When I was eleven years old, I was shocked when Marc Vivien Foe collapsed in the middle of an intense soccer match between Cameroon, the darlings of the 2003 Confederations Cup, and Colombia.
Foe had the physique of a titan and was arguably one of the best African midfielders of the era. He was just 28 years old.
This episode marked me. This was a player at the top of his game. A Premier League player. How could he collapse and die? How can someone lose their life while playing the beautiful game? Could anything have been done to prevent this tragedy? Is it safe to play soccer?
Players who have had cardiac arrest
These emotions and questions have rushed over and over since that fateful night. They came running when Miklos Feher collapsed in 2004, when Fabrice Muamba lay lifeless for more than 45 minutes in 2012 and when Antonio Puerta lost his life in 2007 after a series of cardiac arrests.
Recently, the world was stunned when Danish superstar Christian Eriksen was revived during a Euro 2020 match. Miraculously, Eriksen has since returned to full form and is regarded as one of the best midfielders in the Premier League.
Why does the super fit athlete suddenly collapse? What really happens to his heart? Can it be prevented? If so, how? Do footballers suffer from playing too many games?
Every time such a tragedy occurs on a soccer field, many media outlets report that the player in question had a “heart attack.” This is incorrect.
A heart attack is the common man’s term to describe a myocardial infarction. A myocardial infarction occurs when an artery to the heart (ie, a coronary artery) becomes occluded.
This deprives the heart muscle (ie, the myocardium) of the oxygen supply that is delivered through the coronary arteries.
The result, literally, is the death of this heart muscle. Thus, a myocardial infarction occurs when a section of heart muscle dies due to a sudden reduction in blood (and thus oxygen) supply.
This is not what usually happens in these athletes.
In most cases, a coronary artery occlusion is caused by a combination of a cholesterol plaque within the artery and an overlying blood clot.
Risk factors for this to happen include smoking, an unhealthy diet, lack of exercise, and age. I wouldn’t expect a professional athlete to check any of these boxes!
Instead, the cause of these athletes’ sudden collapse would be a heart rhythm problem, also known as an arrhythmia.
The heart is divided into four rooms: two small ones called “atria” and two larger ones called “ventricles.” The atria contract as they pump blood into the ventricles. As the atria relax, the ventricles in turn contract, pumping blood to the lungs and the rest of the body.
The contraction and relaxation phases of the heart muscle are made possible by electrical impulses generated within the heart’s own natural pacemaker within the left atrium. This electrical current travels rapidly first to the rest of the atria and then to the ventricles.
Any abnormality in this electrical current means that the heart is not contracting properly. Therefore, the pumping of blood fails, resulting in a rapid drop in blood supply to all vital organs.
Why should the heart’s electricity fail? What causes an arrhythmia? The answer is complex. Different drugs and medications are known to cause arrhythmias. However, the most common cause of a fatal arrhythmia is a structural problem in the heart of a young, healthy individual.
For example, Marc Vivien Foe was found to have hypertrophic cardiomyopathy, while Antonio Puerta was diagnosed with arrhythmogenic right ventricular cardiomyopathy post mortem.
Most structural defects can be diagnosed using modern imaging techniques of the heart. These would include an ultrasound of the heart, called an echocardiogram, and magnetic resonance imaging (MRI). However, such flaws are not always so obvious and can be easily overlooked.
Patients with heart conditions that can result in a fatal arrhythmia are usually implanted with an ICD (implantable cardioverter defibrillator). As soon as the ICD detects an abnormal electrical impulse, it sends a shock to the heart muscles in an effort to stop this electrical current and restore normal heart rhythm once again.
These heart conditions tend to be genetic. People, not just athletes, who have close relatives who have died suddenly and unexpectedly at a young age and/or who have frequent episodes of unexplained fainting are strongly advised to seek medical attention as they may need to be investigated by a cardiologist.
Remember, erratic and fatal electrical currents (arrhythmias) can be reversed by applying a shock from a defibrillator. This is a lifesaver. Also, when resuscitating a patient in cardiac arrest, it is vital to allow blood to continue to circulate to the rest of the body while chest compressions are being applied.
If you are involved in football in any way, or any other sport, being proficient in cardiopulmonary resuscitation (CPR) is essential. It is important to note that cardiac defibrillators must be easily accessible in all sports facilities.
You can visit here to learn more about CPR and various heart conditions.
Editor’s Note: Julian Delicata is a medical doctor based in Malta.
Photo Credit: IMAGO/Sven Simon