Terry Kristin J, Narducci Dusty, Moran Byron, Chang Patrick, Orlando David, Bindas Bradford, Botto Elizabeth, Retzloff Austin, Esan Daniel, Coris Eric
Department of Family Medicine, USF Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL, 33620, USA.
Department of Orthopedics and Sports Medicine, USF Morsani College of Medicine, Tampa, FL, USA.
Sports Med. 2024 Mar;54(3):607-621. doi: 10.1007/s40279-023-01969-z. Epub 2023 Dec 11.
Amidst the SARS-CoV-2 pandemic, myocarditis in athletes has demanded increased attention primarily because of the risk of sudden cardiac death. While most athletes who experience myocardial inflammation recover, extensive measures for screening and diagnosis are taken because of the possibility of cardiac necrosis, fibrosis, and remodeling. Several risk factors have been identified that may contribute to the development of this inflammatory response, predominantly a history of viral or bacterial upper-respiratory infections. Recent research suggests new risks specific to athletes remain in question, such as the intensity and longevity of sustained exercise, vaccination status, and genetic and epidemiologic factors. Electrocardiography, echocardiography, and cardiac magnetic resonance imaging are commonly utilized for the diagnosis of myocarditis; however, reference standards are lacking because of the variety of clinical presentations. In this article, we discuss the epidemiology, pathophysiology, and presentation of myocarditis in athletes. We then review the available literature to provide a deeper insight into the diagnostic testing methods available, with the aim of outlining the efficacy and prognostic value. Next, we discuss an algorithmic approach to patient care and treatment based upon hemodynamic stability, symptoms, and findings on testing. Finally, this article reviews the current return to play guidelines and the rationale for revisions to return-to-play protocols.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间，运动员心肌炎主要因其导致心源性猝死的风险而受到越来越多的关注。虽然大多数经历心肌炎症的运动员会康复，但由于存在心脏坏死、纤维化和重塑的可能性，仍采取了广泛的筛查和诊断措施。已确定了几个可能导致这种炎症反应的风险因素，主要是病毒或细菌上呼吸道感染史。最近的研究表明，运动员特有的新风险，如持续运动的强度和时长、疫苗接种状况以及遗传和流行病学因素，仍存在疑问。心电图、超声心动图和心脏磁共振成像常用于心肌炎的诊断；然而，由于临床表现多样，缺乏参考标准。在本文中，我们讨论了运动员心肌炎的流行病学、病理生理学和临床表现。然后，我们回顾现有文献，以更深入地了解可用的诊断测试方法，目的是概述其有效性和预后价值。接下来，我们讨论基于血流动力学稳定性、症状和检查结果的患者护理和治疗的算法方法。最后，本文回顾了当前的重返比赛指南以及对重返比赛协议进行修订的理由。
