Filenews 19 May 2021
COVID-19 is caused by SARS-CoV-2 coronavirus. This virus has on its surface the spike protein (Spike or S protein, which also gives the characteristic crown form to the virus) which attaches, like the key to the lock, to a receptor protein located on the surface of the body's cells called the Angiotensin 2 Conversion Enzyme (ACE 2). After adhesion the virus enters the cells where it begins to multiply, causing COVID-19 disease.
The new coronavirus mainly affects the respiratory system causing upper respiratory infection. When the infection spreads to the lungs it can develop into a serious respiratory disease called Acute Respiratory Syndrome (SARS).
Covid-19 and heart
But the new coronavirus often also affects the heart. Ace 2 receptors, which the virus uses to attach to the cell membrane, exist in abundance on the surface of heart cells and the virus can use them to enter heart cells and cause inflammation of the heart called myocarditis.
Heart damage can also be caused indirectly as in cases of generalized COVID-19 infection the heart undergoes excessive stress as it has to perform increased work, often in low oxygen conditions due to the respiratory disease that coexists, in an environment of toxic substances that are in circulation due to severe inflammation. These factors ultimately result in heart trauma or even ischemia or heart attack.
Cardiovascular System After COVID-19
Heart damage is most likely in cases of severe COVID-19 disease. Rarely, however, cardiac involvement has been reported in mild forms of the disease or in people who are completely asymptomatic.
As more and more people have a history of COVID-19 disease, the question often arises: I have passed the new crown virus, can I exercise?
Covid-19 & Sport
Those who exercise systematically and athletes generally do not belong to the high-risk groups for severe COVID-19 disease. However, there are several reports of athletes who, after COVID-19, show persistent, recurrent symptoms such as coughing, tachycardia and severe fatigue for weeks.
From cases of individual athletes and/or entire sports teams infected with the new coronavirus we know that most remain asymptomatic or develop mild symptoms, although serious COVID-19 infections have also been reported in athletes.
Studies carried out on athletes and sports teams in the United States and Germany have shown that in a - typically small - number of cases, re-injured athletes from COVID-19 may have heart damage, as shown by the measurement in the blood of levels of Troponin (hs-cTn), a substance that increases in cases of heart trauma. Similar findings have emerged using Magnetic Heart Tomography (cMRI). It is important to identify all those who are suffering from the new coronavirus who have heart damage and wish to return to exercise and exercise in order to be given appropriate instructions and monitored in a way that will allow their safe return to exercise.
In this context, recommendations have been published by the Cardiological Society of both Europe and America on the control and monitoring of those who have recovered from COVID-19 and wish to exercise.
Instructions for returning to exercise after COVID-19 infection.
- Those who were completely asymptomatic (and discovered to be positive for the new coronavirus in random control) or who were minimally symptomatic (fever <38 0C, mild weakness or headache for less than 48 hours) after completing the recommended isolation period, they can revert to an exercise and exercise program gradually, without the need to be examined cardiologically, because the likelihood of heart damage in asymptomatic or minimally symptomatic COVID-19 is extremely small. However, in case of symptoms during exercise (chest pain, severe shortness of breath, cough, dizziness, weakness) the trainee should seek a cardiological assessment.
- All other COVID-19 patients, i.e. those who have had mild (but lasting more than 2 days), moderate or severe symptoms of infection, after recovering, should be assessed by a Cardiologist if they wish to participate in an exercise or exercise program. Especially for those who have had a disease duration of more than a week or have had to be hospitalized the cardiological examination is necessary to rule out possible heart damage from COVID-19, so that they can safely return to sports activities.
The basic cardiological check-up includes, in addition to the clinical examination, the conduct of electrocardiogram and ultrasound (Triplex) of the heart.
Further specialized diagnostic tests should be individualized based on the main discomforts of the test subjects.
Those who report symptoms of tachycardia or palpitations should be examined for possible arrhythmias with a 24-hour electrocardiographic recording (Holter), while those with shortness of breath or effort fatigue should undergo a cardiorespiratory fatigue test to assess cardiac and respiratory function. Similar symptoms may also occur from myocarditis after COVID-19 and the measurement of cardiac Troponin is a simple and easy examination that can contribute to the diagnosis of myocarditis.
If there are symptoms of angina and chest pain it may be necessary to perform a CT coronary to rule out narrowing and/or clots in the coronary arteries of the heart as COVID-19 infection in some cases may lead to an exacerbation of coronary heart disease or the formation of clots in the coronary arteries of the heart
Central to the assessment of cardiac function following COVID-19 infection is the Magnetic Heart Tomography (cMRI) which is highly recommended for those who have had severe symptoms during COVID-19 disease or who have had to be hospitalized and wish to exercise, and certainly for those who are going to exercise at an intense, competitive level. MRI offers extremely detailed imaging of the heart muscle and can reveal cases of even mild or limited myocardial inflammation. The presence of heart damage can lead to an inability of the heart to respond to the increased work of exercise but also to the appearance of life-threatening cardiac arrhythmias. In case of diagnosis of such damage, the trainee should refrain from sports activities until the heart is fully healed. This period can last from a few weeks to 6 months.
Conclusions
- For safe return to exercise and exercise after COVID-19 infection, proper cardiological assessment has an important role to play, especially in those who have had symptomatic or severe disease. Returning to exercise is safe when tests such as Electrocardiogram and Heart Ultrasound are normal, there is no evidence of cardiac inflammation and no arrhythmias are recorded.
- On suspicion of ongoing heart damage, Magnetic Heart Tomography offers valuable information in diagnosing and monitoring those recovered from COVID-19 so that they can safely return to their favourite sports activity when the heart is perfectly healthy.
