COVID-19 and myocarditis in competitive athletes

New research investigates prevalence of myocarditis in competitive athletes diagnosed with COVID-19.

Myocarditis is inflammation of the heart muscle.1 It is often difficult to identify because it is associated with a variety of clinical symptoms, and because it is commonly found in young populations, who are often not considered a risk group for cardiovascular conditions and emergencies.1 Taking treatment is important because it can help avoid the adverse health consequences associated with myocarditis, such as decreased function of the ventricles.2

A variety of different factors can contribute to the development of myocarditis, including infection, specific medications, and underlying health conditions. In the United States, however, the most common cause of myocarditis is viral infections.2 Some viruses are more associated with these cases than others, and the inflammatory response of the immune system to the virus is thought to temporarily contribute to the development of myocarditis.

Unfortunately, myocarditis is a frequent cause of death in competitive athletes.3 The exact cause of this is unknown; however, some researchers believe that severe levels of physical exertion may increase the risk of myocardial injury for athletes with established myocarditis.3

Even if regular exercise is accompanied by improved immune system function, prolonged exercise with vigorous vigor may be associated with immunosuppression.4 This has been suggested by some research; one study found that endurance elites showed fewer T cells, which are important components of the immune system that help identify and prevent harmful pathogenic behaviors microbes.5 As a result, some competitive athletes may be theorized to have an increased risk of contracting myocarditis -related infections.4

Because COVID-19 is a novel virus, researchers are investigating whether it may contribute to the development of myocarditis. There is not enough evidence to establish whether that is possible. However, the high prevalence of COVID-19 in the United States warns further research on this topic.

One study investigated the prevalence of COVID-19 myocarditis in competitive athletes. The results of the study are published in JAMA Cardiology.6

The study group consisted of 1597 competitive athletes from 13 U.S. universities with COVID-19; they tested positive for SARS-CoV-2 by polymerase chain testing (PCR) methods.6 All participants filled out surveys to test for any potential signs and symptoms of COVID-19 myocarditis. In addition, participants underwent a variety of heart testing procedures to screen for COVID-19 myocarditis. This heart test has a screening technique called cardiac magnetic resonance (CMR) screening, which helps with the diagnostic process.

From the study group, 37 athletes were diagnosed with myocarditis; nine participants had clinical-stage myocarditis, and 28 participants had subclinical myocarditis.6 This represents 2.3% of the study population. However, if the heart test was based solely on survey results without CMR testing, only about 0.31% of athletes would be diagnosed with myocarditis.6

The results of this study suggest that CMR screening may be an important technique to help diagnose this condition that is often asymptomatic; however, further research is needed. In addition, further research is needed to determine the relationship between COVID-19 and related myocarditis.


  1. Al-Akchar, M., Kiel, J. (2021, May 12). Acute Myocarditis. StatPearls [Internet]. Accessed 2021, June 1, from
  2. Kang, M., An, J. (2021, May 10). Viral Myocarditis. StatPearls [Internet]. Accessed 2021, June 1, from,frequently%20the%20cause %20of%20myocarditis.
  3. Hurwitz, B., Issa, O. (2020, November 4). Management and Treatment of Myocarditis in Athletes. Treatment Options for Curr Cardiovasc Med 22 (12): 65. doi: 10.1007 / s11936-020-00875-1.
  4. Martin, SA, Pence, BD, Woods, JA (2009, October). Exercise and Respiratory Impacts on the Viral Tract. Exerc Sport Sci Rev. 37 (4): 157-164. Doi: 10.1097 / JES.0b013e3181b7b57b
  5. Prieto-Hinojosa, A., Knight, A., Compton, C., et al (2014, July). Reduced thymic output in elite athletes. Brain Behav Immun 39: 75-79. Doi: 10.1016 / j.bbi.2014.01.004
  6. Daniels, CJ, Rajpal, S., Greenshields, JT, et al (2021, May). The prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: Results from multiple COVID-19 cardiac registers. JAMA Cardiol. Doi: 10.1001 / jamacardio.2021.2065.
  7. Photo by Gerd Altmann from Pixabay

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