Infectious and lymphocytic myocarditis: epidemiology and factors relevant to sports medicine

Myocarditis is a disease entity of permanent actuality and of special concern in the sports setting. This is because the probability of complications or sequelae increases if exercise is imposed. Myocarditis may pass unrecognized by the sufferer or be easily overlooked by the physician, especially in athletes, where electrocardiographic changes often exist normally. Furthermore, although the immune system of the conditioned individual may be more efficient than that of the sedentary individual, very strenuous and frequently repeated or long-lasting exercise may cause immunosuppression and an increased susceptibility to respiratory tract infections (RTI). Several causative agents of RTI can give rise to myocarditis as well. The true incidence of proven infectious myocarditis in society is unknown. Histopathologically defined myocarditis (lymphocytic myocarditis), on the other hand, has been found in about 1% of unselected routine autopsies. In general, the long-term prognosis in myocarditis is favorable but exercise stress may cause long-term sequelae or sudden death. It is thus essential to refrain from strenuous exercise during RTI.