Teenagers who had moderate COVID-19 may need heart check before returning to sports

As high school football players across South Carolina return to their playing fields this week, a cardiologist at MUSC Children’s Health is encouraging teenage athletes in any sport who had moderate COVID-19 to consider getting a heart evaluation.

COVID-19 can cause myocarditis, which is an inflammation of the heart muscle. It’s part of the body’s immune response to the illness caused by the coronavirus. It’s considered a rare complication, but myocarditis has already shown up in some college football players who had COVID-19.

 

Lanier Jackson, M.D., is part of a team of pediatric cardiologists who wrote about myocarditis and COVID-19 in the journal of the American College of Cardiology. They noted that while there has been plenty of discussion about heart trouble in adults who had COVID-19, that wasn’t the case when it came to kids. The pediatric cardiologists are especially concerned about children 13 and up because teenagers’ sports can get so physically intense.

“We’re trying to err on the side of being cautious but allowing kids to get back to physical activity,” Jackson said. “From our basic understanding of it, most kids should tolerate having COVID well without any long-term repercussions or manifestations from the disease process. But the potential for myocarditis needs to be brought to light.”

That’s because while myocarditis goes unnoticed in some people, in others, it can be dangerous and even deadly. The Myocarditis Foundation reports that in young adults, up to 20% of sudden death cases are due to myocarditis.

“We want to identify anybody at risk of having some kind of adverse event happen,” Jackson said.

He defined moderate COVID-19 as being bad enough to keep a person in bed for days with a prolonged fever but not bad enough to send that person to the hospital. “If they had a moderate COVID infection in the past, they need an electrocardiogram to help identify that.”

An electrocardiogram, also known as an ECG or EKG, measures electrical activity in the heart. It’s not painful or risky. Jackson said it should be covered by insurance.

Kids who had milder infections need to be monitored, too. “If your kid doesn’t feel well, that should be a trigger to at least go to your primary care doctor. Say they had COVID-19 a month ago and they’ve been cleared to go back to activity, and then something like their energy level doesn’t seem right, they complain of their heart feeling funny or chest pain or shortness of breath, those should all be triggers to be reevaluated in the medical system,” Jackson said.

He’s calling on schools and clubs to make sure stadiums and other playing fields have the right equipment on hand, just in case. “We need defibrillators at all sporting events. They’re a lifesaving measure if somebody were to have myocarditis and participated in sports and had sudden cardiac arrest."