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Sports competition can be a trigger to fatal arrhythmias in predisposed individuals, leading to sudden cardiac death. Athletes have 2.8 fold more risk of sudden cardiac death than non-athletes. However, female athletes seem to have some cardiac protection, dying suddenly much less than men during sports. Although the mechanisms for this protection have not been well established until now, hormonal, genetic and molecular factors may play a role in it. The so-called "fair sex" might harbour the key for sudden cardiac death prevention.

Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

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Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

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There are truly two different things: knowing and believing one knows. Science consists in knowing;in believing one knows lies ignorance." HippocratesExercise is medicine! Although this premise is well established, how to maintain this "treatment" for various diseases during the COVID-19 pandemic? This has been a concern of all doctors in the world since exercise contributes to the control of cardiovascular diseases and other comorbidities recognized as risk factors for a worse outcome in COVID-19. Moreover, it has already been shown that higher cardiorespiratory fitness is inversely associated with the likelihood of hospitalization due to In addition to the hygiene and social distancing measures necessary to prevent coronavirus infection, cardiovascular sequelae in individuals recovering from COVID-19 may contribute to the delay in resuming exercise. Cardiovascular complications, including myocarditis, are relatively common in patients affected by SARS-CoV-2. Although the occurrence of myocarditis as a consequence of COVID-19 was initially described in hospitalized patients with severe presentation of the disease, subsequent studies have reported its occurrence in individuals with mild COVID-19 and even in asymptomatic patients. 2 Thus, an alert was raised regarding the return to sports after COVID-19, since myocarditis is an important cause of sudden death in young individuals, especially in athletes. Since then, experts around the world have studied the occurrence of COVID-19-related myocarditis and discussed what would be the best way to return to exercise safely after recovering from the disease. 3 The meta-analysis by Puga et al., 4 makes a review of studies published until June 2020, to evaluate the prevalence of myocardial injury and propose a flowchart to assess cardiovascular risk in patients affected by COVID-19, to ultimately guide a safe return to exercise. Data from more than 6,000 hospitalized patients from China and the USA were divided according to the severity of the disease, based on requirement of intensive care unit (ICU) admission including non-survival. This interesting article, published in this issue, shows that there is a correlation between elevated troponin levels and the presence of myocardial injury. Also, the prevalence of myocarditis in hospitalized COVID-19 patients (21,7%) increased with disease severity -9.5% among patients who did not require intensive care unit (ICU) admission, and 57.7% among those who did not survive. These findings are similar to another recent review 4 that reported a prevalence of myocarditis of 24.4% in hospitalized patients with COVID-19 and troponin elevation in 90% of them. Puga et al., 4 highlighted the lack of information in asymptomatic patients, including athletes, and reported a frequency of 1.9% of myocarditis in symptomatic non-hospitalized individuals (considered to have mild COVID-19), and many cases of severe COVID-19 in previously healthy individuals. Based on these, the authors discussed the urgent need for recommendations for resuming ex...