Jules Heningburg (left) developed heart complications from COVID-19. Photo courtesy of Premier Lacrosse League
Jules Heningburg sprinted uphill and played pick-up basketball about a month after being diagnosed with COVID-19.
It was asymptomatic and not contagious. After being quarantined and following health guidelines, the Premier Lacrosse League player felt fit and ready to return to the field.
His season ended before it began. The 24-year-old Redwoods LC star left the league's bubble in July after doctors said tests showed he was at high risk of cardiac arrest with high-intensity exercise.
The assessment was part of the league's health protocol for players who tested positive for COVID-19. While the number of such cases, which are publicly known among professional and college athletes, is low, cardiologists examined the problem carefully when professional athletes restarted with new health and safety precautions.
Boston Red Sox pitcher Eduardo Rodriguez is perhaps the most famous athlete to sit outside after being diagnosed with myocarditis, an inflammation of the heart muscle. But with the end of the NBA, NHL and Major League Baseball seasons, the NFL season begins.
Dr. Benjamin Levine, who co-authored numerous scientific statements for the American Heart Association on exercise and cardiovascular health, is generally pleased with the cautious attitude of sports organizations.
"What I hear and the questions I am asked are thoughtful, carefully considered, and really focused on athlete safety," said Levine, director of the Institute of Exercise and Medicine at Texas Presbyterian Hospital Dallas and professor of medicine and cardiology at the University of Texas Southwestern Medical Center.
The concern extends beyond the sport. In a small JAMA cardiology study, researchers found abnormalities in the hearts of 3 out of 4 people who had recovered in more than half from COVID-19 and "persistent myocardial inflammation."
"We're still learning," said Dr. Matthew Martinez, Director of Exercise Cardiology for the Atlantic Health System at Morristown Medical Center in New Jersey. He is a cardiologist for the New York Jets, the NBA Players Association, and Major League Soccer, and a member of the NFL's medical team.
"What we see in early numbers is that the vast majority (of the athletes) are doing well and recovering with no short-term complications, and there is a small percentage who appear to have heart involvement," he said.
College athletes and conferences also consider the issue when considering how to approach autumn sports.
Mikele Colasurdo, a newcomer to Georgia state, announced on social media that he would sit out this season because of what he calls heart disease due to his COVID-19 infection. University of Houston defense attorney Sedrick Williams cited heart complications related to COVID-19 when he decided to suspend his season.
Martinez said more data is needed that the pro leagues and NCAA are collecting right now, including the results that the NBA and WNBA are expected to release over the next several months.
In a May article by JAMA Cardiology, members of the American College of Cardiology's Sports and Exercise Cardiology Council outlined recommendations for determining when athletes who tested positive for COVID-19 can resume physical activity. For example, an athlete with mild symptoms who did not require hospitalization should rest for two weeks and recover after the symptoms have subsided. The athlete should then undergo further examinations and medical tests, including an electrocardiogram. Echocardiogram; and testing for high levels of the blood enzyme troponin, an indicator of heart damage.
On the flip side, athletes who test positive during routine screening but have no symptoms should be rested for two weeks and carefully monitored on their return to the game. They don't necessarily need further investigation if they remain asymptomatic.
Martinez said professional sports leagues and most Power Five conferences – the NCAA's largest soccer conferences – have performed comprehensive heart tests on every athlete exposed to COVID-19.
Levine is a member of the ACC panel that issued the May recommendations and said the group plans to update the guidelines in the near future, taking into account new studies and other information released since spring.
"One of the biggest problems with COVID is not so much the virus itself, but this inflammatory, or 'cytokine storm,' which is a robust and very violent (immune) response to the presence of the virus," he said.
After Heningburg went through his test battery in the Premier Lacrosse League training bladder in Utah, doctors told him that his oxygen saturation was dropping "alarmingly quickly".
"That was the scariest part. I didn't feel it in my body at all," said Heningburg. "The doctors immediately told me you had to go home." I did this to rebuild my lungs. "
He's also spent that time making a difference in the league and in the community. The sophomore has taken an active role in the discussion of racial justice and justice as the founder of the new Black Lacrosse Alliance, which aims, among other things, to improve access to sport for blacks and other people of color.
Heningburg wants to play a leading role in educating people about the dangers of the coronavirus. He knows that his young age and general health likely saved him from the misery and dangers of COVID-19.
"But we've seen trends where it doesn't matter. We've also seen trends where it can be worse for people who are older, smokers, or have pre-existing conditions," he said. "These people should be even more careful."
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A Closer Look at COVID-19 and Cardiac Complications in Athletes (2020, September 11th)
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