Dear all, after a week or two of serious illness a respiratory illness can leave residual lung abnormalities (permanent or slowly resolving), loss of skeletal muscle (from lying in bed mostly, rarely from viral myositis), and in rare cases heart dysfunction.
Cardiac MRI is *not* the way to tease these apart.
Far more helpful could be exercise testing. This will help confirm the degree of limitation and whether there is an arrhythmic risk at high exercise levels.
Far more helpful could be exercise testing. This will help confirm the degree of limitation and whether there is an arrhythmic risk at high exercise levels.
It is an approach commonly used in patients with heart failure or recent heart attacks to determine how much exercise is safe for them to do while they are rehabilitating.
The same approach seems reasonable to me in people at far lower risk of cardiac complications like athletes post COVID.
We don't do MRI in everyone with a heart attack before they can go back to exercise. Why should we do that for people at much lower cardiac risk?
We don't do MRI in everyone with a heart attack before they can go back to exercise. Why should we do that for people at much lower cardiac risk?
Sometimes, exercise testing can be coupled with measuring the oxygen you inhale and CO2 you exhale and even echocardiogram during exercise to get lots of insight into whether limitations are from lungs, heart or skeletal muscle.
Why is all this necessary?
Because all three organs (lungs, heart, skeletal muscle) can cause windedness with exercise.
With a respiratory virus the likelihood first is the lungs, but skeletal muscle is also commonly an issue.
The heart is much less commonly so.
Because all three organs (lungs, heart, skeletal muscle) can cause windedness with exercise.
With a respiratory virus the likelihood first is the lungs, but skeletal muscle is also commonly an issue.
The heart is much less commonly so.
Sometimes people just want to identify the source. This can give piece of mind to some people. For others it can guide a training regimen to optimize performance.
It can also help guide a safe level of exercise.
It can also help guide a safe level of exercise.
There is a ton of scientific literature and clinical experience on exercise testing to guide exercise prescriptions.
By contrast, there is almost no literature on what the medical treatment of subtle abnormalities on cardiac MRI should be.
I'm all for research into this, but we shouldn't view it as something that is appropriate to apply to broad swaths of people outside of research.
I'm all for research into this, but we shouldn't view it as something that is appropriate to apply to broad swaths of people outside of research.
As @VPrasadMDMPH has pointed out, in the COVID19 era, we seem to eager to apply unproven tx to patients outside of proper research studies.
Let's not make that mistake again for cardiac MRI!
Let's not make that mistake again for cardiac MRI!
