The Point

Last updated: 27 June 2022.

Why the Fit Can Die Young

Health campaigners urge the Scottish Government to have a heart and introduce a proper health screening programme for youngsters involved in sport.

By Graeme McIver.

The domestic football season of 2012/2013 will live long in the memory on both sides of the Border. In Scotland the implosion of Glasgow Rangers due to financial irregularities was the single biggest story in a season that saw Celtic retain the title and Hearts win the first all Edinburgh Cup Final since 1896. In England, the climax to the Premiership season was simply sensational with Manchester City pipping their rivals United to the league title with two injury time goals on the final day.

However, it was an incident in the first half of an FA Cup tie at White Hart Lane in London that provided perhaps the single most emotive memory of the season. During the first half of the Tottenham Hotspur versus Bolton Wanderers FA Cup quarter final tie on March 17th, Fabrice Muamba a Bolton midfielder collapsed. With no one around him it was immediately clear that this was no normal footballing injury. Tens of thousands of fans inside the ground and millions watching on television collectively held their breath as medical personnel worked on the stricken player. It later emerged that Muamba’s heart had stopped for 78 minutes as first of all paramedics and then a consultant cardiologist who happened to be in the crowd battled to save the life of the young Bolton star.

Muamba was taken to the London Chest Hospital where he remained in a critical state until on March 21st a hospital spokesperson announced that the player’s recovery had, “exceeded our expectations.” On May 2nd, Muamba made an emotional return to the pitch prior to his club’s home tie against Tottenham. Supporters of both clubs chanted the name of a clearly emotional Muamba. Few who had witnessed those frantic attempts to resuscitate the player just weeks before could have dreamed that he would be taking the fans acclaim just weeks later. Other professional footballers have not been so lucky. In June 2003, the former Manchester City and West Ham star Mark-Vivian Foe collapsed and died during a FIFA Confederation Cup tie between his nation Cameroon and Columbia. In August 2007, Antonio Puerta, a midfielder for La Liga side Seville died three days after suffering a series of cardiac arrests during a league game against Getafe. In 2009, Daniel Jarque, the captain of Espanyol, died during pre-season training in Italy. The Japanese international Naoki Matsuda collapsed and died during a training session in the summer of 2011 whilst Piermario Morosini of the Italian side Livorno suffered a fatal cardiac arrest episode on the pitch during a Serie B match in April 2012. Here in Scotland, in late December 2007, the former Celtic star Phil O’Donnell collapsed on the pitch whilst playing for Motherwell against Dundee United and never regained consciousness. These high profile deaths of sportsmen at the pinnacle of the professional game leave many unanswered questions. How can such seemingly fit and healthy individuals succumb to heart attacks? Surely the medical tests they had been subjected to would pick up any defects? Yet until recently, the types of medicals and health checks that even professional athletes have undertaken would not have identified potential problems and risk.

It is a long established fact that Scotland ranks as one of the worst countries in the western world for health problems related to the heart. In the majority of cases, the poor health of the nations hearts are related to lifestyle choices, poor diet, lack of exercise and excessive smoking and alcohol intake. Families in the lowest earning areas of the country are most at risk from heart disease. Poverty, unemployment drug and alcohol addiction all contribute towards the figures.

There has been a noticeable effort on behalf of government agencies and health professionals in this country to raise awareness and promote alternative lifestyle choices and improve diet and fitness levels. The smoking ban introduced by the Scottish Parliament has helped and the Government will hope that minimum unit alcohol pricing will also contribute towards a downward trend in levels of heart disease.

Yet outwardly healthy and fit young athletes do not drop dead on a sports field because of poor diet or lack of exercise. Their deaths are not related to lifestyle choices. Instead, in the majority of cases, underlying genetic heart conditions are the root cause of the problem. Very often, traditional medical checks do not pick up these defects. Heart conditions responsible for Sudden Cardiac Death (SCD) in sport such as hypertrophic cardiomyopathy (HCM) require a more complex series of checks in order to correctly diagnose risk. Cardiomyopathy is defined as a disease of the heart muscle. It affects people of all ages and is mostly an inherited genetic condition. Whilst it is not curable, it can usually be treated successfully, with most of those affected going on to lead a long and full life. If undetected however, it can lead to problems for those who expose their heart to excessive stress and strain such as individuals involved in sport. The nature of cardiomyopathy, which results in a thickening of the heart muscle, is such that it manifests itself in periods of maximum body growth, that is usually during the teenage years. All across the country, children and young people are participating in sport who may be endangering their lives.

Thankfully SDC in sport remains at a statistically low level. Whilst robust data is in short supply, indicators from studies conducted in the Republic of Ireland, Italy and the USA suggest that SCD occurs in around 3.6 people per 100,000.

Yet even at these low levels, campaigners involved in raising awareness of conditions such as cardiomyopathy have called for a full and proper screening programme to be introduced for all youngsters taking part in sports. They argue that an effective screening programme would not only save lives, it will also help medical professionals build up a much better understanding of levels of genetic heart conditions in the population.

Current screening by medical history and physical examination are ineffective as cardiomyopathy is asymptomatic. HCM can however be detected with over 80% accuracy by screening using both echocardiograms and electrocardiograms. Campaigners point to the success of a screening programme operating in Italy that has reduced sudden cardiac death in sport by 90%. The Italians introduced the scheme which is unique in developed countries following the death from heart failure by a footballer with Perugia called Renato Curi in 1977. From the programme’s introduction in 1982, any person involved in organised sporting activity must undergo regular heart screening to identify if they are in the at risk category.

Wilma Gunn from Selkirk in the Scottish Borders lost her son Cameron on the eve of his 20th birthday after he collapsed whilst playing five-a-side football with his workmates. Through the charity she established shortly after her sons death, Scottish HART (Heart at Risk Testing), Wilma has campaigned tirelessly for the Italian model to be introduced to Scotland. The charity claims that many of the sudden deaths experienced by young people undertaking sporting activity could be avoided if a proper screening programme was introduced. Following years of pressure and two visits to the Scottish Parliaments petition committee, Wilma joined other campaigners in welcoming a pilot project, based at Hampden Park Glasgow, which offers screening for young athletes along the lines of the Italian experience. The initiative announced by Deputy First Minister Nicola Sturgeon in 2008 committed the Scottish Government to establishing a pilot screening program in conjunction with health professionals at The Scottish Football Association based at Hampden Park. The Cardiac Assessment in Young Athletes (CAYA) screening programme, led by Professor Stewart Hillis performs a series of tests in the young athletes to exclude conditions which may reduce sporting performance or lead to serious health risks. The scheme is run in partnership between Hampden (National Stadium Sports Health and Injury Clinic), The University of Glasgow, The Scottish Football Association and the Scottish Government. Speaking to The Point, Wilma said;

The pilot project has been an important development in the process of identifying those suffering from the disease and whilst we congratulate all those involved in bringing this scheme forward, we would like to see a much broader scheme that deals with screening all children and young people involved in organised sport. We are pleased that at long last politicians in Scotland have recognised the benefits of screening for heart disease. Scotland is in advance of the rest of the UK in this respect. However, we would ask Scotland’s politicians to examine the evidence from the successful Italian program which has resulted in a 90% reduction in sudden cardiac deaths amongst those taking part in sporting activities.

The screening offered by the professionals at Hampden Park is non-invasive and consists of;

• A health questionnaire regarding the individuals health and family’s medical history including symptoms such as chest pain, undue breathlessness and an abnormal awareness of heart beat or fainting on exercise which may suggest a problem.
• A medical examination including blood pressure measurements and audible assessment of the heart.
• An electrocardiogram (ECHO); this records the electrical signal of the heart from the surface which gives information concerning the rate, rhythm and electrical function.
• An echocardiogram; this gives a 2D picture of the heart which shows the structure and shape of the heart muscle and also assesses the valves.

The screening can detect heart muscle disease (Cardiomyopathy), structural problems of the heart affecting the valves or blood vessels and abnormalities of the electrical system of the heart. The pilot project emphasises that although screening is used to confirm normal cardiac function, occasionally cardiac abnormalities may be identified and may lead to advice being given concerning future exercise activity, and to recommend further investigations and treatment if advisable.

Campaigners like Wilma are aware that due to the austerity measures introduced in order to pay for the financial crisis budgets are becoming increasingly squeezed. However, she argues;

Yes, rolling out this scheme would require substantial funding. Yes it requires health professionals to be fundamentally involved in the whole process. Yes it requires the political will to introduce the proposal but without the introduction of a full and wide ranging screening programme, fit for purpose and with the backing of government we will continue to see the preventable deaths of many more young people. Our youngsters deserve better.

 

With both the Olympic Games later this year and the Commonwealth Games taking place in 2014 there has been much talk of the sporting benefits that will be brought to Scotland and the rest of the UK. I believe that a truly fitting legacy of both events would be not just the building of new facilities and arenas but to see the establishment of a screening programme that saves young lives.”