CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Myocarditis

Need to know:

Serum markers of myocardial injury, inflammation, and heart failure
Presence of arrhythmias
Ventricular systolic function

Need to do the following no less than 3-6 months after initial illness:

Echocardiogram
24-hour Holter
Exercise ECG

"Before returning to competitive sports, athletes who initially present with an acute clinical syndrome consistent with myocarditis should undergo a resting echocardiogram, 24-hour Holter monitoring, and an exercise ECG no less than 3 to 6 months after the initial illness."

(Class I Recommendation; Level of Evidence C)

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Active inflammation present

"Athletes with probable or definite myocarditis should not participate in competitive sports while active inflammation is present. This recommendation is independent of age, gender, and LV function."

Competitive sports inadvisable (see conditions above)

(Class III Recommendation; Level of Evidence C)

All tests/labs reassuring

"It is reasonable that athletes resume training and competition if all of the following criteria are met:

Ventricular systolic function has returned to the normal range.
Serum markers of myocardial injury, inflammation, and heart failure have normalized.
Clinically relevant arrhythmias such as frequent or complex repetitive forms of ventricular or supraventricular ectopic activity are absent on Holter monitor and graded exercise ECGs.

At present, it is unresolved whether resolution of myocarditis-related LGE should be required to permit return to competitive sports."

Competitive sports are reasonable if all the above criteria are met.

(Class IIa Recommendation; Level of Evidence C)

Reference: Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities. A Scientific Statement From the AHA and ACC. Circulation 2015

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