Sudden deaths in footballers are more common than we previously believed and despite screening, cardiac conditions are still the leading cause of death in footballers.
There are increasing calls made by some doctors and bereaved families for regular cardiac testing for footballers.
In recent times there have been a number of high profile deaths including Marc-Vivien Foe aged 28 and former England defender Ugo Ehiogu, who died, aged 44. However, possibly the most well-known case of a sudden cardiac arrest is that of Fabrice Muamba who collapsed whilst playing for Bolton Wanderers. Thankfully, due to the actions of staff and a doctor at the stadium, he managed to pull through.
But why does this happen? Sudden cardiac arrest in young athletes is mostly caused by a number of factors, with the most common being:
Hypertrophic cardiomyopathy (HCM)
an inherited condition where the heart muscle walls become thick. The thickened muscle can then affect the heart’s electrical system, leading to fast or irregular heartbeats (arrhythmias) which can lead to sudden death.
Coronary artery abnormalities
sometimes people are born with coronary arteries that are connected abnormally. These arteries then become compressed during exercise and do not provide proper blood flow to the heart muscle, leading to sudden death.
Undetected congenital heart disease (present at birth)
Screening study of 11,000 Football Association players
To investigate the issues facing young footballers further, Consultant Cardiologist Dr Aneil Malhotra conducted a study that screened more than 11,000 Football Association players aged 16 for sudden cardiac death over a period of 20 years. They all had an electrical recording of the heart (ECG) and a cardiac ultrasound scan (echocardiogram).
The results were shocking.
42 individuals had cardiac diseases that could cause sudden cardiac death, having presented with hardly any symptoms prior to the test.
30 out of the 42 players had surgery or other treatment for their heart defect and were able to go back to playing football, but the other 12 stopped playing.
Eight died during exercise – six from conditions that had gone unidentified and two, who were diagnosed with HCM and were advised against competitive sport.
Should we increase the amount of cardiac testing in athletes? The worldwide debate
There is ongoing debate worldwide regarding the implementation and the extent of screening needed of athletes and their hearts.
Mandatory screening for all young adults who participated in sports has been introduced in Italy, which has resulted in an 89% reduction in sudden cardiac death. However, screening isn’t always supported and critics say that false results can lead to increased anxiety and a negative effect on well-being. There are also cost implications of carrying out further screening tests. These are the reasons why in the USA, they do not recommend this way of screening athletes. Instead, they suggest a healthcare professional go through a 14-point checklist to screen for heart disease, with a follow up only if necessary.
There is likely to be a continuing debate about whether increased screening is proven to be successful. However the study by Dr Malhotra provides evidence that early detection saves not only lives, but also sporting careers.
Our partners at British Heart Foundation view is
“Hypertrophic Cardiomyopathy (HCM) is the most common inherited heart condition. Whilst cardiac screening amongst athletes may help detect the condition, we also stress the importance of everyone having a full awareness of their family medical history, especially if a member of the family has died suddenly under the age of 50.”
Although my view is that cardiovascular screening programmes should be a targeted and planned strategically (with focus on those who have family history) there should be regular screening for young adults who participate in sport.
In addition to screening, an increased education and awareness of cardiac arrests within the sporting field through resuscitation training and easy access to defibrillators will really help to prevent deaths both on and off the sporting field.
What can we do to lower my risk of heart disease?
Fortunately, there are many things you can do to reduce your chances of getting heart disease:
Control your blood pressure. High blood pressure is a major risk factor for heart disease. It is important to get your blood pressure checked regularly - at least once a year for most adults, and more often if you have high blood pressure. Take steps, including lifestyle changes, to prevent or control high blood pressure.
Keep your cholesterol and triglyceride levels under control. High levels of cholesterol can clog your arteries and raise your risk of coronary artery disease and heart attack. Lifestyle changes and medicines (if needed) can lower your cholesterol. Triglycerides are another type of fat in the blood. High levels of triglycerides may also raise the risk of coronary artery disease, especially in women.
Stay at a healthy weight. Being overweight or having obesity can increase your risk for heart disease. This is mostly because they are linked to other heart disease risk factors, including high blood cholesterol and triglyceride levels, high blood pressure, and diabetes. Controlling your weight can lower these risks.
Eat a healthy diet. Try to limit saturated fats, foods high in sodium, and added sugars. Eat plenty of fresh fruit, vegetables, and whole grains. The DASH diet is an example of an eating plan that can help you to lower your blood pressure and cholesterol, two things that can lower your risk of heart disease.
Get regular exercise. Exercise has many benefits, including strengthening your heart and improving your circulation. It can also help you maintain a healthy weight and lower cholesterol and blood pressure. All of these can lower your risk of heart disease.
Limit alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain. Both of those raise your risk of heart disease. Men should have no more than two alcoholic drinks per day, and women should not have more than one.
Don't smoke. Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, do not start. If you do smoke, quitting will lower your risk for heart disease. You can talk with your health care provider for help in finding the best way for you to quit.
Manage stress. Stress is linked to heart disease in many ways. It can raise your blood pressure. Extreme stress can be a "trigger" for a heart attack. Also, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are bad for your heart. Some ways to help manage your stress include exercise, listening to music, focusing on something calm or peaceful, and meditating.
Manage diabetes. Having diabetes doubles your risk of diabetic heart disease. That is because over time, high blood sugar from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. So, it is important to get tested for diabetes, and if you have it, to keep it under control.
Make sure that you get enough sleep. If you don't get enough sleep, you raise your risk of high blood pressure, obesity, and diabetes. Those three things can raise your risk for heart disease. Most adults need 7 to 9 hours of sleep per night. Make sure that you have good sleep habits. If you have frequent sleep problems, contact your health care provider. One problem, sleep apnea, causes people to briefly stop breathing many times during sleep. This interferes with your ability to get a good rest and can raise your risk of heart disease. If you think you might have it, ask your doctor about having a sleep study. And if you do have sleep apnea, make sure that you get treatment for it.