GUEST: Dr. Aaron Baggish, Director, Cardiovascular Performance Program at Massachusetts General, Boston, MA, USA
On Thursday, April 15th, 2021 we hosted our second event in our Return to sport in pandemic times series. Prof. Aaron Baggish, USA, joined ShePower Sport. There is a lot of uncertainty about what the heart injury caused by the coronavirus means for athletes who want to return to sport. In his presentation, Dr. Baggish explained: “We have learned over the last year that not all Coronavirus disease 2019 (Covid19) is created equal”.
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Watch Our Discussion on the Heart of the Matter here
We know that the coronavirus may cause injury to the heart. This includes a condition called myocarditis—an inflammation of your heart muscle. Inevitably, this has caused concern in the sports community because myocarditis can cause sudden cardiac death during exercise. News of myocarditis allegedly caused by Covid19 in high-profile athletes have magnified these concerns.
In this webinar, Prof. Aaron Baggish from Harvard Medical School, an internationally renowned sports cardiologist and founder and Director of the Cardiovascular Performance Program at Massachusetts General in Boston, explains with exceptional clarity what we know and with great honesty what we don’t know about how the coronavirus affects athletes hearts. He also details the recommendations of the American College of Cardiology for athletes’ return to sport.
Key Learnings from the discussion
How does Covid19 affect athletes?
- The vast majority of athletes have either no or only mild symptoms of Covid19.
- At present, we do not know what heart injury caused by the coronavirus looks like in athletes.
- So far, athletes with Covid19 who experienced no or only mild symptoms have not shown signs of heart injury.
- Long Covid with its wide spectrum of symptoms emerges as a problem with many unknowns.
How to screen athletes who return to sport?
- This entirely depends on the severity of Covid19 in the individual athlete.
- No or only mild symptoms: No specific screening is required for these athletes.
- Moderate to severe symptoms: Screening is mandatory before return to sport. It should begin with an electrocardiogram (ECG) and heart ultrasound or a specific blood test. This test is called high-sensitivity cardiac troponin and detects heart muscle injury. If these tests have abnormal results, magnetic resonance imaging (MRI) of the heart may be considered.
Return to sport
- All athletes who have had Covid19 should return slowly and gradually to training and carefully watch their symptoms, regardless of the severity of their Covid19.
- The recommended period for complete abstinence from exercise is ten days. This counts from the date of a positive test in athletes with no symptoms or from the date when symptoms started in athletes with mild symptoms. This recommendation applies to any level of competition.
- In athletes who had moderate or severe Covid19, a staged return needs to be carefully planned and monitored by the treating physician and depends on the examination results.
- Return to sport is a shared decision between the physician, athletes, and further stakeholders.
Myocarditis
- Myocarditis may be caused by a viral infection.
- It is a common cause of sudden cardiac death in athletes.
- It may be present in athletes with persistent symptoms after Covid19.
- Symptoms include chest pain, inability to exercise, heart rhythm disturbances, and abnormal findings in different examinations.
- An ECG alone cannot diagnose myocarditis.
Emergency planning remains critical
There is still a lot to learn about Covid19 and athletes’ hearts. However, we must not forget the basics of preventing sudden cardiac death on any field of play all around the world. Emergency plans must ensure a timely response to any athlete who has collapsed. This ideally includes the immediate availability of an automated external defibrillator.
Questions and Answers
Do we know if there are greater risks or specific things to think about by the type of sport?
What are red flags that athletes should watch out for when training and competing?
Any symptoms related to their heart, such as a racing pulse, extra beats, pain, shortness of breath, fatigue, or unusual exhaustion after small efforts should be investigated.
In long Covid, similar symptoms to those seen with a condition known as postural (orthostatic) tachycardia syndrome may occur. What is this and are athletes at risk?
This is also called POTS and describes racing of your heart and dizziness when moving from sitting or lying to an upright position. The most effective treatment of POTS is sufficient fluid intake.
Resources
This is the statement by the American College of Cardiology in October 2020 that is reflected in Dr. Baggish’s recommendations in this talk. The language is aimed at physicians.
Athletes and Covid19: Q&A with Sports Cardiologist Meagan Wasfy, MD, from General Massachusetts Hospital
About Doctor Aaron Baggish
Dr. Aaron L. Baggish is the founder and Director of the Cardiovascular Performance Program at Massachusetts General in Boston, MA, USA, the United States’ first program designed to provide comprehensive cardiovascular care to athletes.
Dr. Baggish is an Associate Professor of Medicine at Harvard Medical School and serves as medical director for the BAA Boston Marathon and cardiologist/team physician for US Soccer, US Rowing, the US Olympic Training Centers, the New England Patriots, the Boston Bruins, the New England Revolution, and numerous colleges and universities.
He has published widely on issues such as the prevention of sudden cardiac death, changes in the heart with exercise, and pre-participation screening of athletes.
