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SPORTS MEDICINE: COVID causes cardiac concerns
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SPORTS MEDICINE

SPORTS MEDICINE: COVID causes cardiac concerns

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On May 6, The Indiana High School Athletic Association offered a glimmer of hope that there will be a fall sports season.

“Provided there are no adjustments to Governor Eric Holcomb’s announced plans to reopen the State of Indiana, school sponsored summer activities may resume on July 1, 2020,” a IHSAA press release said. Furthermore, the governing body for Indiana interscholastic sports announced that it was waiving its rule that prohibits contact between coaches and athletes during the week of July 4.

No such announcements have been forthcoming yet from the Illinois High School Association.

Nor was the IHSAA statement a full release to engage suddenly in any and all activities. Expect further information from association leadership that is based on guidance received in coming weeks from Gov. Holcomb’s office.

Meanwhile, coaches anxious to make up for lost time would be wise to curb their enthusiasm and, regardless of whatever Holcomb and IHSAA allow, plan for a very gradual ramp up over weeks, not days. To do otherwise will invite an epidemic of sprains, strains, and stress fractures.

While coaches and players typically start preparing for fall seasons at this time of year, so do parents by scheduling appointments for pre-participation physical examinations. However, they may not need to do so.

An email to high school administrators dated April 22 from Commissioner Bobby Cox announced, “Due to the COVID-19 pandemic during the 2019-20 school year and the continued stress on the medical community, the IHSAA will waive the provisions of Rule 3-10 for the 2020-21 school year. Effective immediately, valid physical and consent forms presented to member schools on behalf of eligible students during the 2019-20 school year shall be valid during the upcoming 2020-21 school year.”

Those who did not play high school sports in the 2019-20 school year and those transferring from an out-of-state school will still be required to undergo a physical exam that is documented on the appropriate IHSAA form.

Parents whose children are eligible for the waiver may be inclined to celebrate the resultant savings in time and money. Perhaps, though, they should hit the pause button

In fact, based on a blog posted online by the British Journal of Sports Medicine on April 24, parents should at the very least consult with their child’s physician by phone before restarting athletics.

Co-authored by sports cardiologists from major medical centers across the country, the document combined optimism with wariness. “As rates of new infection begin to plateau and even decline in some countries, there is mounting enthusiasm for a resurrection of sport. When it finally comes, the first serve, the first kickoff, and the first starter’s gun will aid in global recovery and the redefining of normal life,” the document read. “We eagerly await this day but proceeding too soon and without a unified and purposeful approach by the sports medicine community to ensure the health and wellness of our athletes may prove disastrous.”

The disaster to which they refer is undiagnosed heart damage caused by COVID-19. While the viral infection’s most apparent manifestation is in the respiratory system, damage to the heart has been documented, as well.

Dr. Samer Abbas, an interventional cardiologist with Community Care Network in Munster, Hammond, and East Chicago outlined three possible cardiac-related scenarios: a large inflammatory response to the virus that occurs throughout the body, including the heart, causing a temporary cardiomyopathy that resolves itself; a direct invasion of heart tissue by the virus causing myocarditis and/or pericarditis that results in permanent scarring thereafter; or an acute event where the virus causes the formation of a clot that lodges in one of the blood vessels of an otherwise healthy heart.

While the first possibility is not that scary and the third seems to occur only while the virus is active, the second is ominous if it is occurring to those who have been infected and experienced minor symptoms or none at all. That scarring could lead to arrhythmias later when the heart is being stressed.

“The bottom line is we just don’t know,” said Abbas of whether there is an incidence of heart damage among the mildly affected.

We do know about those who have been sick enough to require hospitalization. According to BJSM post, “COVID-19 myocardial injury … has been described in 28% of the sickest patients.”

Among the authors of the blog post is Dr. Jonathan Drezner, of the Center for Sports Cardiology at the University of Washington. Also a team physician for the Seattle Seahawks, Drezner was interviewed for a story in this space in 2013. Due to the high incidence of heart damage among those hospitalized with COVID-19, Drezner and his co-authors are recommending comprehensive testing for such individuals attempting a return to sport. That testing should include and EKG, echocardiogram, and a stress test.

For those who have had documented mild illness, they urge at least an EKG.

But what about those who were infected and didn’t even know it? The only method to detect that previously unknown infection is antibody testing. Should all athletes, then, be tested for the antibodies before they return? For those whose antibody test is positive, should they undergo EKG testing, too? Is that the course we should be following?

“Honestly, it is,” said Abbas.

Consequently, at the very least, while many high school athletes in Indiana may not be required to get a preseason physical for the coming school year, they should still have one. Then during that physical, Abbas urges physicians — now, more than ever — to ask detailed questions about any history of chest pain or unexplained loss of consciousness for the patient and any family history for cardiac conditions and unexplained sudden death at a young age among close relatives.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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