In recent times, there have been numerous sudden cardiac arrests in football which have led to deaths and therefore I asked Dr. Shibu Varughese to try to explain what sadly happens on the football fields. Here is his detailed explanation.
Football is the world’s most popular sport, with in excess of 250 million players worldwide. Football has the power to change people’s lives for the better. When a young, fit popular player suddenly collapses and dies during play, the tragic event is frequently screened and publicised worldwide. The death of Marc-Vivien Foe at the 2003 FIFA Confederations Cup, who collapsed while playing for Cameroon against Colombia in France, was the turning point in football’s awareness of potential heart problems.
The reported incidence of sudden cardiac arrest (SCA) varies from 1:65,000 to 1:200,000 athletes. It’s rare, but seen in male footballers. A broad spectrum of cardiac and non-cardiac causes have been implicated, and regular pre-competition medical assessments are recommended as a preventive measure.
Definition: Unexpected natural death of cardiac origin within one hour of the onset of symptoms without a previously recognized history of cardiovascular conditions that will appear fatal.- Most important cardiac emergency- SCD without resuscitation (Fatal)- Rare but catastrophic event
Common causes- Hypertrophic cardiomyopathy- Dilated cardiomyopathy- Congenital coronary anomalies- Over 35 years – coronary artery disease
Signs/Symptoms- Usually no symptoms- If they do occur, palpitations, dizziness, angina, syncope and dyspnoea- Never ignore such symptoms in players
How to prevent sudden cardiac arrest?- PCMA (Pre Competition Medical Assessment) – an important tool in the prevention of SCD (Africa: 60% no medical exam.)- Compulsory document to be submitted prior to all FIFA Final Competitions.- Declaration Document “Player is FIT for participation in FIFA Final Competition”.- Electrocardiogram (ECG) testing , Echo as indicated- Identify high risk individuals- Player education
What is Commotio Cordis?- Direct precordial impact, particularly by ball or foot of another player- Occurs in the young – compliant chest wall- Causes Ventricular fibrillation- Low rate of resuscitation (10%)
Treatment- Definitive – Defibrillation- > 50% survival outcomes in < 2-3- Initiate CPR if no AED
FIFA Medical Emergency Bag (FMEB)FIFA has distributed FMEB to all its 209 member associations and also introduced the use of FMEB on pitch-side at all the stadiums hosting matches at the just concluded 2013 FIFA Confederations Cup in Brazil. The critical element of the backpack is the automated external defibrillator (AED), easily visible in a clear pocket at the front of the bag. The portable device can immediately diagnose suspected heart problems and defibrillation can be initiated if the heartbeat appears weak, irregular or has stopped altogether. The bag also holds an instructional video and a medical emergency kit.
(Dr. Shibu Varghese (M.S (ORTHO), F.A.J.R(GER), F.A.S.M(SA)), is an Orthopaedics Sports Surgeon from Kerala)