-19 infection.

Highlights

Competitive sports, including training and matches, create favorable conditions for the spread of SARS-CoV-2 virus, which causes COVID-19 infection [1]
Hospitalization for acute COVID-19 infection is uncommon in athletes, it may result in myocarditis, even in the absence of symptoms with the rate of 2 to 3% [1,2,3]
We present the case of an athlete who experienced symptoms after return to play (RTP)

Summary

Introduction

Competitive sports, including training and matches, create favorable conditions for the spread of SARS-CoV-2 virus, which causes COVID-19 infection [1]. Recent recommendations for the evaluation of athletes who test positive for COVID-19 prior to return to play (RTP) were based on the presence of symptoms, electrocardiography (ECG), cardiac biomarkers, and echocardiography or cardiac magnetic resonance (CMR) imaging for advanced assessment [2,3]. COVID-19 infection in athletes usually has a milder course, in the case of complications, myocarditis and even sudden cardiac death may occur, as with myocarditis of other causes [4].

Results

Conclusion