Myocarditis Exercise Recommendations

young athlete
young athlete. Henrik Sorensen/Getty Images

Myocarditis is an inflammation of the heart muscle, and is one of the cardiac conditions associated with sudden death in young athletes. Fortunately myocarditis is uncommon in young people. When it occurs, however, it often produces no symptoms early on. This means that a young athlete with myocarditis will often feel well enough to compete, and will be entirely unaware that they have a medical problem.

Young athletes who have been diagnosed with myocarditis must be significantly restricted in their athletic activities.

What Is Myocarditis?

Myocarditis is an inflammatory disease affecting the heart muscle. Myocarditis can be caused by numerous underlying conditions including infections (such as the Coxsackie virus, toxoplasmosis, and Lyme disease), various autoimmune diseases (such as lupus), and reactions to various toxins and drugs (such as to cocaine). In more than a few cases no specific underlying cause can be found, in which case the myocarditis is said to be “idiopathic.”

Symptoms can vary tremendously in patients with myocarditis, depending largely on the degree of inflammation present in the heart and the amount of heart muscle damaged by the inflammation.

When myocarditis is severe and affects a large portion of the heart muscle, it can produce overt cardiomyopathy and heart failure.

On the other hand, myocarditis may affect only small portions of the heart muscle, with only very mild symptoms. Myocarditis may occur as a very acute illness, or it may produce a chronic, smoldering illness.

If heart failure occurs it is usually accompanied by all the typical symptoms of heart failure, including dyspnea, fatigue, weakness, and edema (swelling).

Milder cases may produce symptoms that are much less pronounced, such as mild weakness or easy fatiguability. And some cases of myocarditis may produce no particular symptoms at all.

How Is Myocarditis Diagnosed?

Myocarditis is typically diagnosed when a patient sees a doctor for symptoms that indicate a possible heart problem (typically, dyspnea, fatigue or edema), or if signs of a heart problem are uncovered on routine testing, such as with an electrocardiogram (ECG)

How is Myocarditis Treated?

The treatment of myocarditis depends to a large extent on the underlying disease which is producing inflammation of the heart muscle. The primary therapy needs to be directed toward the underlying condition. If heart failure is present, or if the heart muscle appears to be weakening, therapy is also specifically directed toward treating the heart failure.

Exercise Recommendations For Young Athletes With Myocarditis

Young athletes with mild myocarditis, who may have only "mild" symptoms and who feel well enough to exercise, are those most prone to sudden death during athletic events. Sadly, because in such cases there is usually no reason for a doctor to perform an echocardiogram or an ECG — tests that might give clues that heart inflammation is present — these individuals rarely receive a diagnosis before their fatal event.

Once their symptoms progress to the point that they can no longer be ignored, getting the correct diagnosis becomes much more likely. When a diagnosis of myocarditis is made in a young athlete, it is strongly recommended that they completely avoid all competitive sports for at least six months, only resuming thereafter if cardiac tests show complete recovery.


Maron, BJ, Ackerman, MJ, Nishimura, RA, et al. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 2005; 45:1340

Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34:2636.

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