Indiana Medical Experts Offer Explanation on Myocarditis, Its Effects on Athletes

Two Indiana doctors who work in cardiology give insight to myocarditis and the effects it can have on athletes following the postponement of the Big Ten football season.

Dylan Wallace | Aug 14, 2020

BLOOMINGTON, Ind. — When Indiana offensive lineman Brady Feeney contracted the coronavirus and had potential heart issues and was hospitalized, it created a lot of concern since Feeney was a healthy athlete.

Not much later, an article was released on ESPN about myocarditis, essentially inflammation of the heart, that was found in five Big Ten athletes and was a rising concern for college sports this fall.

The Big Ten then decided to postpone fall sports – and myocarditis was a big reason why.

And it should have been, according to two Indiana health experts who recently spoke with Sports Illustrated about the effects of myocarditis and why it can be a concern for athletes.

Dr. Subha Raman, Vice President for Cardiovascular Services for IU Health, said patients without symptoms are a concern because the heart damage due to inflammation can lead to scarring over time, which can cause long-term heart complications.

She said myocarditis usually has a trigger, such as the common cold or influenza, but studies are showing it is becoming increasingly linked to COVID-19.

“Myocarditis is basically inflammation of the heart muscle. It’s an issue related to some type of trigger, in this case, it’s the coronavirus,” Raman said. “It can damage heart muscle. It can change the electrical properties to cause abnormal heart rhythms.”

She said myocarditis is “definitely scary if you don’t know what to look for.” Often times to detect myocarditis, doctors will have to use Troponin tests, which can be helpful because it’s a sensitive blood test for heart muscle damage. If that’s positive, additional testing can look more closely at the heart and help doctors determine appropriate treatment.

Raman doesn’t want to speculate why myocarditis could be a problem with athletes, but she said it’s important to remember that it’s not always the viral infection itself that causes the problem, but it’s the immune system’s response to it. Even though younger people, including college athletes, typically have strong immune systems, the response their immune system has to combat the virus can attack the heart muscle.

Another reason why this has become such an important issue with athletes is the recovery time. Mohan Shenoy, a cardiologist at IU Health Southern Indiana Physicians, said non-athletes can typically recover from myocarditis.

“With athletes, that’s a little bit more difficult to answer,” Shenoy said.

As outlined in the Big Ten’s bulletin regarding COVID-19 and cardiovascular involvement earlier this week, every athlete who contracts COVID-19 needs to take it easy two weeks after testing. They need a very slow conditioning plan before they get back to full-go.

A lot of the times that’s not the case, and athletes will try to jump back into things, which could cause more damage and inflammation to the heart.

Shenoy said EKG’s, Troponin tests and echocardiograms are all ways to detect myocarditis. He also thinks one of the more effective and accurate ways to do it is with cardiac MRI’s. He said the Bloomington hospital has cardiac MRI’s.

Both Shenoy and Raman agree that it was the best decision by the Big Ten to postpone fall sports.

“I think it’s a reasonable decision. The safety of athletes is always paramount. We just need more data,” Shenoy said. “We want players and the fans and everybody to be safe. For that, we just need more data and clarity moving forward. The bulletin is a start. Hopefully we can get everybody to safely enjoy sports again.”

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