After suffering a cardiac arrest on March 17th, will Bolton’s Zaire-born midfielder ever play football at the top again?
What we witnessed that day was horrific. A young, seemingly healthy, standout role model for football and sport in general was taken away from us. For 78 minutes.
Fortunately he is now well on the mend, making an emotional appearance at the Reebok Stadium just last month. There is much speculation over the future of the former England U-21 international, with Bolton manager Owen Coyle suggesting back in April that he may yet play again. “Knowing Fabrice and how much of a battler he is, it wouldn’t surprise me if he comes back,” said Coyle. Although the details of his sudden cardiac arrest remain a mystery, senior cardiologists have suggested that the underlying cause is unlikely to be hypertrophic cardiomyopathy (enlarged ventricular walls) as the 24 year-old has been screened several times over the past few years.
Prevalence and Pre-Participation Screening: While the prevalence of cardiac events in sport remains low, with estimations ranging from 0.4 to 3% in 100,000 in athletes under 35 years of age, some research suggests that the incidence levels are slightly higher in those of African descent. The screening process involves taking and analysing a resting, 12-lead electrocardiogram (ECG). The ECG machine produces a trace that can be used to identify abnormal electrical activity in the heart, known as arrhythmias. How accurate the ECG trace is depends on both the application of the electrodes and the interpretation of the trace.
Cardiac Risk in the Young (CRY) [1] recommends screening via your GP if you suffer from: Young sudden deaths in the family, Chest pain(exercise related), Severe Breathlessness. Palpitations, Prolonged dizziness, Fainting / Blackouts
Many athlete’s and professional footballers that exercise at a high-intensity on a regular basis are bradycardic, i.e. their heart rate is less than 60 beats per minute. This is usually due to increases in the size of the left ventricle and thickening of the hearts walls, making the mechanics of the heart more efficient. These symptoms are reminiscent of hypertrophic cardiomyopathy. Therefore distinguishing between a natural adaptation to training and a hereditary heart condition can be difficult. Many physicians are now calling for a review of the guidelines. Cardiologists argue that some rhythm abnormalities may only occur during exercise and therefore an ECG should be taken while the athlete is on the move.
Return-to-Play Considerations
Most people that suffer such a terrible ordeal would scarcely consider putting themselves at risk again, especially in Muamba’s case, as he has a young family. Such is the resolve of Muamba, he may yet attempt it.
If Muamba does return to the professional game he will likely be fitted with an implantable cardioverter defibrillator (ICD) similar to one fitted to Bolton’s former midfielder, Khalilou Fadiga. The device seeks to ‘shock’ the user and return them to sinus rhythm should their heart enter fibrillation (rapid, irregular contraction of heart muscle). However, despite improvements in recent years, questions have been raised over the reliability of the device in contact sports. Nevertheless, if Muamba is diagnosed with hypertrophic cardiomyopathy, according to the European Society of Cardiology (ESC) he would be excluded from competitive sports, as the risk to his health would be deemed too great.
The Italian Perspective: Italy’s world class screening programme first introduced in 1971, states “every citizen engaged in official competitive sports activities must successfully pass periodic preventive examinations intended to evaluate their eligibility for sports participation.”
Despite a reported 50% of Italian athlete’s actually undergoing annual medicals, since 1982, there has been a 90% reduction in mortality, due in part to the sensitive ECG screening programme. However, the tragic death of Piermario Morosini in Livorno’s Serie B game against Pescara on April 14th is another stark reminder of how professional sport is not without its risks, and no current screening programme is 100% full-proof.
[1] Visit the CRY website for more information.
@Michael_Viggars
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