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Major League Baseball (MLB) has had a tough opening week. The Miami Marlins had at least 11 players and two coaches test positive over the past few days. This led to a cancellation to not only the Marlins’ home opener, but also additional games between teams that had exposure to the Marlins. Adding insult to injury, the outbreak has left the team stranded in Philadelphia.

Also from MLB comes the story of Eduardo Rodriquez, a 27 year old pitcher for the Boston Red Sox and a breakout star in 2019. He had tested positive for COVID-19 before the start of summer camp, but he was cleared and returned to workouts on July 18. He has not had another positive coronavirus test. However, an MRI revealed an inflammation of the heart muscle called myocarditis. This type of inflammation can lead to arrhythmias, cardiomyopathy or heart failure.

Myocarditis from a viral infection isn’t unheard of and may be somewhat more common than we think. As early as the 1960s, a link was suggested by seroepidemiologic studies between viral infection and myocarditis. Since that time, approximately 20 viruses have been implicated in such. Classically implicated are coxsackieviruses named after a small New York town along the Hudson River – a story for another time.

It is difficult to estimate how often a viral infection will lead to myocarditis. In early studies, cardiac involvement was suspected to occur in 3.5 to 5 percent of patients during outbreaks of Coxsackievirus infection. But the true incidence of “viral” myocarditis in the general population is unknown.

Cardiac involvement seems to be common in patients with COVID-19, even months after diagnosis, according to two recently published research papers in JAMA Cardiology.

In one study (MRI Study Link below), 100 randomly selected patients who had recovered from COVID-19 underwent cardiac magnetic resonance imaging (MRI), Generally this testing occurred about two and a half months after having tested positive. At the time of MRI, 20% reported chest pain or palpitations, and over one third said they had ongoing shortness of breath. Overall, 78% had abnormal MRI findings, regardless of preexisting conditions, COVID-19 severity, or cardiac symptoms. In particular, some 60% showed cardiac inflammation. The part I find astonishing about this study is, upon closer read, these patients do appear to be truly randomly selected (although 20% did report active cardiac symptoms and 33% with shortness of breath which seems unusual so far out from infection). If this is indeed the case, then this study has worrisome implications for the population at large

In a second study (Autopsy Study Link below), researchers examined cardiac tissue from 39 patients who died from COVID-19. Genetic material from the virus – RNA – was found in the myocardium in 62% of the cases. In the five patients with the highest viral load, there was evidence that the virus was in fact replicating within the heart tissue.

The accompanying editorial warns that “the crisis of COVID-19 will not abate but will instead shift to a new … incidence of heart failure and other chronic cardiovascular complications.”

Links:

https://www.espn.com/mlb/story/_/id/29542729/red-sox-eduardo-rodriguez-awaits-heart-test-results?fbclid=IwAR29a0E4Ckt5H3kqoVGW-Ix5cbL4TwiG-sz9zIsn9dXDbaTWbuS4jwksB0g

https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916?fbclid=IwAR1AZXELTwqNxHUVQQHim8nbtslVyq0TuUbWuU4yVZXQ1Ea3zeOVmQF7xes

https://jamanetwork.com/journals/jamacardiology/fullarticle/2768914?fbclid=IwAR2ElVBNhVw3oIaJOxMrmpuwGJ9Wo91DffjstlTXZOftVDAKq0LlCpc8xAQ

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