New advice on young athletes’ post-COVID return to play

Tests for myocarditis should be done only if cardiac symptoms exist, says a sports-medicine specialist who co-wrote the guidance.

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Student athletes ages 14-25 who experience COVID-19 infections need not undergo diagnostic testing for myocarditis in the absence of cardiac symptoms, according to guidance published today by the American College of Cardiology (ACC).

Dr. Kimberly Harmon, section head of sports medicine at the University of Washington School of Medicine, was a member of the ACC subpanel that authored its “Return to Play” recommendations. It was part of an expert-consensus document advising care of heart issues stemming from COVID-19. 

“Large registry-based studies showed that the incidence of cardiac issues was not nearly as high as initially feared and that diagnostic testing should be based by symptoms,” Harmon said. “If people have chest pain during their infection or upon return to play, then they should have a diagnostic workup, but aside from that, they should have a gradual return to exercise.”

As COVID-19 emerged, early patient data indicated that many infections seemed to involve the heart. In 2020, some single-institution studies suggested that up to 50% of athletes might experience myocarditis, heart inflammation, as a result of a COVID-19 infection.

“This was part of why the Pac-12 and Big 12 (college athletic conferences) paused playing in August 2020. So we put together the ORCCA Registry to follow athletes throughout the country and see what happened to them after COVID infections. Our registry showed that 0.5% to 1% of athletes developed COVID-associated myocarditis – which is still something we need to pay attention to, but it is far less than 50%. And most of the athletes with myocarditis had cardiac symptoms,” Harmon said.

The new guidance should help primary-care providers and clinicians who conduct sports physicals, she added, because they’ve contended with evolving guidance for recovering patients over the course of the pandemic.

The return-to-play guidance was part of a bigger report detailing the ACC's recommended evaluation and care of people who experience cardiovascular effects of COVID-19.  See the ACC's related news release

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