On March 2020, WHO has declared the coronavirus disease (COVID-19), caused by the virus severe acute respiratory syndrome coronavirus 2 outbreak, a pandemic. Young people can be affected by the disease, and some of them require hospital admission and intensive care. The clinical manifestations of COVID-19 include cardiac involvement and complications, among which are myocarditis (including fulminant cases), arrhythmias and rapid-onset heart failure.1 Since the first cases reported in Wuhan, China, increased levels of serum myocardial biomarkers were found in the sickest patients and associated with worst outcomes. In a series of 41 cases, 12% patients had elevated levels of troponin, indicating myocardial injury.2 Another study showed acute arrhythmias in 17% and acute myocardial injury in 7% of patients with COVID-19.3 In a meta-analysis including six studies with a total of 1527 patients with COVID-19, 8.0% suffered acute cardiac injury with an incidence about 13-fold higher in critically ill patients admitted in intensive care units.4 Increased levels of natriuretic peptides has also been reported in these patients and associated with worst prognostic. We opine that in athletes clinically recovered from a proved infection (even those with mild disease, without cardiac symptoms or hospital admission), a subclinical myocardial injury may be present. We recommend a medical evaluation before the athlete resume trainings, eventually with exams as transthoracic echocardiogram, maximal exercise testing and 24-hour Holter monitoring to exclude subclinical disease.
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