Management and Treatment of Myocarditis in Athletes
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Curr Treat Options Cardio Med DOI 10.1007/s11936-020-00875-1
Sports Cardiology (M Wasfy, Section Editor)
Management and Treatment of Myocarditis in Athletes Benjamin Hurwitz, MD Omar Issa, DO* Address * Department of Cardiology, Mount Sinai-Miami, Miami Beach, FL, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Sports Cardiology Keywords Myocarditis I Cardiomyopathy I Athletes I Sports eligibility I Return to play I COVID 19 Abbreviations SCD Sudden cardiac death GCM Giant-cell myocarditis EMB Endomyocardial biopsy CMR Cardiac _ _ _ magnetic resonance T2w T2-weighted LGE Late gadolinium enhancement COVID-19 SARS-Coronavirus-2
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Abstract Purpose of review Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes. This review aims to summarize the current evidence and treatment guidelines for the management of myocarditis in the active population. Recent findings Physical exertion is likely a trigger for dangerous arrythmias and further propagates myocardial damage in athletes with myocarditis. For this reason, abstinence from sports is a critical facet of management in the initial inflammatory period. The use of cardiac magnetic resonance imaging, specifically late gadolinium enhancement, to guide return to play decisions is becoming more common in clinical practice. Summary Establishing a stepwise approach for proper diagnosis and risk stratification, with an emphasis on contemporary cardiac magnetic resonance (CMR) imaging techniques, in myocarditis is critical. After a diagnosis of myocarditis is made, it is imperative for any athlete or highly active individual to refrain from physical exercise. Additionally, therapy for heart failure should be applied in cases of myocarditis with cardiac dysfunction. Undoubtedly, COVID 19, and its potential to cause myocarditis, is sure to change the landscape of management of this disease.
Introduction Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and
arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes [1]. The
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Curr Treat Options Cardio Med
treatment of myocarditis is tailored to the individual patient and severity of myocardial insult. Physical exertion is likely a trigger for dangerous arrythmias when myocardial inflammation is present and for this reason
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is a critical aspect of management, with the goal of preventing adverse cardiac events [2, 3•]. While necessary, these restrictions can be difficult to implement in a competitive athletic population.
Etiology Myocarditis has a variety of etiologies including viruses, bacteria, drug reactions, radiation, and even autoimmune diseases. The growing use of molecular techniques, such as polymerase chain reaction amplification, suggests th
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