Cardiac Sequelae of COVID-19 in Children and Young Adults

Coronavirus disease 2019 (COVID-19) has a predilection to cardiac involvement. The early clinical phase, during viremia, may manifest as pericarditis, acute myocarditis, and sepsis-related cardiomyopathy. Delayed presentations, such as multisystem inflammatory syndrome in children, coronary artery dilation/aneurysms, and late myocarditis, may occur in the weeks after the acute infection. These delayed presentations commonly test negative for severe acute respiratory syndrome coronavirus 2 via polymerase chain reaction testing and are thought to be primarily postviral hyperinflammatory sequelae. The long-term consequences of cardiac involvement in COVID-19 are unknown. Most recommendations for cardiac management are based on known conditions that are similar. For example, coronary aneurysms can be managed under Kawasaki disease guidelines. Similarly, for patients with COVID-19 myocarditis, they can be cleared for sports under protocols for other types of myocarditis. There is concern for cardiac involvement as a subclinical entity even in more minor presentations. Several expert algorithms have been developed for clearing competition athletes to return to exercise. Sports clearance should be individualized considering the severity of disease, age of patient, and performance level of the sport.