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Big Ten Medical Report Details Serious Cardio Concerns

Paul Steinbach

A medical bulletin dated Aug. 11 likely played a major role in the Big Ten Conference's decision that same day to postpone its fall sports.

Part of a five-page document obtained by Sports Illustrated, the bulletin titled "Cardiovascular Evaluation and Recommendations for Returning to Full Practice and Competition Following COVID-19 Infection/Testing Protecting the Safety of Big Ten Student Athletes," was prepared by three cardiologists — Lawrence D. Rink, who works with Indiana's athletic department, Michael S. Emery from the Cleveland Clinic, and Eugene H. Chung from the University of Michigan. It raised concerns about myocarditis and other cardiovascular issues related to the COVID-19 virus and its unknown risks to college athletes playing sports this fall.

The Big Ten and Pac-12 are the only two Power 5 conferences to postpone their fall seasons so far, with the SEC, ACC and Big 12 preparing to push ahead.

"While there is general agreement among sports cardiology experts to increase the level of scrutiny for potential cardiac involvement in athletes who have or are recovering from COVID-19, there are conflicting recommendations with regards to which athletes to test, the extent of cardiac testing, and convalescent periods," the bulletin states.

According to SI, the report referenced a study conducted from 100 recently recovered patients from COVID-19. The median age was 49 years old with the median time interval between COVID-19 diagnosis and cardiac MRI of 71 days. The results were that 67 percent of patients recovered at home rather than needing hospitalization, including 18 asymptomatic patients. High sensitivity Troponin — a sensitive marker for cardiac cellular injury — was detected in 71 percent of the patients and cardiac MRI revealed evidence of cardiac inflammation and/or scarring in 78 percent of the patients.

"These studies demonstrate that cardiac injury can occur in less ill and even asymptomatic people with COVID-19 and requires due diligence on cardiac assessment and thoughtful consideration for longitudinal care. While these studies may not be completely applicable to university athletes, we must exercise extreme caution given the level of heightened concern for myocardial involvement and the potential implications of sudden cardiac death in athletes with myocarditis."

The report outlines current cardiac recommendations for athletes who are asymptomatic and athletes who are very symptomatic. They can be viewed here.

After the Big Ten announced that it was postponing the fall football season, league commissioner Kevin Warren was asked about the emerging information of myocarditis, and he said the uncertainly over its affects on athletes warranted further conversations.

'There has been a lot of discussion about myocarditis, so there has been discussion as of late," Warren said. "That's not the primary reason. All of those items from a medical standpoint, you have to consider. 

"I know there's been a lot of discussion about that, but overall when it comes down to it, it's just the litany of things that created this state of uncertainty that we need more clarity on from a health, wellness and medical standpoint."

On Thursday morning, the NCAA's chief medical officer and two primary infectious disease advisers said they don't think fall sports should happen.

"I feel like the Titanic. We have hit the iceberg, and we're trying to make decisions of what time should we have the band play," said Carlos Del Rio, who serves on an NCAA COVID-19 advisory panel. "We need to focus on what's important. What's important right now is we need to control this virus. Not having fall sports this year, in controlling this virus, would be to me, the No. 1 priority.

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