A stepwise return-to-exercise strategy and high-dose corticosteroids enabled a 21-year-old athlete with fulminant myocarditis to safely resume unrestricted exercise 3 months after presentation.
Case Report (n=1)
Individualized, shared decision-making can guide a safe return to exercise in athletes recovering from performance-enhancing drug-associated myocarditis.
BACKGROUND: Current guidelines on activity restriction in myocarditis carry significant implications for athletes. CASE SUMMARY: We present a case of fulminant myocarditis in a 21-year-old athlete after performance-enhancing drug use. He presented with chest pain and dyspnea with ST-segment elevations on electrocardiogram. Coronary angiography was normal, and cardiac magnetic resonance confirmed myocarditis. His course was complicated by cardiogenic shock requiring inotropic support but improved with diuresis and high-dose corticosteroids. A shared decision-making approach guided a stepwise return-to-exercise strategy based on symptoms, biomarkers, cardiac magnetic resonance, and exercise stress testing. The patient gradually resumed training and returned to unrestricted exercise 3 months after presentation. DISCUSSION: This case demonstrates the value of individualized, shared decision-making for management of myocarditis in athletes. TAKE-HOME MESSAGES: Individualized, guideline-informed return-to-exercise strategies help balance safety with athlete goals after myocarditis. Screening for performance-enhancing drug exposure is essential because these agents may represent an underrecognized contributor to myocarditis.
Parks et al. (Thu,) conducted a case report in Fulminant myocarditis associated with performance-enhancing drug use (n=1). Stepwise return-to-exercise strategy and high-dose corticosteroids was evaluated on Return to unrestricted exercise. A stepwise return-to-exercise strategy and high-dose corticosteroids enabled a 21-year-old athlete with fulminant myocarditis to safely resume unrestricted exercise 3 months after presentation.