Fabrice Muamba: Heart conditions and sport

The collapse of Bolton midfielder Fabrice Muamba has left the world of football praying for the former England under 21 player's life. During the sixth round FA Cup tie against Tottenham Hotspurs, Muamba fell to the ground and received resuscitation on the pitch, after suffering a sudden cardiac arrest. Muamba was taken immediately to the London Chest Hospital where he remains fighting for his life.

The reaction from both sets of players and fans only highlighted the shock and worry about the 23-year-old’s life. When similar events occur people are understandably concerned, but many will wonder why such events can happen in the first place. The questions that routinely arise are how such a defect could go undetected and how can someone so fit suffer from a heart attack?

Sportsmen and women suffering from heart conditions are not new to sport. There are countless examples of athletes collapsing on the pitch, some dying and some going on to survive. Fans will recall the deaths of footballers Marc Vivien-Foe, who died during an international match for Cameroon, and Antonio Puerta, the 22-year-old Sevilla full-back, who died after numerous heart attacks during a Spanish league match against Getafe. Real Madrid and European Championship winner Ruben de la Red retired after suffering from a syncope and former Ajax midfielder Evander Sno suffered a heart attack, only to restart his career installed with an internal cardiac defibrillator.

Samuel Eto'o and Rigobert Song remember Foe.

Most heart-related deaths suffered by over 35-year-olds are attributed to cardiac disease, whereas similar incidents for a younger age group usually account for an inherited heart condition. The UK charity Cardiac Risk in the Young (CRY) believe that every week twelve ordinary and fit youngsters die from genetic heart disorders, many of them treatable.

Heart screening in the UK is not routine for most youngsters. Whereas in Italy, authorities will not allow you to train professionally until you have had your heart screened. All Olympic athletes, NFL and Premier League players all receive routine heart screening during their careers too. Electrocardiograms (ECG) or echocardiogram are available on the NHS if you are referred to a cardiologist by a GP. Tragically, they are also provided to a family in the aftermath of a heart-related death within the family.

It must be recognised that increased or intense sporting activity does not induce the risk of suffering from a heart condition. Miguel Indurain, the five-time winner of the Tour de France, had a resting heart beat of 28 bpm – mainly down to the fact his heart is 50% bigger than an average person. This is not harmful, nor does it increase the risk for subsequent heart conditions. Risks are only enhanced if an athlete uses drugs to increase their performance. This may account for the high proportion of deaths in professional entertainment wrestling.

The issue for some athletes affected by genetic or congenital defects is the natural increase in thickness of the left ventricle chamber. Intense cardiovascular sports will naturally see the heart enlarge, as it attempts to provide more oxygen for the athlete. This again is not a medical problem. Doctors say that since it is pumping out more blood with every contraction, a fit person’s heart does not need to beat as often and is therefore in better shape. The unnatural growth, also known as ‘hypertrophy’ makes the heart wall excessively thick and the fibres arranged unnaturally. Therefore abnormal heart rates like ventricular fibrillation (VF) or ventricular tachycardia can lead to apparently fit and well people to drop dead. Perhaps most sadly is the fact that defects like Hypertrophic Cardiomyopathy (HCM) or Long QT are treatable.

Sergio Ramos remembered Puerta after Euro 2008 success.

These players’ deaths are haunting and we can only hope that Fabrice Muamba goes on to make a full recovery. It is worth noting that although death is a tragedy, it enhances the notoriety of such diseases. Research shows that pre-screening in Italy has reduced deaths by around 90 per cent. Charities like CRY and the British Heart Foundation want defibrillators to be compulsory at every football stadium. The Western Isles of Scotland now screens all youngsters and the University of Ulster has a screening centre after the death of the young rugby player John McCall.

These deaths are tragic but we can only hope it goes on to save many more lives.