Return to play after COVID-19: a sport cardiologist’s view

On March 2020, WHO has declared the coronavirus disease (COVID-19), caused by the virus severe acute respiratory syndrome coronavirus 2 outbreak, a pandemic. Young people can be affected by the disease, and some of them require hospital admission and intensive care. The clinical manifestations of COVID-19 include cardiac involvement and complications, among which are myocarditis (including fulminant cases), arrhythmias and rapid-onset heart failure.1 Since the first cases reported in Wuhan, China, increased levels of serum myocardial biomarkers were found in the sickest patients and associated with worst outcomes. In a series of 41 cases, 12% patients had elevated levels of troponin, indicating myocardial injury.2 Another study showed acute arrhythmias in 17% and acute myocardial injury in 7% of patients with COVID-19.3 In a meta-analysis including six studies with a total of 1527 patients with COVID-19, 8.0% suffered acute cardiac injury with an incidence about 13-fold higher in critically ill patients admitted in intensive care units.4 Increased levels of natriuretic peptides has also been reported in these patients and associated with worst prognostic.1 In some …