An athlete–healthy as a horse, but the heart fails

In January 2004 Miklós Fehér, the Hungarian forward of Benfica walked on the field with a smile, until 20 seconds later he lied lifeless on the field. The 24 year old player died in spite of resuscitation attempts. Behind his sudden death was hypertrophic cardiomyopathy, a congenital heart disease.

Jarque, Foe, Fehér, Puerta, O’Donnel. These are all top football players who have died of acute heart failure. Over decades, several young athletes have lost their life during physical effort. Cardiogenic sudden death is something that goes beyond comprehension. Still, the fact is that a top athlete may be suffering from a latent, potentially deadly heart illness, whose first symptom can be acute heart failure.

All in all, heart diseases are usually mild while serious and fatal ones are very rare. Almost all athletes have benign arrhythmia sensations at some point of their life. These sensations are characterized by the fact that they pass by themselves without any specific measures, even during a sports performance. After the age of 35 the prevalence of coronary artery disease increases also among those who exercise actively. The coronary artery disease distracts the circulation of the heart, i.e. coronary arteries, because of narrowing artery walls or arterial thrombosis.

Statistically cardiogenic sudden deaths happen 1 to 2 times per 100,000 athletes. Cardiogenic sudden deaths occur relatively more often in endurance and ball sports, but statistically the difference between sports is minimal. Football is by no means an exception in terms of prevalence, but the awareness of sudden deaths among football players is explained by the media value and large number of players football has. Football is the most popular sport in the world.

Research and statistics show that most cardiogenic fatalities occur due to hypertrophic cardiomyopathy. Three issues relate to hypertrophic cardiomyopathy: it is hereditary, congenital and latent. It is a heart muscle disease, which makes the wall of the heart muscle thicker over time. A great number of people who suffer from it feel well and do not know that they have it. Combined with continuously reducing pumping power of the heart, the thicker walls can make the heart collapse during physical workload. Hypertrophic cardiomyopathy can be diagnosed with an ultrasound scan as early as in childhood. In these cases the scan shows abnormally thick heart muscle walls. It is worth noting that hypertrophic cardiomyopathy is a serious illness in competitive sports, but it can present itself significantly milder and less risky as well.

In addition to the congenital illness, cardiogenic sudden deaths can also occur due to an untreated or prolonged infection. A tenacious viral disease, commonly known as the flu, can lead to the development of myocarditis, if sports are performed while ill. Myocarditis combined with physical activities may lead to a sudden halt of vital functions. Anabolic steroids or stimulating drugs, such as cocaine, strain the heart and they can also in worst cases lead to sudden death. The third, a bit less common reason for cardiogenic sudden deaths among athletes is a blow to the chest, which can stop the electrical activity of the heart or rupture it.

The risk for sudden deaths can be reduced. It is essential to find those athletes who have showed alarming symptoms or whose immediate family has had sudden deaths at young age. In cases with sudden deaths in sports, it is common that there have been symptoms or there had been family members with sudden deaths at young age before. A performance drop, chest pain, abnormal shortness of breath, dizziness or an inexplicable loss of consciousness are alarming symptoms that must be carefully examined.

The risk of sudden deaths can be reduced by performing medical examinations on athletes. These medical examinations identify the background and family, as well as preconditions and possible limitations to performing sports. They include an electrocardiogram and an ultrasound scan of the heart, if possible. On the other hand, hypertrophic cardiomyopathy can be diagnosed with a single heart ultrasound scan.

Medical examinations are mandatory for professional athletes, but regular medical examinations are also recommended for young semi-professional (over 10 hours per week) athletes. The electrocardiogram and ultrasonic scan measure different aspects of the heart in a complementary way. These together can virtually eliminate the possibility of a heart illness.