Bronny James and what to know about heart health, COVID-19 and vaccines

On July 24, 18-year-old USC freshman guard Bronny James – the son of Los Angeles Lakers star LeBron James – suffered cardiac arrest during a practice at USC. In January, Buffalo Bills guard Damar Hamlin, then 24, suffered cardiac arrest during a game against the Cincinnati Bengals. In June 2022, then-19-year-old USC freshman center Vince Iwuchukwu suffered a cardiac arrest during a practice session. In June 2021, Danish midfielder Christian Eriksen, then aged 29, suffered a cardiac arrest on the pitch during a Euro 2020 match.

In all four cases, the athletes received immediate care from qualified specialists and survived. Hamlin, Iwuchukwu and Eriksen were all cleared to return to the game – and on Sunday, James made his season debut for USC in an 84-79 overtime loss to Long Beach State, scoring 4 points in 17 minutes action on the bench. .

James' return came after his family announced in August that he had a congenital heart defect that was treatable. Three months later, on November 19, he underwent pre-match warm-ups for the first time, and 11 days later doctors cleared him to return to play. On Thursday, James participated in his first full contact practice for USC.

James' situation – along with that of Hamlin, Iwuchukwu and Eriksen – made international headlines and raised questions in and around the sports and medical communities about heart problems in young, seemingly healthy athletes. Studies have been commissioned by leading specialists, and cardiologists across the country have attempted to address parents' concerns, especially in the age of conspiracy theories and misinformation.

Today, after a year-long pandemic and several rounds of new vaccines and booster shots, cardiologists regularly face questions about the impact of COVID-19 and its vaccines on heart health.

“We see no signs that pre- and post-Covid conditions [cardiac] events are different,” said Dr. Matthew Martinez, director of the Sports Cardiology and Hypertrophic Cardiomyopathy Center at Morristown Medical Center in New Jersey and a consulting cardiologist for the National Basketball Players Association.

“What we're seeing, though, is that more people are being evaluated as a result of COVID, so we're making a diagnosis of underlying congenital heart disease in those who didn't know it. [they had it], such as hypertrophic cardiomyopathy, more frequently than before. And because of the fear of COVID myocarditis, more and more parents and more and more athletes are saying, “Hey, I have these symptoms and it's worrying me,” and they're seeking medical attention. »

Myocarditis is an inflammation of the heart muscle and it can be detected or develop from viral infections or sometimes autoimmune diseases. “These inflammatory mediators get stuck inside the heart muscle and can slow down the heart muscles,” said Dr. David J. Engel, director of the sports cardiology program at NewYork-Presbyterian/Columbia University Irving Medical Center. “And so the pumping force of the heart decreases and people can get very sick from it.”

Hypertrophic cardiomyopathy is an increase in the thickness of the muscles of the heart and, according to Martinez, it is a common genetic heart disease found in about one in 500 people worldwide, according to a 2015 study published in the Journal of the American College of Cardiology. “Most of them live normal lives and die of something else,” said Dr. Steve Ommen, a cardiologist and medical director of the Mayo Clinic Hypertrophic Cardiomyopathy Clinic in Rochester, Minnesota.

However, it is one of the known causes of cardiac arrest, according to Martinez.

Sudden cardiac arrest occurs when the heart beats one minute and then stops beating the next minute, Martinez said, and the only way to get it pumping again is to use an automated external defibrillator (AED), which sends a electric shock to the heart. . (Cardiac arrest is different from a heart attack, which is when the heart arteries become blocked and blood flow to the heart muscle is reduced, resulting in damage to the heart muscle. If this damage are important, they can cause cardiac arrest.)

“This is not a person who was hospitalized with symptoms of chest pain for the last three days or heart failure for the last few weeks, and his condition gets worse and worse, and then he dies.” , Ommen said. “It's 24 hours from the first symptom until they die. And that's usually caused by electrical irregularities in the heart, which make the heart inefficient in the way it pumps.”

In many cases, however, the cause of cardiac arrest is unknown.

In an effort to better understand the heart health of athletes, ESPN interviewed four leading cardiologists, several of whom work with professional and college athletes, and reviewed recent peer-reviewed studies that cardiologists have cited as being fundamental to these questions.

Are athletes at higher risk of heart problems?

“Just the general population? No,” said Dr. Thomas McGarry, an interventional and clinical cardiologist with Oklahoma Heart Hospital Physicians. “But some athletes are at risk.”

McGarry cites a 2023 study of 76 NCAA and professional athletes who had genetic heart conditions and were cleared to return to play. “And out of these 76 individuals, three people had problems, but they all survived because the institutions and/or teams knew what was happening and were able to take care of them very quickly with external defibrillators,” he said. -he declares.

Ommen also notes that, in general, athletes are not at risk for heart problems. “For recreational athletes, the answer is definitely no,” he said. “For those of us who are not professional athletes, more exercise is always better. There are rare diseases like exercise-induced atrial fibrillation, which is an abnormal heart rhythm caused by exercise .So there are a few individuals that we've identified over the last couple of years who have had this on professional sports teams, and have generally been treated for it and returned to action. But it's kind of a rare thing .

Martinez said the same thing. “Exercise is medicine. Exercise is our best blood pressure management, it's our best cholesterol management, it's our best mental health management, it's a stress reliever” , did he declare. “For people under 40, heart risk from the heart is often a congenital problem. But for people over 40, it is acquired heart disease. [heart attacks]. In this group, the best way to prevent sudden cardiac death is through exercise. Exercise therefore does not promote risk; this reduces the risk.

Can a player with myocarditis or hypertrophic cardiomyopathy still play?

It depends.

With myocarditis, “you're going to hold someone down and let that heart muscle heal,” Martinez said. “And then, once that muscle is healed, you're going to do an expert risk stratification assessment – an assessment to determine, in part, the risk of a cardiac event – to see if they've really returned to that minimal level. risk that they had before myocarditis. And we're going to do the same thing with hypertrophic cardiomyopathy.

Other cardiologists have echoed this point. Engel cites guidelines from the American Heart Association and the American College of Cardiology that a player with active myocarditis should refrain from exercise for three to six months and then be reevaluated before returning to play.

“Almost all the time, once the inflammation subsides, the heart muscle remains in good condition,” Engel said. “And if the markers of active inflammation are no longer present, then the athlete can return to play.”

Martinez cites the aforementioned 2023 study he authored that looked at all 76 athletes with genetic heart conditions. This shows that “having an underlying heart condition is not an automatic disqualification, that an athlete with myocarditis or hypertrophic cardiomyopathy can continue to play after careful consideration,” he said.

What, if any, links are there between the COVID-19 virus and heart problems?

According to every cardiologist, the most common link, especially in earlier variants of COVID-19, is myocarditis. That COVID-19 could lead to myocarditis was not unexpected, they say, because myocarditis can often be caused by viral infections.

“Viruses have been causing myocarditis for as long as we have known anything about viruses, and the COVID virus is no different,” Martinez said. “COVID is one of the viruses that can cause myocarditis. There was myocarditis before COVID, there will be myocarditis after COVID.”

A 2021 study published in JAMA Cardiology — which Martinez helped author — examined 789 professional athletes infected with COVID-19 who underwent post-COVID cardiac testing as recommended by the American College of Cardiology. Among this group, the prevalence of myocarditis was low: approximately 0.6%.

In an April 2021 national study published in the American Heart Association's journal Circulation, which examined 3,018 college athletes who tested positive for COVID-19 and underwent cardiac evaluation, heart problems were detected in 21 – or 0.7% – of these athletes.

“It’s not a strong connection,” Engel said.

What, if any, links are there between the COVID-19 vaccine and heart problems?

The four cardiologists say heart problems are more likely to result from a COVID-19 viral infection than from vaccines. Citing a 2023 peer-reviewed study in the international scientific journal Biomedicines, Martinez and Engel note that the rate of people receiving a COVID-19 vaccine and then suffering myocarditis is 30 in 100,000, or 0. 03%.

“Concern about myocarditis should not be a justification for not taking the vaccine, because the incidence of myocarditis after the COVID vaccine is exceptionally low,” Engel said.