Q&A: Athletes and Heart Complications from COVID-19

Even as professional and college sports make their return, researchers are learning more about the post-recovery impact of COVID-19 on the body. Of the virus’ many possible after-effects, damage to the heart is both an immediate and long-term concern for athletes at all levels.

Athletes have different requirements when it comes to diagnosing and treating heart problems, says Eli Friedman, M.D., medical director of sports cardiology at Miami Cardiac & Vascular Institute. The sub-specialty of sports cardiology has emerged to address the specific needs of not only pro and student athletes, but also weekend warriors and first responders.

“For those of us in the sports cardiology world, the last severalmonths have been all COVID all the time,” says Dr. Friedman. “This virus, forwhatever reason, seems to have an increased risk of causing cardiac effects, whether that’s blood clots,whether that’s arrhythmias, dangerous heart rhythms. Specifically, it relates to thiscondition called myocarditis (an inflammation of the heart muscle). When peoplehave inflammation or infection of the heart and they exercise at high levels,there’s pretty good data out there that suggests that it could lead to a riskof sudden cardiac arrest.”

On a recent episode of the Baptist HealthTalk podcast, Dr.Friedman joined host, Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certifiedlipid specialist at Miami Cardiac & VascularInstitute,  to discuss sportscardiology and the recommendations for athletes returning to training after COVID-19or other illnesses.

You can access the full Baptist HealthTalk episode, which also includes information about medications and nutritional supplements for athletes, on your computer or smartphone, or via Apple Podcasts and Google Podcasts.

Hereare selected questions and answers from their discussion.

Dr. Fialkow:
“There are a lot of specialties in medicine, cardiology being one, and many sub-specialties within cardiology. Where does sports cardiology sit in our cardiology armamentarium, and how did you first become interested in developing your leadership and knowledge in sports cardiology?”

Dr. Friedman:
“I think sports cardiology — let’s use a sports analogy — is sort of like the quarterback of cardiovascular care for an athlete…

“Now personally: my father was a cardiologist, I was born into this field, and I’ve been a lifelong athlete. So, as I matriculated through my medical career, I’ve merged these two fields together. And, fortunately, there’s been a wealth of data out there more recently that has supported the field. And obviously Baptist Heath supports it as well, which is why I’m here.”

Dr. Fialkow:
“Let’s speak about athletes who have true cardiac conditions. What makes them unique? What would make them specifically seek you out based on your knowledge?”

Dr. Friedman:
“When someone uses their body to exercise, whether it’s at high intensities or just meeting the guidelines of exercise, he or she might experience symptoms in a different way than someone who who’s not exercising as much will experience them. How we look into those symptoms, how we work them up, how we do our testing, how we treat them can oftentimes be different than somebody who isn’t exercising very much.

“So it really takes someone who understands what an athlete is, how he or she exercises, how those symptoms might manifest and then understanding what type of tests are going to be most beneficial in an athlete, and then understanding what types of medications that we should use, or maybe even we shouldn’t use in athletes, because medications can have a significant impact on the performance of an athlete as well.”

Dr. Fialkow:
“What approach are you taking when it comes to athletes who have had COVID-19?”

Dr. Friedman:
“We’re being very diligent. We’re being very careful in how we are triaging our athletes and their return to sport. Most of this is focusing on our higher-level athletes, so college, professional, Olympic level, but I think we still need to have the same care with our (amateur) athletes who have been infected by this and then want to get back into their sports. So, a slow resumption of activity, being mindful of any symptoms they had or are still having, and then triaging and dedicating our testing based on that.

“Now what we do for a professional team or an Olympic level athlete may be different than a weekend warrior, but I think that the important information is you need to listen to your body and you need to pay attention to it. If your body is telling you something, that’s not a day to go out and do high intensity interval training. Slow resumption of activity after COVID. And again, if you’re one of those higher-level athletes, we do have treatment algorithms that have been developed to help get the athlete back into sport.”

Dr. Fialkow:
“Do you have any general recommendations you would make to athletes if they are recovering from other medical illnesses? For example, if someone’s got a bad flu and they’re achy and feverish, should they go out and exercise to burn off the virus or should they rest and let the virus take its course?”

Dr. Friedman:
“It’s a phenomenal question. If you look at histories of people who’ve had unfortunate events during exercise, and when I say unfortunate events, I mean sudden cardiac arrest. If you go back and look, maybe some of them had a viral illness at the time or just leading up to the event that they had.

“I think we all need to be careful that when we don’t feel well, that we need to slowly resume activity. When you’ve got the flu, or even if you just have a cough or a cold, maybe that’s not the day to go do that high intense training. Maybe we should be a little bit mindful of going out and running a marathon. And I know that’s difficult for people who have trained and have spent all this time preparing for it, but my adage is always listen to your body. It’s when we don’t listen to our bodies that bad things can happen. Whether that’s a heart illness, whether that’s respiratory illness, whether even that’s a knee problem, if your body’s telling you something, in my world, you’re better off listening to it and getting help and then being reassured, versus pushing through and maybe having something bad happen.”

Dr. Fialkow:
“So, basically, a very athletic person whose body is at peak physical fitness is still not superhuman.”

Dr. Friedman:
“No. If you look at Olympic level athletes and very high level athletes, respiratory illness plays a significant role in decreased performance, and there’s data out there that supports that. But just coughs, colds, viral illnesses, or even pneumonias can significantly impact how an athlete then performs later on. COVID has made me wonder whether or not we should be taking these smaller viral illnesses more seriously and if we should have greater concerns. We don’t have good data to support the long-term effects of that, but definitely in the short term, it reinforces my need to make sure every athlete knows, those days when you don’t feel well, don’t push it. Listen to your body, stay hydrated, take care of yourself. There will be more days to exercise and push.”

Dr. Fialkow:
“Any final thoughts?”

Dr. Friedman:
“Despite our best efforts, despite trying to be able to get to every athlete out there, cardiac arrest will happen. And that’s what we care about, that’s what we’re trying to prevent by being accessible to our athletes. So, what I always encourage everybody to do is to learn CPR, learn how to use an AED (automated external defibrillator), be ready to respond if something really bad happens. We’re far more likely to do CPR and need an AED inside of our homes with our family.”