The blog of a travelling psychiatrist and football lover. Who happens to be a halfway decent photographer. Takes a cynical view of the world

Archive for the tag “HOCM”

Preventing Sudden Death in Young Sportsmen . Craig Cunningham

A 26 year old athlete and professional ice hockey player, Craig Cunningham, collapsed and almost died before a recent game in Canada. The cause of the collapse was a cardiac arrest.  The BBC report this in their headline as a heart attack which it was not it seems. He was lucky to be resuscitated after maybe efforts lasting 90 minutes. The exact cause is unknown but may well be HOCM , hypertrophic obstructive cardiomyopathy. An illness that can often lead to fatal cardiac arrests and yet in many cases is easily diagnosed with correct screening. 

A horrifying high number of sportsmen have had cardiac arrests at a young age. Two things bother me. Firstly the media report this as heart attacks which almost always they are not. A heart attack has a distinct pathology of a blocked artery . A cardiac arrest has many causes but in young sportsmen is mostly a sudden serious abnormal heart rhythm.  It is feasible of course for a young sportsman to have a heart attack and these are not unknown in people in their twenties. However it is very uncommon and causes might be cocaine abuse , chest trauma or familial hyperlipidaemias. These are highly unlikely in this and most cases. 

In many cases forms of cardiomyopathy are the underlying cause. Hypertrophic obstructive cardiomyopathy is the most well known . Sometimes this can be easily detected by various forms of heart screening such as ECG or Echocardiogram. Greater awareness of this potentially fatal abnormality needs to be observed in sports clubs and routine screening is not unreasonable. Lastly the presence of defibrillators at all sports clubs should now be mandatory. If these currently exist in the departure lounges of airports like Arlanda and in small cafes in New York then this seems totally justifiable. 

Another death of a young footballer? Is this acceptable? How can we reduce the risk of cardiac deaths in nonleague football

A 26 year old footballer playing in the ninth tier of English league football collapsed and died during a game . Daniel Wilkinson was playing for Shaw Lane a West Yorkshire nonleague side.  There are no reported further facts on the cause of death . Other than that he appeared to have had a cardiac arrest 

Daniel had been playing for various nonleague clubs having originally signed a professional contract with Hull City in 2010.

There have recently been a plethora of reported deaths and collapses of young footballers during games.  What are the likely causes?  There are many causes of sudden death in the general population however the most likely cause would be an undiagnosed form of cardiomyopathy or a massive subarachnoid haemorrhage. Or a few more unusual causes of sudden cardiac death that may or may not have cardiac structural defects. 

There are differing forms of cardiomyopathy however they all have inappropriately thickened portions of the heart muscle . A common form is hypertrophic left ventricular obstructive cardiomyopathy . HOCM. The real risk is a double risk that the condition is undiagnosed and the propensity for serious and often fatal cardiac arrhythmias. This would be a possibility for Daniel. 

Over the years a greater awareness of this condition which can be both treated and managed has come about. Andy Scott the ex-Brentford player and manager and now chief scout had his career ended by a diagnosis of HOCM. He now regularly campaigns for the charity CRY which advocates routine echocardiography which mostly is the diagnostic test needed for a diagnosis. 

Deaths have been reported in all forms and levels of football and the most recent death in UK nonleague football was Junior Dian a 23 year old player with Tonbridge Angels who collapsed and died In Juky 2015. Other than occasional causes of death that include being struck by lightening most cases are reported as was Daniel Wilkinson as cardiac arrest or possible heart attack. Heart attacks are relatively rare in this population and it is likely that sudden arrhythmias such as from cardiomyopathies were the cause. 

Daniel was the seventh reported death in 2016 with 6 having similar features.  In fact 47 such deaths have been recorded since 2010 in Europe. Mostly these cases were young players aged 20-30 and mostly sudden collapse. Only one case is formally reported as right ventricular cardiomyopathy. 

In Italy for many years players have had to be tested and obtain cardiac certificates. Some testing clearly goes on in top tier football but how much In nonleague?  There is an argument that routine screening using ECG and Echo could be the optimal screening tool . These are not expensive tests and even in lower tiers of nonleague football some wages are high enough for players or clubs to fund this testing. 

Some nonleague players such as Tobi Alabi were fortunate and survived and also now campaign for cardiac testing .

Nonleague football should take a view on what it considers reasonable to protect their mostly young players who play for some degree of payment . If the FA can impose regulations designed to allow financial probity then they should be able to propose some form of health regulations. There needs to be some form of mandatory cardiac screening for young footballers
The other issue is that all football clubs should have defibrillation equipment . In an acute emergency where cardiac arrest has occurred speed is of the essence and an immediate defibrillation is the best option in all cases. Defibrillators are cheap and save lives. They are also easy to use and should be available at every football club at any level. There is really no debate about this. 

Fabrice Muamba – News Update

During the day there have been a few short updates that only state that he remains critically ill in ITU. Nothing more tangible than that however an important aspect is that is it being reported that it took two hours to get his heart going again. Cardiologists on TV are reporting what we suspected last night that they are thinking along the lines of HOCM as a potential cause ( hypertrophic obstructive cardiomyopathy). This is a disorder in which part of the heart, the main pumping chamber the left ventricle, has a thickened wall. This causes many things but maybe the most common is that the heart becomes liable to serious totally unpredictable arrhytmias and cardiac arrest. The other aspect to hope is that no part of the body was deprived of oxygen for too long ( brain, kidneys etc). Anyway lets be positive and hope that things turn out better than we might have hoped 24 hours ago. 

On a more positive footballing note anyone watching Real Madrid v Malaga would have seen an equalising goal from a free kick in the 92nd minute that was superb. Well worth watching on any catch TV. One of the best goals I have seen this season. Jose Mourinho was not amused

Fabrice Muamba Bolton Footballer

Very worrying news. He collapsed on the pitch seemingly face down. Had over 6 minutes CPR on the pitch. Taken to hospital  we are told still having CPR. There are many threads on twitter but essentially they all say the same. Pray for /Fabrice Muamba. It is wrong to speculate but as the TV commentators said a cardiac condition seems likely. Something like HOCM which fellow medics will understand. Lets all hope and pray that this ends better than it looks. The commentators and players all looked distraught as well.

A later update tells us that he is critically ill in hospital but the key thing is that he is alive. Once you reach hospital after a cardiac arrest of any kind the chances of survival are very much greater, depending obviously on what the cause might have been. But the questions that remain include if the cardiac muscle is functioning well and if any damage occurred to any other organs. Twitter has been full of footballers, and ordinary fans praying for Fabrice. Let us all hope that he survives this awful event.

As someone who used work as a medic in ITU, I have immense regard and respect for all those who saved his life on the pitch. The club medic and all the staff are truly heroes and makes one realise where maybe the important aspects of life lie.

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