Posicionamento Sobre Avaliação Pré-Participação Cardiológica Após a Covid-19 - Orientações para Retorno à Prática de Exercícios Físicos e Esportes

Por: Sociedade Brasileira de Cardiologia (sbc) (Organizador) e Sociedade Brasileira de Medicina do Exercício e do Esporte (sbmee)) (Organizador).
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.Resumo

O comprometimento cardíaco tem sido descrito como complicação frequente na COVID-19, o que representa um alerta para a necessidade de investigação de lesões miocárdicas, especialmente miocardite, nos indivíduos acometidos pela doença. Dados iniciais relatam alterações eletrocardiográficas, níveis de troponina detectável e achados anormais em ressonância magnética cardíaca até cerca de 70 dias após o diagnóstico da doença, que não se correlacionaram necessariamente com a gravidade do quadro clínico apresentado. Apesar de ainda não sabermos o real significado de tais achados, devemos considerar a possibilidade de que possam representar um substrato arritmogênico durante o esforço, aumentando o risco de morte súbita em esportistas e atletas. Desta forma, torna-se essencial realizar uma avaliação pré-participação cardiológica antes do retorno à prática de exercícios e esportes. Neste documento sugerimos um algoritmo de avaliação para esportistas recreativos, competitivos e atletas na idade adulta, incluindo anamnese, exame físico e ECG para todos. A indicação de outros exames complementares varia conforme a gravidade do quadro clínico prévio da COVID-19, podendo incluir dosagem de níveis séricos de troponina, teste ergométrico ou cardiopulmonar de exercício, ecodopplercardiograma e ressonância magnética cardíaca, sendo a recomendação de avaliação mais abrangente nos esportistas competitivos e atletas. Ressalta-se a necessidade de acompanhamento regular e reavaliação a médio e longo prazo, visto que a evolução tardia da doença ainda é pouco conhecida. Estas recomendações foram elaboradas baseadas em publicações iniciais e experiência clínica que temos até o momento, estando sujeitas a modificações à medida que evolui o conhecimento sobre a COVID-19

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