Heart damage in college athletes after COVID-19 infection | Norton Healthcare Louisville, Ky.

Heart damage in college athletes after COVID-19 infection

Program aims to help student-athletes after COVID-19 recovery

A collaboration between Norton Healthcare, the University of Louisville and Bellarmine University aims to evaluate student-athletes for heart damage after having the COVID-19 virus.

Norton Healthcare is uniquely positioned to facilitate this partnership: Norton Sports Health is the official health care provider of the Louisville Cardinals and the official sports health provider for Bellarmine University athletics.

Scotty Newcomer, D.O., sports medicine physician with Norton Orthopedic Institute and Norton Sports Health, serves as the program’s liaison with the University of Louisville. Robin G. Curry, M.D., sports medicine physician with Norton Orthopedic Institute and Norton Sports Health, serves as the liaison with Bellarmine University. When needed, this team works to connect athletes to Norton Healthcare’s network of specialty care, like cardiology services provided by Norton Heart & Vascular Institute.

The aftermath of COVID-19

“Obviously, COVID-19 has thrown everybody for a loop. But we are learning more every day,” said Mostafa O. El-Refai, M.D., M.S., MBA, interventional cardiologist with Norton Heart & Vascular Institute.

We do know, however, that COVID-19 can damage your heart, even if you haven’t had severe symptoms, according to Dr. El-Refai.

Dr. El-Refai spearheads the efforts to test college athletes from the University of Louisville and Bellarmine University for signs of heart damage — specifically, myocarditis (inflammation in the heart muscle).

If myocarditis is left untreated, “it can lead to long-term scarring, which could weaken the heart muscle and lead to more long-term effects,” Dr. El-Refai said. “The goal is to let the heart rest while it is inflamed so that it heals appropriately and is back to baseline.”

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With two recent studies showing a large number of post-COVID-19 patients with some changes on cardiac magnetic resonance imaging (MRI) scans, due diligence is necessary to ensure the safety of these young, competitive athletes. Dr. El-Refai and Norton Sports Health physicians who work with the two universities developed a protocol that would safely screen student-athletes for possible heart disease.

“It includes an EKG [electrocardiogram], an echocardiogram and a troponin test, which measures heart enzymes,” Dr. El-Refai said. “They also are tested for two markers of inflammation — CRP [C-reactive protein] and ESR [erythrocyte sedimentation rate]. If those enzymes are high, it can mean there is inflammation in the heart.

“Our Norton Sports Health multidisciplinary and multiprofessional team has been amazing; they’ve helped us make it a one-stop shop. Athletes come in and get all those tests at once. We interpret them same day, and then the team doctors have the results by the next morning.”

Invincible youth

It’s hard to tell an otherwise healthy 19-year-old who is used to high physical performance to rest, especially when they don’t have any pain or other severe symptoms, according to Dr. El-Refai.

“We remind them their test results suggest that there might be inflammation, so we don’t want to do more damage,” he said. “We need you to rest. This is not the time to tough it out.”

If the athlete’s symptoms are more severe, the athlete could require hospitalization and advanced therapies. Fortunately, the majority have tolerated the condition well. Patients also are triaged to other specialists if needed.

“If we rule out heart issues, but they’re having shortness of breath, they are sent to a pulmonologist,” Dr. El-Refai said. “If they’re having dizziness, they are sent to neurology. The point people, like Dr. Newcomer and Dr. Curry, are the overseers of their general health, and if things arise, they send them to the appropriate providers in the various specialties.”

“We will continue to adapt as new data and national guidance arises. Each and every team member is invested in the well-being of the young athletes in our community,” Dr. El-Refai said. “We take their care very seriously.”


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Norton Sports Health is the official health care provider of the Louisville Cardinals and the official sports health provider of Bellarmine University.

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