Doctor’s Conrner with JOSEPH KABUNGO
FIFA through the FIFA Medical Assessment and Research Center (F-MARC) has remained committed to a programme of research, education, standardisation and implementation of emergency management of sudden cardiac arrests (SCA).
One question, which I keep asking myself each time I am at a stadium, is just how ready are we in Zambia in handling a medical emergency such as a SCA?
It is a devastating experience of sudden cardiac deaths on the field of play, which makes it important for urgent solutions to be sought.
Soccer players have to feel safe each time they are on the pitch.
Safety has to be from actual soccer related injuries, treatment of bad injuries on the field and also the ability of their respective medical teams in responding to emergencies that might occur.
Players that have been around when a colleague collapses and dies have sad stories to tell.
It is through such moments when the sports fraternity needs to sober up and reflect on the way forward.
I do not want to drift away from what I want to discuss but suffice to say that a lot of work has to be put in.
It is still sad that a number of games in the super division are played in environments were ambulances are not in sight.
Football is the most popular sport across the world and the issue concerning the safety of players including that of spectators is of importance.
The cause of SCA that has been documented in young athletes below the age of 35 is a condition of the heart muscle that is commonly referred to as hypertrophic cardiomyopathy.
This condition affects young athletes and most of the deaths on the pitch are attributed to this condition.
Of course there are other conditions that predispose someone to suffer a cardiac arrest and if not attended to, lead to death.
Hypertrophy means enlargement or increase in the size of the heart muscle and it is the left ventricle that shows abnormal enlargement.
The increase in the size of the heart is not the normal physiological increase of the heart seen as a result of physical exercise.
A cardiomyopathy also implies that that heart muscle is not normal.
It is not the pathology or disease pattern that I am interested in but emphasise is on the primary condition that has been found in a lot of cases of sudden cardiac arrests/deaths in young football players.
Most of the hypertrophic cardiomyopathes go unnoticed and the only time they show is when someone actually suffers a cardiac arrest.
The important thing to do for sports men especially those involved in strenuous activities is to have regular medical assessments with an emphasis on the heart.
Once the heart looks suspicious after doing tests such as an electrocardiography (ECG) and an echocardiography (cardiac echo), it is vital that heart or cardiac specialists get real involved in the care of such a player.
Good medical advice from the heart specialists (cardiologists) will help in the prevention of a sudden cardiac arrest from occurring on the pitch.
This is what is known as primary prevention of sudden cardiac arrests.
Over fifty percent of hypertrophic cardiomyopathies are hereditary and relatively common in the general population (1:500).
It is thought that there is a genetic basis for the occurrence of the disease, as often demonstrated by DNA tests of victims and close family members. Apart from the above-mentioned tests (ECHO and ECG), high levels of suspicion have to be held in a player with history of recurrent episodes of syncope or fainting, chest pain and dizziness.
A positive family history of a similar condition or sudden death at a young age below the age of 45 all might point to this condition.
Apparently in some cases, sudden cardiac arrests have occurred in individuals who had undergone medical examinations and the possibility of not detecting an enlarged cardiac or heart muscle, which might be dangerous, cannot be ruled out.
It must be appreciated that the heart muscle in athletes or sports men like football players enlarge in size in comparison to someone who does not exercise at all.
This enlargement is a normal physiological process in order for the heart to meet the extra work it has to do in an exercising individual.
However, the problem comes in when the heart muscle on top of the normal changes it undergoes, it also has problems with its normal functioning.
This is the main reason why a cardiologist has to assess all those taking part in sport so that any abnormalities in the heart can be quickly identified and appropriate medical interventions put in place.
As we all reflect on the causes of sudden cardiac deaths it is important that we also think of how to prevent these from occurring on the pitch.
There is definitely the first step in prevention, which is adequate medical screening or examination for the heart.
This involves doing an electro cardiograph commonly known as an ECG and also doing an echocardiography as already stated.
These two medical tests will actually give us a pointer as to which heart needs attention.
The other issue is having competent medical personnel who are well trained in handling medical and surgical emergencies.
The competences of various health providers have to be coupled with appropriate equipment and in this case, an automated external defibrillator (AED) is a must.
In fact an AED is a must have at any facility were football is played.
The use of an automated external defibrillator does not need extra ordinary specialisation, but needs someone with good resuscitation skills and general knowledge on how to use a particular automated external defibrillator.
The responsibility of playing sport in an environment, which is safe with basic medical requirements, must be given priority.
For questions and comments write to: Dr Kabungo Joseph – Email: firstname.lastname@example.org or kateulejk@gmail.
Doctor’s Conrner with JOSEPH KABUNGO