COVID-19: Asymptomatic infection could still damage the heart

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American researchers warn about cardiovascular risk in young people with mild or asymptomatic COVID-19 infection. Because even if they recover from the infection without worrying, the virus can still cause various types of inflammation in the heart.

This phenomenon is especially worrisome for students participating in sports competitions.

Among the attacks of COVID-19, there is the appearance of severe acute respiratory problems but those related to the cardiovascular system have also received special attention within the scientific community. A new study published by American cardiologists finds that even young people with asymptomatic COVID-19 are at risk of developing potentially dangerous inflammation in the heart. In their study published in JAMA Cardiology, they say they found signs of heart abnormalities in more than a third of the students who tested positive and underwent cardiac tests at West Virginia University.

"Although we did not detect ongoing damage to the heart muscle itself, we frequently found signs of inflammation and excess fluid in the pericardium, the sac around the heart. Almost all of the 54 students tested had mild COVID-19 or were asymptomatic," the researchers explain. Results that led them to officially recommend that student athletes (who regularly participate in sports competitions) who test positive for COVID-19 consult their physician quickly to determine if cardiac screening tests are necessary, even if they have never shown no symptoms.

Inflammation of the myocardium or pericardium.

In point: SARS-CoV-2 can trigger inflammatory responses in the heart muscle and surrounding tissues as the body tries to fight it. According to their estimates, up to 1 in 8 hospitalized patients with COVID-19 suffer some type of heart injury. What worries us the most when it comes to competitive athletes is whether the virus can enter the heart muscle and trigger myocarditis, the inflammation of the heart muscle (myocardium) most often caused by a viral infection. Myocarditis can interfere with the hearts ability to pump blood and cause arrhythmias.

According to the researchers, "it can also cause sudden heart failure in athletes who appear to be in good health." Several previous studies have reported that a small number of college athletes with COVID-19 have been diagnosed with myocarditis: In a September study, doctors at Ohio State University evaluated 26 college athletes and found signs of heart inflammation consistent with myocarditis. in one of every four cases. At West Virginia University, researchers this time examined 54 student athletes who had tested positive for COVID-19 three to five weeks earlier.

No physical activity before a heart exam

While the researchers found no convincing signs of myocarditis, they did find that some college athletes recovering from COVID-19 infection exhibited features of pericarditis, inflammation of the pericardium (the membrane that covers the heart) in the process of resolving. This was the case of 40% of the student athletes screened, but 58% of them presented pericardial effusion, that is, accumulation of fluid in the pericardium. This type of inflammation can heal in a few weeks with no residual effects, but in some cases there can be long-term effects, including recurrent pericardial inflammation.

As the researchers explain, "it can cause symptoms similar to heart failure and cause congestion in the lungs and liver." They insist on the importance of establishing a quarantine as soon as a student athlete tests positive, but also to determine on a case-by-case basis if cardiac screening tests are necessary, even for asymptomatic people. For athletes showing signs of myocarditis, they recommend not competing in sports or strenuous training for three to six months, having follow-up checkups with a cardiologist, and then gradually resuming exercise.

Finally, if an athlete has characteristics of pericarditis, physical activity is also not recommended, as it can exacerbate inflammation. Only after cardiac tests show no swelling or excess fluid will it be possible to resume training and competition. "COVID-19 is no joke. The best way for athletes to stay healthy so they can continue exercising is to avoid getting it in the first place. They should be tested and those who test positive should see a doctor to determine if tests are needed to detect heart damage, "the researchers conclude.

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