Covid-19 can damage hearts of some college athletes

https://directorsblog.nih.gov/2020/10/01/covid-19-can-damage-hearts-of-some-college-athletes/

by rkolberg • 6 years ago

157 108 6 years ago

directorsblog.nih.gov

The studies on covid lung damage found that it lasts 1-3 months and then recovers in all cases where ARDS is not diagnosed. I wonder if this is similar (e.g. intense viral infection, regardless of symptoms, leads to myocarditis but then heals over time). That's the biggest open question mark about how bad covid is that hasn't been addressed yet.

henrikschroder2• 6 years ago

I'm so tired of all reports talking about things that could happen, may happen, but fail to produce numbers of how common it is.

Hundreds of millions of people have had sars-cov-2 by now, if long-term effects were a widespread phenomenon, we would know by now. And yet, absolute crickets except rare outliers.

An old friend of mine was sick for months with the virus, and she has many months of rehab in front of her before she's back to normal. That sucks, but she's still the outlier. And you can't let the outliers dictate your behaviour, or you would never leave the house for fear of falling pianos or lightning strikes.

rogerkirkness2• 6 years ago

To be clear, since it never is, I'm commenting that scientifically it's open and shut except for heart stuff. So it's interesting to see early indications. I agree about implications, I'm not arguing for extreme measures, simply stating fact. If it is airborne HIV like people feared in April (which it is not), I would like to know.

titzer6• 6 years ago

Trust me we are all tired.

Hundreds of millions of people have had sars-cov-2 by now,

No, worldwide numbers are ~34 million confirmed. You don't get to just randomly multiply by some fudge factor that feels right to you and then reason based on that.

When you do this it makes it clear that numbers really don't mean anything to you and it will just be more sophistry to justify giving up and letting the disease everywhere because of something about "others dictating your behaviour" or something or other. This attitude and shades of it are exactly why 1 million people worldwide have died.

Yeah, we're tired.

toomanybeersies• 6 years ago

if long-term effects were a widespread phenomenon, we would know by now

Wouldn't you have to wait until a long time period has passed before you could make any real claims in regards to "long-term effects"?

graeme2• 6 years ago

Have a link? I missed those studied.

joshgel2• 6 years ago

I've searched extensively for any studies that describe the 3 month follow up and found exactly one, recently published. I would love if you could identify more.

Results aren't really as described here. Some patients recover, but about 1/3 had persistent lung findings and many had decreased lung function (as measured by DLCO).

[0] https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...

sgtnoodle2• 6 years ago

Earlier this year my immune system developed COVID FOMO and caused inflammation that destroyed my heart's AV nerves. I got relatively lucky that the inflammation didn't seem to cause any muscle damage. My heart looked perfect on an MRI, despite only beating at 21 BPM at the time. Apparently inflammation doesn't really show up on an MRI unless it's horrendously bad or it's caused fibrous scarring. The scan that really shows inflammation well is PET, and you don't really want to do a PET scan without good reason since it requires getting injected with a radioactive substance.

I've likely had inflammation in my lungs for years based on a previously unexplained chronic cough, and since getting treated for the inflammatory condition, within weeks my cough was gone and my pulmonary function is quantifiably normal.

So, it seems to me like systemic organ inflammation isn't too big a deal unless it happens to cause nerve damage, or gets bad enough to cause fibrous scarring. Unfortunately, if you can see it on an MRI, then you're probably already screwed. You can get a good view of any inflammation via PET, but you're going to glow for a while after.

Perhaps viral inflammation is a lot more destructive than autoimmune inflammation alone? It sounds like contemporary COVID treatment has become more effective with the addition of anti-inflammatory medications, though, which is great news.

raducu• 6 years ago

My blood pressure dropped from 135/85 to 115/80 after I got COVID.

I haven't checked it recently because I'm left with tinnitus in my right ear (that rings very loud when stressed or when exerting myself) and I was stressed about that, but I'll do an ultrasound checkup on my heart.

You did not mention an ultrasound exam on your heart, I thought it was pretty good?

collyw2• 6 years ago

Do you have any links? (Or a search term to use if you don't know them).

I see numerous reports of "long term" or "permanent" damage, despite the virus having been around for less than a year.

dopylitty• 6 years ago

Makes you think about the LSU football team being so bad this year after admitting most of the team had covid.

I hope the athletes whose pro careers are now in jeopardy are able to hold the college administration and other officials pushing for the return of football accountable for the damage they've caused.

nmfisher• 6 years ago

I hope the athletes whose pro careers are now in jeopardy are able to hold the college administration and other officials pushing for the return of football accountable for the damage they've caused.

On the flipside, a year out of competition may be enough to kill someone's career, or at least seriously derail it. Most people only get a few years at high levels of sport, so losing one is a big hit.

natrik• 6 years ago

https://news.ycombinator.com/item?id=24366614

Relevant other discussion on Covid-19 and athletes. Exaggerated headline proven to be false.

argonaut• 6 years ago

These studies are very tricky to interpret because there's no context for how bad these results are.

How many healthy people have (presumably benign) cardiac abnormalities when you do a cardiac MRI? How many people who got a cold or flu have cardiac abnormalities when you do a cardiac MRI? Covid is undoubtedly more fatal than the flu, but in some demographics, like the young, it is less fatal.

The first cited study of athletes does not provide any context. The other cited study (Puntmann et al) did attempt to have a control group of people who did not contract Covid but had similar risk factors as the people who did contract Covid. If you look at this control group, a ton of people have cardiac abnormalities (in Table 1, as many as 26% of the non-Covid group could have the criteria for myocarditis that the study states).

est31• 6 years ago

Medlife crisis, a cardiologist youtuber has recently made a video [0] about a similar study, that also looked at MRI images of patients [1]. That same story is referenced in the article as well. According to medlife crisis, MRI images aren't really helpful as a sole tool to diagnose miocarditis, instead one uses them together with other data like symptom reports or ECG. Alone, they would be too flaky. Also, we don't even know how healthy people look like as we don't put them into scanners.

Now this [2] study, the one the blog post is about, didn't just study MRI images but also collected other data, like ECG. But quoting the study:

There were no diagnostic ST/T wave changes on electrocardiogram, and ventricular volumes and function were within the normal range in all athletes by transthoracic echocardiogram and CMR imaging. No athlete had elevated serum levels of troponin I.

Some individuals reported mild symptoms typical to COVID, but most were asymptomatic. So the study confirmed that there are no abnormal changes beyond the MRI scans, which, as written above, can be flaky.

[0] https://www.youtube.com/watch?v=iaiQGJqZ6Y8

[1] https://doi.org/10.1001/jamacardio.2020.3557

[2] https://doi.org/10.1001/jamacardio.2020.4916

throwmeaway_pls• 6 years ago

Are you suggesting this blog post might be misleading by not disclosing the limitations of the referenced work? Why would anybody do such a thing? /s

joshgel2• 6 years ago

With tens of thousands of publications on COVID, its absolutely amazing how few there are on the follow up of these patients. (ie what comes next after infection). There is so little data we are flying blind (again).

That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result. In vitro and autopsy evidence suggests that SARS-CoV-2 directly infects myocardial cells. So it's plausible that there will be some cardiac sequelae of COVID, perhaps in many patients or maybe just in those at high risk. We just don't know. Assuming that myocarditis will be a major problem because 2 uncontrolled studies said so is as silly as assuming hydroxychloroquine works because of similar strength of evidence. But dismissing it out of hand (which I'm not suggesting GP is doing) is not smart either. We should be appropriately skeptical, but need to investigate further.

nostromo• 6 years ago

That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result.

It'd be interesting to know how it compares to the flu. Here's an interesting study from just this year:

A CDC study looking at more than 80,000 adult patients hospitalized with flu over eight seasons found that sudden, serious heart complications were common, occurring in 12% of patients, or 1 in 8.

https://newsroom.uw.edu/news/study-confirms-link-between-inf...

irq11• 6 years ago

So 4/26 athletes had elongated T2, in an uncontrolled study, with no pre-exposure baseline measures.

This is one-half step above meaningless. The only argument they have is that the other 22 athletes had a mean T2 of 51, vs 59 for the four in question. The highest reported “abnormal” time is 63ms. The others are 55, 59 and 61ms.

Here is the first set of slides I found for topic from a presentation by a doctor at Columbia University. Slide 14 shows the distributions of T2 times for several control and disease groups. You’ll note that the control group runs from 50-61ms:

https://cdn.ymaws.com/scmr.org/resource/resmgr/2019/new_york...

matz13• 6 years ago

For professional athlete, the risk of not playing is greater than the risk from covid.

xxxtentachyon• 6 years ago

Sure, but these are unpaid college athletes.

matz13• 6 years ago

Don't they get paid in the form of scholarship?

Even if unpaid and no scholarship, without playing they could lose their skill and competitiveness, and they are not getting any younger.

bsder2• 6 years ago

For the "not yet professional" athlete, however, the risk of damage is probably higher than sitting out a year.

The careers of these people live and die based upon their ability to process oxygen. Even a couple percent drop move them out of the "elite" category and can mean the difference between a couple of years as a pro vs a dead end at college.

matz13• 6 years ago

By sitting out a year, they could lose their skill and competitiveness and also getting one year older. For athlete because of short career timespan, time is precious.

Even the risk of playing and having injury during non pandemic time is probably greater than covid.

just-juan-post• 6 years ago

Here is a study from 2009 that shows it happens to athletes that have flu / influenza / "common cold"

https://jcmr-online.biomedcentral.com/articles/10.1186/1532-...

agrenader• 6 years ago

So does flu. From https://www.cdc.gov/flu/symptoms/symptoms.htm possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection.

snapetom2• 6 years ago

Just my own anecdote...

In 2013, I was in ok shape, late 30's, running maybe about 15 miles/week with some gym activity. I was suddenly hospitalized for 4 days with pneumonia and "something else." About four months later, I got on a treadmill and couldn't run for more than a minute.

Long story short, I was diagnosed with viral cardiomyopathy. A virus basically comes in, fucks up your heart, then leaves. Myocarditis was the method in my case. They never ran a test to see what virus, because at that point, there wasn't any reason to. The damage was done. My ejection fraction was at 15% (50-55% is normal). I was given a defibrillator vest to shock me if I collapsed, and eventually I got a permanent implant.

In various conversations with cardiologists, they mentioned that it's believed to be much more common than they once thought. My primarily cardiologist said the week prior to me, she had a young, perfectly healthy male, in his early 20's that had a very similar hospitalization event. His was so bad they immediately put him on the transplant list.

nradov6• 6 years ago

I suspect that a high percentage of chronic medical conditions that people deal with were triggered at least partly by undiagnosed viral infections. But that's just conjecture, there's no way to prove it.

elcomet• 6 years ago

Did you eventually recover ?

rob74• 6 years ago

Yes, but with the flu, most people (a) know that they had it and (b) are aware that they should take it easy with the training for a few weeks after they get well again. With Covid, apparently there is danger of myocarditis even for mild or asymptomatic cases...

nradov6• 6 years ago

Mild or asymptomatic cases are also common with influenza.

https://wwwnc.cdc.gov/eid/article/22/6/15-1080_article

Some of those cases do have heart problems.

neilwilson2• 6 years ago

And as I discovered in my family hyponatremia which has left my mother on anti-seizure tablets for the rest of her days.

Don’t underestimate flu

slg6• 6 years ago

It is anecdotal, but one example is professional baseball player Eduardo Rodriguez. He had COVID-19 in early July which resulted in myocarditis. He wasn't even cleared to walk on a treadmill until this week[1]. While he is expected to return to form eventually, team officials had said they don't expect him to be completely back to normal next season even though the season doesn't start until April[2].

This virus isn't something you want to mess with even if you are young and fit.

[1] https://sports.yahoo.com/red-sox-ace-finally-cleared-to-walk...

[2] https://www.masslive.com/redsox/2020/09/eduardo-rodriguez-bo...

legerdemain2• 6 years ago

As many people in this and other threads have pointed out, we don't have any prior measurements, so we are absolutely unable to conclude that Rodriguez didn't have myocarditis and constipation of the heart prior to contracting COVID.

slg6• 6 years ago

It would be extremely rare for a professional athlete to have an undiagnosed heart condition serious enough that doctors recommend months of zero physical activity. This isn't a normal person. This is someone watched over by world class doctors and who constantly has his performance, health, and bio data measured. The condition is almost certainly a result of COVID.

anoncake3• 6 years ago

So there's no permanent harm. I don't think preventing athletes from doing their jobs for a few months by restricting everyone in that way is a sensible trade.

slg6• 6 years ago

So there's no permanent harm.

The average MLB player's career is 5.5 seasons and this guy might be losing 1.5 seasons. That is still a huge cost even if he escapes without permanent damage.

I don't think preventing athletes from doing their jobs for a few months by restricting everyone in that way is a sensible trade.

I never suggested any specific ways to avoid this situation let alone any type of shutdown. I am simply pointing out the dangers.

nottorp• 6 years ago

Only college athletes? Normal people (or professional athletes) aren't at risk?

anoncake3• 6 years ago

Maybe the damage only matters if you regularily push your heart to the limit.

smoyer• 6 years ago

My 15 year-old cousin had undiagnosed hypertropic cardiomyopathy and collapsed during half-time at a high-school basketball game. Since AEDs were rare then (and still are in rural, less affluent areas), his heart rhythm couldn't be restored and he died.

There are two important points: 1) you don't want to be exercising with many different heart conditions whether temporary or permanent and 2) when you're out and about in your community, keep an eye out for AEDs ... if you don't see them at a reasonable frequency, speak up and help get them in place.

Donations are accepted and funding may be available at https://gregaed.com/

tonyedgecombe• 6 years ago

AED is an abbreviation of automated external defibrillator.

srtjstjsj• 6 years ago

This is good research (I presume) but poor quality news. (Like most medical news, but covid really made a focus on it). Obviously covid can do a lot of terrible things. What matters for the public is overall balance of factors and meaningful concrete lifestyle and policy choices based on those, not these single small pieces of info.

Covid-19 can damage hearts of some college athletes

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