Doctors look to college athletes to understand the effects of COVID on the heart

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Doctors learned early in the pandemic that COVID-19 was more than a respiratory disease. It attacked the organs of the body, including the heart, even in healthy young athletes.

Enough Athletes With COVID Knew heart inflammationcalled myocarditis, which doctors at the University of Maryland and other schools in the Big Ten didn’t want to take any chances.

Myocarditis was already considered one of the leading causes of sudden death in elite athletes, so conference doctors immediately imposed official protocols that barred some players from playing for six months. Some grumbled, but everyone recovered.

“They could be ticking time bombs and we would only find out in retrospect,” said Dr Yvette Rooks, who oversees the care of more than 530 athletes from 19 teams as the team’s chief medical officer at the University. of Maryland, College Park. “Some had symptoms and many didn’t. It could really save lives.”

Doctors also began taking a closer look at the chests of every student-athlete who tested positive for COVID-19 from the early months of the pandemic, eventually examining some 1,600 cases.

As they learned more about the risks, doctors reduced intensive testing and reduced downtime. But a registry created from athletes’ health data is now poised to help doctors better understand the longer-term cardiovascular effects of COVID-19.

Doctors and researchers at the University of Maryland and other Big Ten schools plan to follow athletes even after graduation to better understand the impact of COVID-19 on the heart, Rooks said, also clinical assistant professor of family and Community medicine at the university’s medical school and a co-investigator on the registry.

The registry contains specific results from several tests, including MRIs, which are not usually done on people who test positive for COVID-19. The detailed images revealed 37 cases of myocarditis, although only eight of those athletes showed cardiovascular symptoms.

Lacrosse player Jack Brennan was one of the asymptomatic cases. While at home in Rochester, New York, in December 2020, he took a COVID-19 test so he could visit his grandparents and was surprised that he came back positive. He was even more surprised when he returned to College Park in January 2021 and an MRI revealed swelling around his heart.

He was frustrated not to participate in the spring 2021 season, but over time and learning the seriousness of the disease, he became more understanding.

He was cleared in the fall of 2021 to return to play, and now 21, he is eligible to compete as an intercollegiate athlete for two more years, instead of one. (The Big Ten gave athletes who missed a season under the more extended timeouts an extra year of eligibility.)

“I didn’t know what to think or what it was at first. All I heard was, ‘You’re not allowed to play’, and I gave them a hard time, because I couldn’t wait,” Brennan said. “But I’m no expert. You have to listen to the doctors.”

And he’s glad they’re using his records to keep looking at the long-term effects.

“If they can understand the process you go through, understand how myocarditis affects athletes, that would be helpful,” Brennan said. “No one really knows the long-term effects yet.”

Among the things researchers want to know is whether the damage or scarring will cause problems and when and what is the cardiovascular link to the so-called long COVID, where symptoms persist long after an infection. Another lingering question is whether those who had asymptomatic cases, like Brennan, should be concerned.

Early indications show that mild cases without symptoms won’t be a problem, said Dr. Matthew Martinez, former chair of the American College of Cardiology’s Sports and Exercise Cardiology Section. He is not involved in the Big Ten register.

Martinez studied data from a subsequent larger registry of athletes who found up to 15% myocarditis developed after COVID-19 infections, but there were no cases of sudden cardiac death.

The study concluded that the intensive testing at all levels performed by the Big Ten, particularly the use of MRIs, was only necessary when athletes had cardiac symptoms or other cardiac tests were abnormal.

Additionally, Martinez said, returning recovered athletes to play faster was safe in most cases.

Martinez, however, said the abundance of precautions taken for all athletes was not a bad idea when no one knew what to expect from the new virus.

“That’s really important to know,” said Martinez, also medical director of the Atlantic Health System Sports Cardiology at Morristown Medical Center in New Jersey. “We all learn this on the fly. There is a certain relief through the athlete community.”

Going forward, Martinez said, sports programs should have a plan for athletes who develop heart problems on the field, including increased access to defibrillators in all playing arenas.

He said heart tests, even an MRI, are needed when athletes have symptoms such as pressure in the chest, rapid heart rate or shortness of breath, or if they later develop these symptoms.

He also said there should be a study of the protections of vaccines against myocarditis, which appears to be significant, as well as the risk of the vaccines themselves, which appears to be minimal. None of the Big Ten athletes developed the disease after vaccinations.

Martinez hopes there will be “a continued focus on athlete health and safety, including cardiovascular health.”

The Big Ten researchers say studies are underway using the registry data and more are planned.

Dr. Geoffrey Rosenthal is Professor of Pediatrics at the University of Maryland School of Medicine and Chief of Pediatric Cardiology at the University of Maryland Medical Center. He is the coordinator of six “base laboratories” which make up the register. This is where specific test data is housed so that it is interpreted in a uniform manner. The Epidemiology and Cardiac MRI labs are housed at the Maryland School of Medicine, while the Global Registry is based at The Ohio State University.

Rosenthal said answers to doctors’ questions will come in time. But he already had immediate advice for the general population.

“One of the biggest takeaways for athletes and the general population is that the best way to protect your heart is to get your shots and get a boost when the time is right,” he said. “The second public health message for people who have or have had COVID: if they have heart palpitations or chest pain, they should see a doctor.”

The researchers were also pleased to have an MRI database identifying all cases of myocarditis, even asymptomatic cases. This provides a unique opportunity for researchers, said Dr. Jean Jeudy, professor of diagnostic radiology and nuclear medicine at the Maryland School of Medicine. He runs the central cardiac MRI lab for the registry.

“It will be important for us to follow these student-athletes over time to determine if mild myocarditis has a permanent impact on their heart health,” he said, “and how the findings may apply to the future. general population that tends to be older and sicker than these athletes.”

COVID-19 linked to heart inflammation in college athletes

2022 The Baltimore Sun.
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Quote: Doctors look to college athletes to understand the effects of COVID on the heart (2022, June 28) Retrieved June 28, 2022 from covid-effects.html

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