Introduction
Due to the high frequency of asymptomatic and undetected cases, the incidence of acute myocarditis, an inflammatory illness of the myocardium, is not well known in the general population. An inflammatory, non-ischemic heart muscle condition called myocarditis can cause arrhythmias and cardiac dysfunction. Although the cause of myocarditis varies, it may be generally classified as an immune system reaction, a toxic insult, or an infectious one. Some athletes may have a history of poisons like cocaine and catecholamines. The main mechanisms of the pathophysiology are necrosis and inflammatory infiltrates in the heart.
What Is Myocarditis?
The central muscle layer of the heart wall, or myocardium, can become inflamed and cause myocarditis, a dangerous but uncommon ailment. The heart's electrical system may become weaker due to myocarditis. Consequently, the heart's capacity to pump blood decreases.
The illness might be severe and pass rapidly. Alternatively, it could be persistent and continue longer than two weeks. Myocarditis can cause a heart attack, stroke, heart failure, or even death in extreme circumstances.
Myocarditis frequently has an unclear etiology. Myocarditis is typically caused by a fungal infection (candidiasis), bacterial infection (diphtheria or strep), or viral infection (cold or flu). Toxic agents, autoimmune diseases, and medications can also induce it.
What Are the Symptoms of Myocarditis?
Not everyone who has myocarditis experiences symptoms. Some have mild or severe symptoms, like:
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Exhaustion.
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Breathing difficulty.
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Temperature spike.
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Chest ache.
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A strong, fast, or erratic pulse.
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Feeling dizzy or fainting.
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Flu-like symptoms include sore throats, joint discomfort, headaches, and body soreness.
Myocarditis can sometimes have symptoms similar to a heart attack. In the event of unexplained chest discomfort or dyspnea, immediately get emergency medical attention.
How Are Athletes More Prone to Myocarditis?
Highly skilled sportsmen appear to have an increased risk of myocarditis. Extensive exercise training has been associated with a temporary immunological depression (leukocytopenia, decreased salivary IgA) that increases susceptibility to infections, especially upper respiratory tract infections, both during and after individual physical activity sessions (the so-called "open window" theory).
Although myocarditis can have a variety of causes, respiratory and gastrointestinal viruses are usually to blame. Therefore, it stands to reason that immunological modification following vigorous exercise may make athletes more susceptible to acute myocarditis and affect how it develops clinically. When returning to sports, athletes recuperating from acute myocarditis should refrain from moderate to intense exercise for six months, maintain normal cardiac function, and show no signs of arrhythmia.
What Are the Risk Factors That Are Associated With Athletes Having Myocarditis?
The following are the risk factors that are associated with athletes having myocarditis:
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Travel-related stressors.
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Jet lag.
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Time change.
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Change in climate zones.
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Lack of sleep.
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An increased risk of infection.
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Frequent travel to other countries.
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Competitive location, including shared apartments and cafeteria.
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Bus transportation between competition locations and severe weather circumstances.
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Chilly (such as ice and snow sports).
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Heat (summertime high temperatures, for example).
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Harsh surroundings (desert runs, for example).
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Altitude (mountain climbing and skiing, for example).
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Low humidity (lowering of the barrier to the airway) rivalry.
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Elevated mental strain.
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High levels of strain from repeated, intense activity.
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It takes a shorter time to recuperate.
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Despite early illness symptoms, exercise drugs.
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Illicit substances, such as cocaine.
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Doping substances (such as anabolic steroids and amphetamines).
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There is a higher chance of depression symptoms (such as those caused by tricyclic antidepressants) being elevated.
What Are the Diagnostic Criteria for Diagnosing Myocarditis in Athletes?
The following are the diagnostic criteria for diagnosing myocarditis in athletes:
ECG (Electrocardiogram) - Contraction and supraventricular arrhythmias, multiple-lead ST-elevation in concomitant pericarditis, T-wave inversions, left bundle branch block, ventricular ectopy, high-grade AV block, and low voltage from pericardial effusion or myocardial edema are typical electrocardiogram (ECG) findings. The ECG, however, does not change in certain athletes with acute myocarditis. Furthermore, the differential diagnosis of "athlete's heart" in elite endurance athletes might be more challenging since cardiac adaptation to prolonged exercise's distinctive ECG signals is comparable to myocarditis.
As the gold standard for non-invasive diagnostics to assess tissue features, cardiac magnetic resonance imaging (CMR) is superior to echocardiography. It is essential for patients suspected of having acute myocarditis. Assessing suspected myocarditis using CMR has been suggested as a fundamental diagnostic tool for clinical work-up and risk assessment in athletes due to recent developments in connecting CMR results to prognosis. When combined with tissue characterization techniques and late gadolinium enhancement (LGE), it is precious for athletes and patients who cannot have an echocardiogram. These approaches offer careful cardiac disease diagnosis information.
What Are the Treatment Modalities for Treating Myocarditis in Athletes?
Treatment for myocarditis in athletes, leisure exercisers, and sports participants follows the same principles as in other patient populations. They have their roots in common strategies for treating heart failure and antiarrhythmic medication. Antiviral treatment (for example, HHV), immunomodulation (for example, AV and enterovirus), or immunosuppression (for example, B19V) may be explored in cases with EMB virus-positive myocarditis. For giant-cell, eosinophilic, lymphocytic, sarcoid, or virus-negative myocarditis, as well as myocarditis resulting from an autoimmune illness, immunosuppression is required. Giant-cell myocarditis can be deadly and frequently progresses in a fulminant manner. Therefore, it is critical to diagnose and treat it quickly. Complete recovery is possible with antibiotic therapy in cases of Lyme disease, which frequently causes AV block. Consequently, postponing pacemaker or defibrillator placement after the acute stage is best.
Conclusion
In young, otherwise healthy people, myocarditis is thought to be one of the most frequent acquired causes of arrhythmias, myocardial dysfunction, heart failure, and sudden cardiac death (SCD). The evaluation of exercise intensity, the creation of a phased training program, and suggestions for eligibility in competitive sports are preventive measures and guidance for getting back into sports and physical activity after myocarditis. In these situations, it is often possible to continue physical activity beyond a modest level after three months, such as cardiac rehabilitation or recreation, which may be advised as early as one month following the acute phase with a regular reevaluation. This advice is equally valid for cases of pericarditis with minimal cardiac involvement.
