In the face of multiple unfortunate incidents of deaths on the pitch, sports medicine expert Dr. Tapas Francis Biswas investigates the causes and remedies
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.
The four most common causes are:
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.
Coronary artery anomalies (CAA): It is a congenital defect in one or more of the coronary arteries of the heart.
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.
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.
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.
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.
First Whistle – April, 2012
At the impressionable age, when I just entered high school, the goal that left a lasting impression is what we depicted on the cover of our very first issue. We call it the ‘Locus of God’. But that’s not the only way to score a great goal. There could be a set of amazing passes leading into a goal, or a chip or a free-kick. Our revamped look from March onwards is somewhat a convex combination of such techniques; largely run solo, but ably assisted by other key players in team Goalden Times. We have received encouraging feedback on our new layout from our readers and this kind of support eggs us on to continuously improve and enrich our content.
Moving on to the football pitch, news of Antonio Cassano, the Milan and Italy striker finally receiving a go-ahead to resume playing following a heart surgery has been very heartening. With the collective prayer of football fans around the globe, Fabrice Ndala Muamba is getting better and Eric Abidal is progressing fine. However, not all news has been good for the heart. We would like to take this opportunity to send our sincere best wishes to Aston Villa’s captain Stiliyan Petrov, who doctors say, has been a victim of the Chernobyl disaster. We wish him a positive outcome and speedy recovery. The game also lost a great man in Livorno midfieder Piermario Morosini who collapsed on the pitch and died of cardiac failure last week. We extend our condolences to his family and friends.
Outside of health hazards, Carlos Tevez is back doing what he does best – showing his (hat)tricks on the football pitch. But his club, Manchester City is now 5 points behind the city rival United with five matches to go. In Italy, just 1 point separates the league leader Juventus, still unbeaten this season, and AC Milan. Borussia Dortmund seems to have a decisive 8-point lead over Bayern Munich in Bundesliga. In La Liga, Real Madrid won an El Clásico inalmost five years at the Camp Nou to almost seal the top spot. Elsewhere in Europe, Montpellier has a narrow 3-point lead over their nearest rival – the big spending Paris Saint-Germain, while Ajax is 6 points ahead of AZ Alkmaar and Feyenoord Rotterdam. In India, Dempo Sporting Club has clinched the I-League title.
Odds are of another El Clásico on May 19 in the UEFA Champions League final. There is a distinct possibility of an all-Spanish final in the UEFA Europa League as well with three Spanish clubs in the final four.
We shall see how the Spanish national team dominates the UEFA Euro 2012 starting June 8, in Poland and Ukraine. Goalden Times will celebrate Euro and football in more ways than one. Keep watching this space, our Facebook page and Twitter.
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A Humble Man
Gino de Blasiopays respect to Piermario Morosini on behalf of the entireGoalden Timesteam
The sporting world paid tribute to Piermario Morosini last weekend.
During a Serie B match between Livorno and Pescara, the young midfielder collapsed, and later died from what appears to have been a fatal cardiac arrest on the pitch.
Stories from friends and colleagues, however, will tell a story of a man much loved by those who knew him, with the word “humble” being the most used adjective. And quite deservingly so, the streets of Bergamo were filled with thousands of fans on Thursday to pay their final respects to the man whose motto, if GT had to guess, would quite aptly translate to Ludo Ergo Sum.
“I lost my mother and father when I was a child, and I played for them. These are things that change your life, and at the same time it teaches you to never give up on your dreams, and mine was to be a football player, as it was their dream for me”.
He grew up in the youth Atalanta scheme before being bought by Udinese and then sent on loan around the country to get match experience. Everywhere he went, he made friends; he was loved in the dressing rooms, always there for his companions when they needed someone they could trust.
His impact on the pitch may not have been the greatest, and his death may unfortunately be the only thing that those outside of calcio may ever get to know about him.
His Reach was Greater than that of the Game
Of all the stories that have been pouring in from those who knew him best, what stands out is that he was a man who apparently “made you know how to smile everyday”. According to Marco Andreolli, a former under-21 Italian national, colleague and friend, Morosini was a happy man, who always saw the “glass half full”.
His death will pose some pertinent questions for, and teach a few important lessons to Italian football.
His life, however, whilst filled with sadness and tragedy was one of hope, positivity and kindness.