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COVID: Myocarditis, Blood Clots, and Exercise.

Let's talk sports for a bit. But the following information is significant for all of us, but with a special emphasis in those physically active.

I have been a sports fan for many, many years, from football to tennis to golf to the Olympics.

No, we will not get into a debate about whether golf is a sport or not 🤣.

College football, specifically Michigan football - GO BLUE!!! - is the singular sport I am most passionate about. Fan is short for "fanatic" and boy, I have had my moments of irrationality, confirming my fandom.

I have experienced great joy, incredible anger, and immense sadness and despair (yes, despair), more often than I care to admit. And I have many friends who can deeply empathize with these feelings.

So when I initially heard the Big 10 was planning to move the college football season to the spring due to COVID, I had mixed feelings. My initial reaction to this news was one of immense disappointment. But then I recently half-jokingly stated to my friend Sarah this may be the first fall since 2004 I would not end the fall season distraught 😅.

Some institutions are trying to pressure the Big Ten to begin college football - including our own coach, Jim Harbaugh.

But Mark Schlissel is unlikely to budge in his stance.

He not only is the President of the University of Michigan, but a physician/scientist trained at Johns Hopkins whose research is in immunology.

But upon further investigation, his concerns seem justified.

So yeah - good luck Big Ten.

Recently, the director of sports medicine at Penn State University (PSU) stated 30-35% of all of their athletes who tested positive for COVID, symptomatic or not, had evidence of myocarditis on their MRI scans.


Now, when I first had those numbers presented to me by my friend Eric, I thought those numbers were absolutely absurd. But there is growing evidence it may not be as absurd as I initially thought.

Some retrospective studies show those numbers could be even worse, but these are small sample sizes - therefore, we all need to take this data with a grain of salt until we know more. But it is something to be aware of.

So first, what is myocarditis and why are we concerned about it?

It is an inflammation of the myocardium, or the muscle wall of the heart. This disease can lead to irregular heart rhythms, heart wall damage, and in extreme cases, heart failure or death.

Generally speaking, we know some viruses can lead to weakening of the heart in those susceptible. Some cases resolve. But some do not. And at this point, we do not know how heart damage caused by COVID will progress. And it is this possibility of long-lasting damage that concern many.

A small German study who looked at the MRI scans of a 100 recovered COVID patients, most with mild to moderate symptoms, showed 78% (!!!) with evidence of cardiac injury with 60% still showing ongoing inflammation 2+ months later:

We know children have showed evidence of myocarditis in MIS-C, with an 11yo who recently died of heart failure as a result:

So the concern is: are we going to start seeing an increase in heart failure in the future related to COVID?

Some symptoms of heart failure are as follows (not exhaustive): 1. Shortness of breath (dyspnea) when you exert yourself or when you lie down. 2. Fatigue and weakness. 3. Swelling (edema) in your legs, ankles and feet. 4. Rapid or irregular heartbeat. 5. Reduced ability to exercise. 6. Persistent cough or wheezing with white or pink blood-tinged phlegm.

And yup - lots of overlap with the symptoms of lung disease.

At this point, it is too difficult to sparse out whether many of the above symptoms could be related to lung injury or cardiac injury or both. And it is still too early to determine if a cardiac work-up in COVID patients should be routine.

So I am not saying those with COVID all have heart involvement (hint: they do not), but I would take extra caution if you are feeling shitty.

One reason: with COVID, it seems exercise can actually WORSEN the progression of the disease and actually increase the risk of developing myocarditis.

A CrossFit athlete in her 30s decided to workout when she was not feeling well, believing the workout would help her feel better and work through her illness.

She was wrong. And she died:

In addition, and this is EXCEPTIONALLY IMPORTANT: low resting heart rates, inflammation, and dehydration, all things athletes regularly deal with, are all potential risk factors for the development of deep venous thromboses (DVTs) - blood clots in a deep vein, typically in the leg. These clots can dislodge and travel to the blood circulation of the lungs, get stuck, and potentially cause a clinically significant pulmonary embolism (PE), which could include death. And in even rarer cases, a paradoxical embolus can occur where the clot bypasses the lung circulation and causes a stroke instead.

Now imagine adding COVID to the mix, which is known to increase the risk of clotting.

This is just asking for trouble.

In short: LISTEN TO YOUR BODY IF YOU HAVE COVID. If you want to exercise, that is okay but do so only within your limits. DO NOT PUSH YOURSELF. This is not like sweating out a hangover.

Just be cognizant. And maybe cut those football conferences some slack. I know I finally did.

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