Weekend Argus (Saturday Edition)
Matters of the sporting heart raise concerns
‘Better screening’ needed to prevent sudden deaths
SUDDEN cardiac death is becoming an increasing concern for athletes, and the question of screening of their hearts was a topic for discussion at this week’s Sixth World Congress of Paediatric Cardiology and Cardiac Surgery, held in the city.
Leading sports scientist Professor Wayne Derman of the South African Medical Research Council defined this condition as “natural death resulting from sudden cardiac arrest, occurring unexpectedly within six hours of the onset of symptoms”.
Last year saw the deaths of several athletes as a result of sudden cardiac arrest, including London Marathon runner Claire Squires, Italian soccer player Piermario Morosini, and Norwegian Olympic swimmer Alexander Dale Oen, drawing attention to the tragedy of young, fit sports people.
Perhaps most dramatically, Fabrice Muamba suffered a cardiac arrest in March during an FA Cup match between Tottenham Hotspur and Bolton Wanderers, from which he recovered even though his heart stopped for more than an hour.
“The risk of sudden cardiac death for people younger than 35 is 0.3 to 3.6 per 100 000 people per year,” Derman told delegates. “In athletes, this figure is much higher – one to three people per 100 000 per year.”
But he was at pains to point out that exercising remains good for you: “Exercise is potent at reducing your overall risk of a heart attack. An obese diabetic smoker has a lower chance of a heart attack than someone who doesn’t exercise.”
Derman said that although exercising was beneficial to the heart, the risk of sudden cardiac arrest was raised when the intensity of the exercise was too high, and the recovery period too low. Better screening was needed to prevent deaths.
“Of the two athletes who died in the Ironman race in East London last month, both had recently tweeted that they were suffering from upper respiratory tract infections.”
In a separate presentation, the Mayo Clinic’s Professor Michael Ackerman questioned whether the role of doctors in respect of sports people was a “disqualifier” or an “educating informer”.
The message of many cardiologists, he said, was “unless your heart is perfect, you can’t play”, pointing out that the 36th Bethesda conference in the US, which determines the eligi- bility recommendations for competitive athletes with cardiovascular abnormalities, had opened up some room to manoeuvre.
“Now the message from the US medical fraternity has been modified to ‘unless your heart is perfect or the syndrome is confined to just your genome, no sports’.”
The so-called “safe six” sports for people with genetic heart problems were billiards, bowling, cricket, curling and golf Ackerman said.
But he pointed out that the conventional wisdom of physicians of “when in doubt, kick them out” was not the Mayo Clinic’s philosophy.
“We have a number of patients with Long QT Syndrome (a disorder of the heart’s electrical activity) who know that exercise can be harmful to them, but who choose to remain athletes. It’s unfair to impose genetic discrimination on sports people.”
Groote Schuur Hospital’s Dr Bongani Mayosi, who was part of the team responsible for the pre-competition medical assessment for the U20 football World Cup, said it was important to learn players’ personal and family history, as well as to perform clinical examinations.
“Our conclusion was that there are big ethnic variations among different soccer teams and their cardiac risk profiles,” he said. “Clearly Africans are not a homogenous group.”