Coronavirus disease 2019 (COVID-19) is an acute respiratory disease of various severity caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The cardiovascular system is the second most significant target of COVID-19 and involvement includes acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Reports document that in patients with COVID-19, the incidence of myocardial injury is estimated at 28% and is associated with fatal outcome.4 In the acute phase of myocarditis, exercise may exacerbate viral replication, inflammation, myocardial cell death, arrhythmias, and may adversely affect the outcome leading to morbid complications. Taking into consideration the uncertainties regarding the prevalence of asymptomatic COVID-19 cases in the community, the incidence of myocardial injury in COVID-19 patients with mild symptoms and the long-term outcome of COVID-19, a public health policy is required to guide the return-to-sports decision-making particularly for competitive athletes achieving a higher workload and intense exercise training. The present document provides an algorithm for the evaluation and management of athletes (over 14 years old) following infection from SARS-CoV-2 (Fig. 1) based on expert opinion and taking into account the position statements of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases on the management of myocarditis and of Sport Cardiology Section of the European Association of Preventive Cardiology on the management of athletes with myocarditis.
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