Management and Treatment of Myocarditis in Athletes

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.

Keywords: Athletes; COVID 19; Cardiomyopathy; Myocarditis; Return to play; Sports eligibility.

Fig. 1

Algorithm for an athlete with suspected myocarditis. ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; CK-MB, creatine-kinase MB isoenzyme; BNP, brain natriuretic peptide; EMB, endomyocardial biopsy; LGE, late gadolinium enhancement; ETT, exercise treadmill test; LVEF, left ventricular ejection fraction.