Cardiologists Raise Awareness of Heart-Related Side Effects
The novel coronavirus and its resultant disease, COVID-19, is raising concerns among sports medicine providers about the possible impact of the disease on student athletes’ hearts. Because of those concerns, sports medicine and cardiology experts from Harvard University and the University of Washington have joined with the American Medical Society for Sports Medicine and the American Heart Association to create a registry of NCAA student athletes who had COVID-19.
What We Stand to Learn
Data from the registry will give health-care professionals more information about COVID-19’s effect on the heart. More than 60 NCAA schools throughout the country are participating.
“COVID-19 is primarily a pulmonary disease, but we know it also can be a multi-organ, systemic disease,” said Dong Bo Yu, MD, PhD, a cardiovascular disease specialist with ThedaCare Cardiovascular Care in Appleton, and director of its non-invasive cardiac imaging program. “As cardiologists, we see its effect on heart function from time to time. Fortunately, the incidence among student athletes, who typically are very young and healthy, is relatively low. This registry will no doubt provide valuable information.”
Dr. Yu said it is important to note that COVID-19 is a novel disease, and more is being learned about it every day.
A Wide-Ranging Impact
“Despite the low likelihood of complications in student athletes, there are people even in this younger cohort who may come down with quite serious illness and some may require hospitalization,” he said. “No two patients who become infected with COVID-19 are affected the same; there is a wide range of manifestations.”
Still, Dr. Yu projected most student athletes would have relatively milder courses of the virus compared with older people who have co-morbidities.
“The athletes may be asymptomatic or symptomatic for fewer days and typically recover quickly,” he explained. “Most will have a complete recovery and should usually be able to get back to their daily routines and athletic life relatively quickly.”
Allowing Adequate Time to Recover
Some patients might feel okay during their infection, but end up having a more prolonged course of recovery.
“Especially if the affected athletes compete at a high level,” said Dr. Yu. “They may feel they are unable to train or compete at the same level for a while.”
He suggested that taking a couple of weeks to return to a full training routine would be appropriate for most patients recovering from COVID-19, the flu or other respiratory viral illnesses.
“It’s just common sense to take it easy after any kind of acute viral illness,” he noted. “It takes some time for the body to recover. For those athletes who usually train at a very high level, taking some time to slowly reintroduce their body to their workout routine and slowly ramp up their training would be a very reasonable approach.”
Potentially Serious Side Effects
For a small subset of student athletes, there is a risk of severe disease during the acute phase of the infection and prolonged residual effects, and that risk is present for everyone, even this very healthy group of individuals.
When COVID-19 affects the heart, the two most common presentations are acute inflammation of the heart, called myocarditis, and a predisposition to the formation of blood clots. Dr. Yu added that blood clots, if they form in the lung, could adversely affect the ability of the lungs to oxygenate one’s blood, which, in turn, can cause significant strain on parts of the heart. Additionally, pneumonia itself or the associated systemic stress could lead to temporary dysfunction of the heart. An infection with COVID-19 also could trigger other acute cardiac events such as heart attacks, which typically affect older patients with existing risk factors such as high blood pressure, high cholesterol and cigarette smoking.
“Students and parents should be aware that COVID-19 can affect multiple organs, but if the heart is involved, it is typically in the setting of severe respiratory symptoms,” he said. “If there is a significant degree of inflammation, especially to the point where it’s affecting heart function, we expect to see signs of heart failure. Those symptoms would be dramatic; the person might not be able to walk 20 feet without finding it hard to breathe. They may notice swelling in their lower extremities, especially their ankles, and they may wake up at night gasping for air. Additionally, dangerous arrhythmias can occasionally develop leading to unexplained syncope. Those are some of the alarming signs that suggest the heart is in trouble.”
Dr. Yu went on to say that it is rare but theoretically possible to see isolated effects on the heart in the absence of pulmonary dysfunction. If someone has any of those symptoms, they should consider seeking prompt medical care.
“Myocarditis that is severe enough to lead to heart failure occurs in a very small minority of all COVID-19 patients and in an even smaller minority of student athletes,” he said. “People shouldn’t think that just because they had COVID-19, they are at a high likelihood for having a serious complication of the heart; statistically that is an unlikely event. Most people know their body well; if something doesn’t feel right, even in the absence of severe symptoms, they should seek medical care, particularly if they feel they are not improving within a reasonable timeframe.”
Stopping the Spread
Lastly, COVID-19 patients returning to training should be aware they could still be recovering and all CDC recommended social measures to contain COVID spread still apply.
“Even though doctors say that after two weeks of recovery COVID-19 patients can resume most daily activities, there is always the theoretical risk of prolonged viral shedding and infectivity,” he explained. “From the viewpoint of communal responsibility, maintaining social distancing, especially if one is relatively fresh off recovery, would be advised. Wearing a mask while training may not be possible, but social distancing would be very appropriate. Just because you’re no longer sick doesn’t mean you can’t still pass the virus on and make other people very sick. It’s important to follow the guidelines of athletic organizations and local health departments to protect teammates, family, friends and co-workers and stop the spread of the virus.”
If you’re experiencing heart or respiratory distress, whether the result of COVID-19 or otherwise, visit GetThedaCareNow.org to schedule an appointment. If this is an emergency, dial 9-1-1.