As the COVID-19 pandemic evolves, so too does research into its effects on heart health. One particular area of interest for physicians involves whether COVID-19 leads to inflammation of the heart muscle, a condition known as myocarditis.
According to the Myocarditis Foundation, myocarditis most often affects young, healthy and athletic people. Those at highest risk are people from puberty through their early 30s. Myocarditis affects men twice as often as women. If left untreated, it can lead to heart failure. It's also a cause of sudden cardiac death.
As researchers monitored COVID-19 patients and looked for evidence of myocarditis, they found a significant number of people with severe COVID-19 cases who had heart trouble.
It usually took the form of the heart not working well and developing the clinical symptoms of heart failure, but doing so in the setting of severe, systemic illness."
Dr John Boehmer, Cardiologist, Penn State Heart and Vascular Institute
But what remained unclear is whether myocarditis and other heart failure-related symptoms were caused specifically by COVID-19 or other health conditions.
Early research appeared to indicate a direct link. A study conducted in Frankfurt, Germany, reported the results of cardiac magnetic resonance imaging (MRI) tests on a cohort of 100 patients recently recovered from COVID-19.
The results, published in July 2020, revealed ongoing heart inflammation in 60% of patients and cardiac involvement in 78% of patients. "But ongoing studies have failed to replicate those results," Boehmer said.
A smaller study, published in September 2020, examined cardiac MRI results from 26 college athletes at The Ohio State University who had COVID-19 symptoms. The results showed that 15% of those athletes appeared to have myocarditis.
These findings led many athletic programs-;including those associated with Big 10 Conference schools such as Penn State-;to enact aggressive screening programs for student athletes.
"So far, we're not finding myocarditis or significant heart involvement with cardiovascular disease in patients with limited symptoms," Boehmer said. "It doesn't seem that exercise and cardiovascular outcomes are correlated with the pandemic, which is a very reassuring observation."
A special communication written by a team of sports cardiologists and published in JAMA Cardiology in October 2020 supports Boehmer's observations. It states: "Our combined experience suggests that most athletes with COVID-19 are asymptomatic to mildly ill, and to date, return-to-play risk stratification has yielded few cases of relevant cardiac pathology."
While more research is needed to fully determine a connection between myocarditis and COVID-19, anyone involved in any type of athletic activity should take precautions before returning to work or play.
The JAMA Cardiology communication recommends athletes slowly increase their activity after recovering from asymptomatic or mild cases of COVID-19.
People with moderate-to-severe COVID-19 should convalesce for two weeks after symptoms clear, and then should slowly resume physical activity under the guidance of their health care provider and athletic training team.
Although Boehmer hasn't seen an increase in myocarditis or related symptoms in COVID-19 patients locally during the pandemic, he has seen one troubling trend. "There's an excess of heart and vascular death due to people putting off regular medical care because they're afraid to come to the hospital," he said.
People should watch for the signs of emergency heart problems-;chest pain, jaw or neck pain, discomfort in the arms and shoulders, shortness of breath-;and call 911 if they suspect a heart attack.
"We've taken all precautions to keep patients safe at Penn State Health Milton S. Hershey Medical Center," Boehmer said. "Following up with a doctor and getting all the testing you need for any heart condition are the best things you can do for your heart."
Puntmann, V. O., et al. (2020) Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. doi.org/10.1001/jamacardio.2020.3557.