Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
Sports Health. 2021 Mar;13(2):145-148. doi: 10.1177/1941738120974747. Epub 2020 Nov 17.
Myocarditis is a known cause of death in athletes. As we consider clearance of athletes to participate in sports during the COVID-19 pandemic, we offer a brief review of the myocardial effects of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) through the lens of what is known about myocarditis and exercise. All athletes should be queried about any recent illness suspicious for COVID-19 prior to sports participation.
The PubMed database was evaluated through 2020, with the following keywords: , and . Selected articles identified through the primary search, along with position statements from around the world, and the relevant references from those articles, were reviewed for pertinent clinical information regarding the identification, evaluation, risk stratification, and management of myocarditis in patients, including athletes, with and without SARS-CoV-2.
Systematic review.
Level 3.
Since myocarditis can present with a variety of symptoms, and can be asymptomatic, the sports medicine physician needs to have a heightened awareness of athletes who may have had COVID-19 and be at risk for myocarditis and should have a low threshold to obtain further cardiovascular testing. Symptomatic athletes with SARS-CoV-2 may require cardiac evaluation including an electrocardiogram and possibly an echocardiogram. Athletes with cardiomyopathy may benefit from cardiac magnetic resonance imaging in the recovery phase and, rarely, endocardial biopsy.
Myocarditis is a known cause of sudden cardiac death in athletes. The currently reported rates of cardiac involvement of COVID-19 makes myocarditis a risk, and physicians who clear athletes for participation in sport as well as sideline personnel should be versed with the diagnosis, management, and clearance of athletes with suspected myocarditis. Given the potentially increased risk of arrhythmias, sideline personnel should practice their emergency action plans and be comfortable using an automated external defibrillator.
心肌炎是运动员死亡的已知原因。在考虑 COVID-19 大流行期间运动员参加运动的资格时，我们通过了解心肌炎和运动的知识简要回顾了 SARS-CoV-2（严重急性呼吸系统综合征冠状病毒 2）对心肌的影响。在参加运动之前，所有运动员都应询问任何最近疑似 COVID-19 的疾病。
通过 2020 年评估 PubMed 数据库，使用以下关键词： 、 和 。通过初步搜索确定的选定文章，以及来自世界各地的立场声明，以及这些文章的相关参考文献，均用于审查有关患有和未患有 SARS-CoV-2 的患者（包括运动员）心肌炎的识别、评估、风险分层和管理的相关临床信息。
系统评价。
3 级。
由于心肌炎可能表现出多种症状，并且可能无症状，因此运动医学医生需要对可能患有 COVID-19 并患有心肌炎风险的运动员保持高度警惕，并且应该有较低的门槛来进行进一步的心血管检查。患有 SARS-CoV-2 的有症状运动员可能需要进行心脏评估，包括心电图和可能的超声心动图。患有心肌病的运动员可能受益于心脏磁共振成像在恢复期，极少数情况下还需要心内膜活检。
心肌炎是运动员心源性猝死的已知原因。目前报告的 COVID-19 心脏受累率使心肌炎成为一种风险，为运动员参加运动进行资格审查的医生以及场外人员应熟悉疑似心肌炎的运动员的诊断、管理和资格审查。鉴于心律失常的潜在风险增加，场外人员应练习其应急行动计划，并能够使用自动体外除颤器。
