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Myocarditis - Return to Sport — EECC MCQ

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ModerateHeart FailureMyocarditis - Return to SportEECC

A 55-year-old man with acute myocarditis confirmed on CMR (LVEF 35%, diffuse oedema, epicardial LGE) is feeling much better after 2 weeks. He asks when he can return to competitive rugby. What is the recommended advice?

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Correct answer: A — Avoid competitive sport for at least 3-6 months and only return after complete resolution of inflammation on repeat CMR and normalisation of biomarkers

The 2025 ESC Myocarditis/Pericarditis Guidelines and 2020 ESC Sports Cardiology Guidelines recommend abstinence from competitive sport and intense exercise for at least 3-6 months following acute myocarditis. Return to sport requires: (1) resolution of symptoms, (2) normalisation of inflammatory biomarkers (CRP, troponin), (3) resolution of active inflammation on repeat CMR (no oedema on T2, stable or resolving LGE), (4) absence of clinically significant arrhythmias on Holter and exercise testing, and (5) recovery of LV function. This is because myocarditis is a recognised cause of exercise-related sudden cardiac death, particularly during the active inflammatory phase.

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis; ESC (2020): Sports Cardiology Guidelines