Abstract
Myocarditis is among the causes of arrhythmic sudden cardiac death (SCD) in young athletes, with viral infection being the most common cause worldwide. Myocarditis recently has been reported as one of the cardiac complications of coronavirus disease 2019 (COVID-19) in athletes. Here we present a case of a 20-year-old male recreational soccer player with an episode of loss of consciousness in the context of respiratory infection. The patient reports having woken up with symptoms of an upper respiratory tract infection, and after playing a soccer match, he developed dizziness and a headache. He then suffered vasovagal syncope without loss of sphincter control. Physical examination, heart auscultation, peripheral and carotid pulses, and blood, microbiological/serological tests result on admission were normal. Moreover, no jugular engorgement at 45º, malleolar edema, or other heart failure signs were found. The 12-lead electrocardiogram (ECG), echocardiogram, 24-hour Holter-ECG did not reveal any significant finding. A cardiac magnetic resonance (CMR) was finally performed, revealing an abnormal signal increase was observed at the apical level in the short-tau inversion-recovery (STIR) and 4-chamber sequences. In addition, a pattern of apical fibrosis was observed in 4- and 2-chamber and short-axis late enhancement sequences for assessment of myocardial viability confirming the diagnosis of myocarditis. In athletes with suspected myocarditis, CMR seems to be a useful diagnostic tool, with excellent sensitivity for detecting inflammation, myocardial edema, and/or focal scarring.