Time to Run? Evaluation and Management of a College Athlete After COVID-19 Infection

An 18-year old male cross-country runner with recent COVID-19 infection presented for a sports pre-participation evaluation.

Past medical history: attention deficit hyperactivity disorder
Medications: methylphenidate Hcl

History of present illness:
The patient tested positive for COVID-19 after exposure to a known sick contact. He experienced mild symptoms and completed a 10-day quarantine during which he did not exercise. At the end of quarantine, he had two episodes of atypical chest pain with symptoms occurring at rest and lasting 10-15 minutes. The patient was seen in the sports medicine clinic 16 days after his diagnosis and had complete resolution of symptoms.

Vital signs: afebrile, HR 125, BP 108/62
Physical exam: unremarkable besides tachycardia
Electrocardiogram (ECG): sinus tachycardia at 119 bpm, normal intervals, QTc 422ms
Labs: C-reactive protein of 0.6mg/L, sedimentation rate of 2mm/h, troponin I <0.01ng/mL

Transthoracic echocardiogram (TTE) performed approximately 4 weeks from the time of diagnosis: Left ventricular (LV) systolic function was low-normal with ejection fraction (EF) of 51% without regional wall motion abnormality. Global longitudinal strain (GLS) imaging showed reduced peak systolic strain of -12%.

Cardiac magnetic resonance imaging (CMR) performed approximately 7 weeks from the time of diagnosis: Normal LV size and low-normal systolic function (EF 52%), normal right ventricular (RV) size, mildly decreased RV function, and linear sub-epicardial late gadolinium enhancement (LGE) at the basal inferior septum. Mildly elevated native T1 in the basal inferior and inferoseptal segments. Normal global and segmental T2 mapping, indicating absence of edema.

Figures 1 & 2

Figures 1 & 2

When should patient return to play?

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