Sudden Death

In the face of multiple unfortunate incidents of deaths on the pitch, sports medicine expert Dr. Tapas Francis Biswas investigates the causes and remedies

Ciao Moro
Twenty-seven-year-old D. Venkatesh played for a Division A small club Bangalore Mars. Twenty-six-year-old Piermario Morosini played for Livorno (on loan from Udinese). Destiny brought them together, in a heart-wrenching way. Both of them died on field playing their favourite sport, our favourite sport, football. Cause of death was cardiac arrest. In English Premier League, Fabrice Muamba escaped miraculously though. He was ‘clinically dead’ for 78 minutes following a cardiac arrest on pitch. Let us analyse the medical reasons behind these sad incidents.

Football, by its very nature, includes inherent risks, including the risk of death. Death in football or for that matter in any sport is tragic. Fortunately, it is rare. It is important to be aware of the remote possibility and the need for shared responsibility for sports safety among athletes, parents, coaches, sports medicine specialists and sport organisations.

Non-traumatic sudden death in a footballer inevitably stirs public concern as front-page headlines question what more could have been done to identify the risk. Parents may wonder – if this could happen to a young star footballer, could it also strike their child, who participates in recreational football? It might also be natural to ask whether the benefits of sports and exercise are worth the apparent risk.

Cardiovascular causes attribute to most of the cases of sudden death amongst footballers. Sudden Cardiac Arrest (SCA) is the cause of most on-field mishaps. There is a preponderance of such deaths in males compared to females.

D. Venkatesh played for a Division A small club Bangalore Mars

The four most common causes are:

  1.  Hypertrophic cardiomyopathy(HCM): It is a condition in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood. HCM is often asymmetrical; meaning one part of the heart is thicker than the other parts. The condition is usually passed down through families (inherited). It is believed to be a result of several problems (defects) with the genes that control heart muscle growth. Younger people are likely to have a more severe form of hypertrophic cardiomyopathy. However, the condition is seen in people of all ages.
  2.  Coronary artery anomalies (CAA): It is a congenital defect in one or more of the coronary arteries of the heart.
  3.  Atherosclerotic coronary artery disease (ACAD): There is a build-up of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall, which leads to plaque formation leading to narrowing of the artery and subsequently diminished oxygen supply to the heart.
  4.  Myocarditis: It is inflammation of the heart muscle, can be caused by bacteria or viruses, although rare it can lead to fatal consequences in footballers.

Other less significant not-so-much life threatening causes are right ventricular dysplasia, Marfan’s syndrome, conduction system abnormalities, idiopathic concentric left ventricular hypertrophy, substance abuse (e.g., cocaine, steroids), aortic stenosis and mitral valve prolapse.

Opinion is divided amongst cardiologists whether or not to perform routine cardiovascular testing to prevent exercise-related sudden death in footballers because of its limited usefulness, rarity of such events, the cost of screening and poor predictive accuracy of exercise testing for such events.

Fabrice Ndala Muamba – the man who survived

There are various measures taken in different levels of internal tournaments e.g. according to UEFA guidelines, every player should have at least one electrocardiography (ECG) and echocardiography result in their personal records before 21st birthday. And in my opinion, sports medicine specialists should take a proper detailed history, perform a thorough clinical examination, organise some basic investigations including routine blood test, ECG, stress test, echocardiography and try and detect any cardiovascular complications that the footballer might have and take appropriate corrective measures. The clubs and the FA need to ensure this and also need to perform these on a regular basis. One must remember it might not be cost effective in a massive population but when it comes to elite professional footballers who are earning in millions it is worth the price.

Epilogue:

On May 31, 2012, The Federation of International Football Association (FIFA) has already made it mandatory to have Automated External Defibrillators (AED) in all stadiums during high profile games including those of the national teams.