Florida star collapses on court

[LasVegas]

This is extremely likely related to an undiagnosed cardiovascular condition—hypertrophic cardiomyopathy. Many unfortunate instances in the past (e.g. Hank Gathers). Perhaps a new drug with an FDA NDA in 2021 from BMS, who gained the rights from its acquiisition of MyoKardia this year, may be used with success.

Well based on articles I have read, players get a echo before being cleared to play after a covid infection.

http://https://www.gatorsports.com/story/football/2020/10/23/stricklin-says-covid-19-positive-uf-athletes-receive-medical-evaluation-prior-return/3743313001/

[Tooold]

Well based on articles I have read, players get a echo before being cleared to play after a covid infection.

http://https://www.gatorsports.com/story/football/2020/10/23/stricklin-says-covid-19-positive-uf-athletes-receive-medical-evaluation-prior-return/3743313001/

Full disclosure...I am not a doctor. So I hope someone (like RSV) will weigh in on this if I am misinterpreting recent studies. But I have read that the best way to diagnose myocarditis (which could be a consequence of CoVid and could result in a cardiac episode) is through a Cardiac MRI. The UF protocol includes an echo, which I don’t believe is as accurate in assessing inflammation as an MRI. And while the troponin-level test could provide more information and help flag those who might have myocarditis, they are still studying the correlation with troponin levels and when exactly it is safe to return to intense athletic activity. There is still a lot to learn. (Just one reason I personally think we should hold off on college athletics).

[-jk]

Full disclosure...I am not a doctor. So I hope someone (like RSV) will weigh in on this if I am misinterpreting recent studies. But I have read that the best way to diagnose myocarditis (which could be a consequence of CoVid and could result in a cardiac episode) is through a Cardiac MRI. The UF protocol includes an echo, which I don’t believe is as accurate in assessing inflammation as an MRI. And while the troponin-level test could provide more information and help flag those who might have myocarditis, they are still studying the correlation with troponin levels and when exactly it is safe to return to intense athletic activity. There is still a lot to learn. (Just one reason I personally think we should hold off on college athletics).

Hmm. We need a good cardiologist. Anyone know one hanging around a nearby microbrewery?

-jk

[jv001]

Hmm. We need a good cardiologist. Anyone know one hanging around a nearby microbrewery?

-jk

Hm, maybe our good friend is still opening his Christmas presents?

GoDuke!

[Tripping William]

Hmm. We need a good cardiologist. Anyone know one hanging around a nearby microbrewery?

-jk

ClemmonsDevil does.

[LasVegas]

Full disclosure...I am not a doctor. So I hope someone (like RSV) will weigh in on this if I am misinterpreting recent studies. But I have read that the best way to diagnose myocarditis (which could be a consequence of CoVid and could result in a cardiac episode) is through a Cardiac MRI. The UF protocol includes an echo, which I don’t believe is as accurate in assessing inflammation as an MRI. And while the troponin-level test could provide more information and help flag those who might have myocarditis, they are still studying the correlation with troponin levels and when exactly it is safe to return to intense athletic activity. There is still a lot to learn. (Just one reason I personally think we should hold off on college athletics).

Sorry, should of been more clear. I was responding to the poster who said hypertrophic cardiomyopathy which I believe is found on an echo. I’m unsure about myocarditis.

[richardjackson199]

This is extremely likely related to an undiagnosed cardiovascular condition—hypertrophic cardiomyopathy. Many unfortunate instances in the past (e.g. Hank Gathers). Perhaps a new drug with an FDA NDA in 2021 from BMS, who gained the rights from its acquiisition of MyoKardia this year, may be used with success.

What makes you say "this is extremely likely related to undiagnosed hypertrophic cardiomyopathy?"

If it is, then they would have diagnosed that by now after this incident.

Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic condition causing the walls and septum of the myocardium to contract harder and become thicker than normal. The hypertrophied septum can form an obstruction with the anterior leaflet of the mitral valve causing obstruction of blood out of the left ventricle of heart to the body. The characteristic hypertrophied septum (thickening of the heart wall) is usually visible on echo (ultrasound), and it can be diagnosed that way.

I would think that if he had HOCM, they would easily be able to diagnose that with imaging like echo, stress echo, or certainly a cardiac MRI which may not even be needed. Having HOCM - a pre-existing genetic medical disorder, would make you be able to say this could be less likely related to post-COVID because here we have diagnosed a medical condition which is known to cause this in young athletes. Sure the post COVID could conceivably make it worse. But I'm sure that the presence/absence of HOCM could easily be investigated and ruled in or out.

If it's ruled out, well then something else would be more responsible for causing this. Could that be sequelae from myocarditis post Covid? I don't know. But I haven't heard anything from this case to suggest they have diagnosed him with HOCM. And it's safe to assume that was checked for and ruled in or ruled out with imaging.

I will defer to cardiologists or anyone with more knowledge on all this. Please correct any faulty assumptions I'm making. I did get through medical school, and they liked asking us questions about things like this that can cause young people to suddenly die. It's important for any doctor to learn/know.

It's important to rule in and rule out what possible things did and did not contribute to this outcome if that could help prevent a similar outcome in the future. It is safe to assume that is being done, but I have not heard that this player was diagnosed with HOCM. And until/unless we hear that, you better believe post-covid myocarditis is on their differential diagnosis as a possible contributor.

[rsvman]

I am not a cardiologist, and certainly other young, apparently healthy young basketball players have collapsed at various times in the past (not a frequent occurrence), given that SARS-CoV-2 has been associated with cardiac effects and vascular effects, I think they are wise to consider whether the antecedent infection may have been related to this event.

Having said that, I don’t know of any way they would be able to determine that definitively. And it may be that the only way we will know is if more athletes who have apparently recovered completely from Covid (and even had normal EKGs and echocardiograms before returning to the playing field) collapse. If these events start becoming much more common than they were in the past, and they are occurring in athletes with a history of Covid (or with positive antibodies titers), then we will be able to say that it is likely related. Obviously, I’d hate to see it come to that.

I have no idea whether the current case is related to Covid, but it certainly wouldn’t be fair to say it isn’t just because other athletes have collapsed in the past.

[devildeac]

Hmm. We need a good cardiologist. Anyone know one hanging around a nearby microbrewery?

-jk

Nah, not safe; hadn't done that since a meet-up at Compass Rose with a bunch of the Ymm, Beer knurds in early October. We stood in line staying about 6 feet apart while we got our brews and then the 5 of us ate at about a 14 foot wooden table outside and put our masks back on immediately after eating, only sliding them down/off to finish our beers. (TMI but I know *someone* will complain...)

Oh, wait, you said good cardiologist.

I'll give it a whirl here as the articles/data I've kept current with are widely variant from slight troponin elevations (a lab biomarker for cardiac damage) to very large increases in the sickest folks with a Lancet (or British Medical/Heart Journal) article stating nearly 80% of COVID patients had heart "involvement." This lab test is ordered almost as frequently as chemistry profiles, blood counts, ecgs and urinalyses; very sensitive and specific but can be abnormal in a number of other clinical situations (congestive heart failure, accelerated/malignant hypertension, chronic kidney disease, sepsis and other forms of shock) without an actual "heart attack," aka a myocardial infarction (or infraction if you're a DBR miscreant). A number of viruses can cause varying degrees of pericarditis or myocarditis and, most seriously/dangerously, myopericarditis. The list includes Coxsackieviruses, echoviruses, influenza viruses, adenoviruses, mumps virus, human immunodeficiency virus (HIV) and viruses that cause hepatitis; and, of course now, coronaviruses.

With this particular person/case/patient in COVID times, the coronavirus certainly becomes a (very?) likely explanation for his collapse, most probably from a cardiac dysrhythmia secondary to an inflammatory cardiac condition. His prior cardiac status/health would need to be known with an athletic history and physical exam, possibly an ecg and even an echocardiogram based on his ecg and/or any cardiac symptoms he may have mentioned. A family history would also be very valuable. With this paragraph, my differential diagnoses include inherited abnormal cardiac rhythms and/or various familial cardiomyopathies (disorders of cardiac muscle). In this particular (or any similar) situation, a cardiac MRI would be imperative in addition to all the above.

Obviously, this is a rather brief overview and I hope it has helped the discussion here.

Thanks for the "call-out,' -jk.

[devildeac]

Hm, maybe our good friend is still opening his Christmas presents?

GoDuke!

Nah, slept in a bit and then cooked breakfast for our (COVID -) younger daughter and her husband. Just sat down to DBR about 30 minutes ago, catching up on Ymm, Beer first, of course.

[devildeac]

Well based on articles I have read, players get a echo before being cleared to play after a covid infection.

http://https://www.gatorsports.com/story/football/2020/10/23/stricklin-says-covid-19-positive-uf-athletes-receive-medical-evaluation-prior-return/3743313001/

Makes 110% sense.

[devildeac]

ClemmonsDevil does.

So do you/I.

[devildeac]

Sorry, should of been more clear. I was responding to the poster who said hypertrophic cardiomyopathy which I believe is found on an echo. I’m unsure about myocarditis.

The history and physical exam might give you clues to the hypertrophic CM. An ecg would be extremely helpful but you'd need an echo (or cardiac CT or MRI) for the definitive diagnosis of hypertrophic CM.

Myocarditis not likely to be diagnosed with echo unless it's fulminant and decreased cardiac function has occurred; even then, it would likely only be "highly suspected." Myocarditis would require a cardiac MRI, looking for tissue involvement/inflammation/dysfunction.

[devildeac]

What makes you say "this is extremely likely related to undiagnosed hypertrophic cardiomyopathy?"

If it is, then they would have diagnosed that by now after this incident.

Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic condition causing the walls and septum of the myocardium to contract harder and become thicker than normal. The hypertrophied septum can form an obstruction with the anterior leaflet of the mitral valve causing obstruction of blood out of the left ventricle of heart to the body. The characteristic hypertrophied septum (thickening of the heart wall) is usually visible on echo (ultrasound), and it can be diagnosed that way.

I would think that if he had HOCM, they would easily be able to diagnose that with imaging like echo, stress echo, or certainly a cardiac MRI which may not even be needed. Having HOCM - a pre-existing genetic medical disorder, would make you be able to say this could be less likely related to post-COVID because here we have diagnosed a medical condition which is known to cause this in young athletes. Sure the post COVID could conceivably make it worse. But I'm sure that the presence/absence of HOCM could easily be investigated and ruled in or out.

If it's ruled out, well then something else would be more responsible for causing this. Could that be sequelae from myocarditis post Covid? I don't know. But I haven't heard anything from this case to suggest they have diagnosed him with HOCM. And it's safe to assume that was checked for and ruled in or ruled out with imaging.

I will defer to cardiologists or anyone with more knowledge on all this. Please correct any faulty assumptions I'm making. I did get through medical school, and they liked asking us questions about things like this that can cause young people to suddenly die. It's important for any doctor to learn/know.

It's important to rule in and rule out what possible things did and did not contribute to this outcome if that could help prevent a similar outcome in the future. It is safe to assume that is being done, but I have not heard that this player was diagnosed with HOCM. And until/unless we hear that, you better believe post-covid myocarditis is on their differential diagnosis as a possible contributor.

Damn, I coulda saved myself a lot of typing if I'd read RJ199's post before typing all my responses.

[JasonEvans]

Based on frb's post on the women's thread that got taken down after being flamed by a lot of people, I think his/her meaning is extremely clear.

You shall not be hearing from him/her again... ever... on the DBR.

[Pghdukie]

Various outlets are reporting that Keyontae Johnson was back at practice - only as a visitor tho. Still good new for the Florida team and very heartwarming for Johnson

[mike88]

Nah, not safe; hadn't done that since a meet-up at Compass Rose with a bunch of the Ymm, Beer knurds in early October. We stood in line staying about 6 feet apart while we got our brews and then the 5 of us ate at about a 14 foot wooden table outside and put our masks back on immediately after eating, only sliding them down/off to finish our beers. (TMI but I know *someone* will complain...)

Oh, wait, you said good cardiologist.

I'll give it a whirl here as the articles/data I've kept current with are widely variant from slight troponin elevations (a lab biomarker for cardiac damage) to very large increases in the sickest folks with a Lancet (or British Medical/Heart Journal) article stating nearly 80% of COVID patients had heart "involvement." This lab test is ordered almost as frequently as chemistry profiles, blood counts, ecgs and urinalyses; very sensitive and specific but can be abnormal in a number of other clinical situations (congestive heart failure, accelerated/malignant hypertension, chronic kidney disease, sepsis and other forms of shock) without an actual "heart attack," aka a myocardial infarction (or infraction if you're a DBR miscreant). A number of viruses can cause varying degrees of pericarditis or myocarditis and, most seriously/dangerously, myopericarditis. The list includes Coxsackieviruses, echoviruses, influenza viruses, adenoviruses, mumps virus, human immunodeficiency virus (HIV) and viruses that cause hepatitis; and, of course now, coronaviruses.

With this particular person/case/patient in COVID times, the coronavirus certainly becomes a (very?) likely explanation for his collapse, most probably from a cardiac dysrhythmia secondary to an inflammatory cardiac condition. His prior cardiac status/health would need to be known with an athletic history and physical exam, possibly an ecg and even an echocardiogram based on his ecg and/or any cardiac symptoms he may have mentioned. A family history would also be very valuable. With this paragraph, my differential diagnoses include inherited abnormal cardiac rhythms and/or various familial cardiomyopathies (disorders of cardiac muscle). In this particular (or any similar) situation, a cardiac MRI would be imperative in addition to all the above.

Obviously, this is a rather brief overview and I hope it has helped the discussion here.

Thanks for the "call-out,' -jk.

That is a really nice summary - just a couple of things to add: much of the literature to date about COVID-related cardiovascular complications comes from older non-athletes (not surprisingly, since they are much more likely to come to medical attention and/or hospitalization) so we really don't know the frequency in younger adult athletes. I don't know any more details about Keyontae Johnson's particular circumstances, other than he seems to have had relatively mild COVID in the Summer, and that it is likely that he received some evaluation (per UF return to play policies) before resuming basketball. Unless another explanation has been identified, I would be concerned that a ventricular arrhythmia secondary to a recent infection is quite likely as the cause of his "collapse".

Troponin levels, 12 lead EKG, and echocardiography are not sufficiently sensitive to rule out myocarditis, but whether all young athletes like KJ should receive cardiac MR before return to play after COVID isn't clear- that depends on both the frequency of cardiac inflammation and whether and to what extent we (as medical professionals) are willing to exclude from participation those who show signs of cardiac inflammation in order to try to prevent what is probably a rare, but terrible, possible consequence. Hopefully, we will learn more soon, but right now (for those who are interested) JAMA Cardiology has a good review from late October on these issues: Kim JH, Levine BD, Phelan D, et al. Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play.

[Tooold]

Troponin levels, 12 lead EKG, and echocardiography are not sufficiently sensitive to rule out myocarditis, but whether all young athletes like KJ should receive cardiac MR before return to play after COVID isn't clear- that depends on both the frequency of cardiac inflammation and whether and to what extent we (as medical professionals) are willing to exclude from participation those who show signs of cardiac inflammation in order to try to prevent what is probably a rare, but terrible, possible consequence. Hopefully, we will learn more soon, but right now (for those who are interested) JAMA Cardiology has a good review from late October on these issues: Kim JH, Levine BD, Phelan D, et al. Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play.

Thank for this informative summary. I actually read the JAMA review a while ago...it is really interesting (even though I am not a doctor). It just further shows that we have a lot to learn about 1) how many CoVid patients actually get myocarditis 2) what that means in terms of long term effects (does it get better on its own, and how long does that take...) 3) how to figure out when it is actually safe for an athlete (young or old) to return to full activity.

One possible positive outcome from this pandemic is that hopefully we will learn a lot that we can use for other viral infections in the future, including how to assess the safest time for athletes to return to full activity.

[DangerDevil]

Various outlets are reporting that Keyontae Johnson was back at practice - only as a visitor tho. Still good new for the Florida team and very heartwarming for Johnson

Like PGH said, Johnson isn’t back practicing as a player but he was back at practice and contributing to the team.

https://www.espn.com/mens-college-ba...-amid-recovery

“Florida forward Keyontae Johnson is back with the team and working as a coach in practice, coach Mike White said Monday.”

“White said "I have no idea" whether Johnson will be able to play again this season, and he added that "even if I did, I couldn't talk about it" because of privacy laws.

"Right now he's really eager to help with scouting and coaching," White said.”

[DukieInKansas]

Update from his family: https://www.espn.com/mens-college-ba...19-family-says

From the article: "University of Florida Health treating physicians consulted with other local and national experts who reviewed the relevant imaging and testing related to this case," the family's statement said. "The unanimous conclusion of all experts is that Keyontae's medical emergency was not related to or a result of a previous or current Covid diagnosis."

Just an FYI


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