Myocarditis Concerns Grow For Athletes Amid Coronavirus Pandemic

GLENVIEW, IL — Earlier this month, Keyontae Johnson collapsed on the court during a college basketball game. The University of Florida player, who had suffered from the coronavirus during the summer, was diagnosed following the collapse with acute myocarditis, an inflammation of the heart muscle which can undermine the heart's ability to pump.

As myocarditis has been linked to the coronavirus, athletes are concerned about their health, especially during high-energy cardiovascular activity. Dr. Jason Robin, a cardiologist with NorthShore Medical Group, is hearing the fears of athletes and parents alike in his role as a consultant for the Illinois High School Association. The IHSA is set to begin play for low risk winter sports this week.

"I tell parents that myocarditis after a viral infection is not something new," said Robin, a resident of Deerfield. "We have recognized this in athletes for years. Although this is a common cause of sudden cardiac arrest in athletes, the overall incidence is fortunately very low."

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Robin was asked by Craig Anderson, executive director of the IHSA, to serve as the cardiology consultant for the sports medicine advisory committee. Robin has met with Anderson and others to review the various new guidelines created by Gov. J.B. Pritzker and the Illinois Department of Public Health in response to the coronavirus.

Tier 3 resurgence mitigations instituted in November led to an immediate pause of the winter high school sports season in Illinois as it was set to begin.

"The new guidelines provide less restrictions for athletes after they test positive for COVID-19. Basically, if an athlete test positive for COVID-19, he/she should quarantine for approximately 10 days," Robin said. "Assuming the athlete was asymptomatic or had mild symptoms, there should be no further cardiac testing required because the incidence of clinically relevant myocarditis is very low."

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He added that if an athlete has moderate symptoms such as persistent fevers or significant muscle aches or any cardio pulmonary symptoms, they should have a cardiac evaluation prior to participating which would include an echocardiogram and a troponin, or blood test (a marker of a cardiac injury. Robin notes this is in contrast to the guidelines put forth by certain collegiate conferences such as the Big Ten, which required a cardiac MRI after a positive COVID-19 test before an athlete could return to play

"Based on the data to this point, It appears that the likelihood of clinically relevant myocarditis after an asymptomatic bout of COVID-19, or a bout of COVID-19 with mild symptoms, is extremely low," Robin said. "I also say that we are still kind of building the ship as we are sailing and learning more and more info every week."

In rare cases according to Robin, some kids can develop a cytokines storm weeks after they recover from COVID-19, and this can present as myocarditis.

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"Therefore it is important for parents and coaches to continue to monitor kids after they return to play after a COVID-19 illness," Robin said. "I also say that the first week after return to play there should be a dial up where they take about five to seven days to get back to 100 percent participation. As a former athlete I want to see these kids back on the field or court as quickly as possible."

Robin is the director of cardio oncology at NorthShore Medical Group. He is also the principal investigator for a clinical trial looking at myocarditis from immunotherapy. Robin says this form of myocarditis is very similar to what the medical field sees with COVID-19. The hospital uses sophisticated technology with echo software to potentially diagnose myocarditis at its earliest stages.

As a father of three children, Robin said he wants to make scheduling for cardiac consultation "as seamless as possible" for the parents. For parents having a difficult time getting an appointment or just wanting to know if their child needs to see a cardiologist at all, they can reach Robin at Jrobin2@northshore.org.