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Monday, July 28, 2014
Trinidad & Tobago Guardian Online
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Heart attack ends athlete's careers but doctors say it’s not unusual
In under three months, this country has lost two national football players to heart attacks.
Akeem Adams, who joined Hungarian club Ferencvaros on August 7, 2013, died last December, four months after suffering a massive heart attack on September 25, last year.
After his heart attack, the condition of the 22-year-old defender did not improve and his left leg had to be amputated on October 8 in a surgery intended to save his life. But he suffered a stroke on December 28, while at the Városmajori Heart Clinic, and fell into a coma. He died in Budapest, Hungary, on December 30.
Barely over Adams’ death, the fraternity went into mourning again when another national footballer, Kevon Carter, passed away following an apparent massive heart attack on February 28. The 30-year-old lance corporal, a high-scoring midfielder, complained of chest pains and feeling nauseous after a training session with his Defence Force team at Volunteers Ground, Macqueripe. He died en route to hospital.
Six days earlier, 17-year-old St Jago High School athlete Cavahn McKenzie from Jamaica died in Tobago at the end of the North American, Central American and Caribbean Athletic Association Cross Country Championships at the Mount Irvine Golf Club. McKenzie collapsed and was taken to the Scarborough General Hospital, where he was pronounced dead. An autopsy later showed he too had died of a heart attack.
It’s not new: sports doctor
The deaths of these young athletes who were supposed to be in top physical shape have left one question—Why?
Dr Terrance Babwah, Fifa-approved doctor with the Soca Warriors, says it’s not unusual for young athletes to suffer heart attacks resulting in sudden death, nor was it a new phenomenon. He said it is estimated that one sudden cardiac death happens one in every 200,000 to 300,000 hours of organised sport.
“It has always been happening. The problem is not that more people are dying, it's just the media sensationalising it. But people have been dying for many years, and even more so in strenuous sports such as football,” Babwah said.
Referring to the tragic deaths of international footballers like Phil O’Donnel, Antonio Puerta, Miklos Ferher, Marc Vivien Foe and David Di Tommaso, Babwah noted there were a host of others who died on the football field.
“Every year, on average, internationally, we lose at least eight to 12 players on the international stage, and mostly it is related to heart disease.”
Asked why, he said, “In athletes who compete and die under 35, the most common cause of this is what is referred to as congenital abnormalities of the heart—abnormalities they might have been born with or developed over the years. And people over 35 years, they die from heart-related diseases such as narrowing of the arteries, heart attack, strokes, etc.”
“So (in) someone who has an abnormality to the heart that they were born with or developed early in life, the heart may not be able to tolerate that sort of load with certain high-intensity sports and it might just be too much for the heart to handle and they can go into heart failure.”
Heart expert: no warning signs
Supporting Babwah’s views was senior cardiologist Dr Feroze Omardeen of Healthy Hearts Cardiac Lab at Westshore Medical Hospital.
He said most afflicted athletes, or ordinary people, have no symptoms before death.
“Many patients don't know what the classic symptoms of a heart attack are. They often describe other things as a heart attack. There are a lot of things that can happen to a patient's heart that they cannot distinguish. For instance a heart arrhythmia—electrical problems, which happen especially in young athletes.”
He described the heart as a mechanical pump that is operated by an electrical system. So a malfunction in the electrical system causes arrhythmias, which are irregular rhythms of the heart, and these can be lethal.
Even with a myocardial infarction, or heart attack, which is usually caused by a blood clot, an arrhythmia may occur. Young athletes may appear to have normal hearts and normal arteries during an ultrasound, but unnoticeably, they are experiencing electrical malfunctioning.
“An athlete's heart may malfunction even during exercise. During exercise or any high-intensity activity, the adrenaline goes to a certain level and the heart pumps harder. That adrenaline can trigger arrhythmias, or rapid electrical malfunctioning that may lead to sudden death.”
He said for this reason football fields in the US have for years made defibrillators available. In the event an athlete suffers a life-threatening cardiac dysrhythmia, the electrical device can be used to provide a shock to the heart which can aid in re-stabilising the electrical system.
“I am not too sure that they are readily available on fields here. But it is important to have them available during any sporting activity,” he advised.
Watch your diet and drugs
Omardeen admitted more research had to be done to verify the negative effects of energy drinks in particular, but said cardiologists do not recommend the use of such products: they are unnatural forms of induced energy laden with caffeine, sugar, and other ingredients that can cause more harm than good.
Babwah said many adolescent athletes take medication and overindulge in energy drinks and performance-enhancement products.
“They take dietary supplements; a lot of them take anabolic steroids. Many also take these high energy drinks and stimulants and these things have been linked to people getting clots in their hearts and dying of heart attacks because of the residual effects they have on the heart.”
Screening may not save lives
Would Adams and Carter still be alive today if they had had screening tests?
Maybe, maybe not. Both doctors said screening is one way to perhaps discover a problem, but not every screening will pick up every problem and as a result of this, some things can be overlooked or in other cases over-investigated.
Babwah pointed out that compulsory screening is now being considered, but for many years it was not a prerequisite. In fact, in many countries there is still no protocol testing.
“Traditionally people taking part in sports were thought to be of great physical fitness and that prowess that would have been greater than the average person.
“So traditionally most of the testing of players would have been geared towards assessing the different components of their fitness required for the type of sport. So for example someone who wanted to do sprinting, they would have gone through power testing, while a long-distance runner's endurance would be tested,” he explained.
Babwah added that people also needed to be realistic.
“A screening test is really a cheap test that is used to either pick up something or give an idea that something might be wrong and will indicate need for further testing. So it is not a diagnostic test in many cases. So you might miss cases and you may over-investigate in other cases, based on the findings of the screening test.”
Besides the fact that screenings may not save lives, Babwah also spoke of the high cost of mass tests. He estimated it would take approximately $10,000 to $15,000 per club to start screenings.
Currently footballers undergo a basic EKG or electrocardiography and an echocardiogram (ultrasound of the heart). In some cases a stress ECG may have been done. But a thorough screening would involve more tests such as blood tests, radionuclide scanning, cardiac catheterisation, electrophysiology test, CT heart scan, myocardial biopsy etc, depending on the circumstances.
Defects hard to detect
Without thorough testing it can be difficult to diagnose an athlete’s condition, the doctors explained. Athletes undergo rigorous training and there are changes to their hearts that are known as adaptations to the sport. Sometimes these adaptations involve the heart being swollen and it is impossible to tell if it is naturally swollen from the training or if it is an abnormality.
“The pathological heart, when in distress due to some complication, can be swollen in many places. How is this to be differentiated during a basic screening? We cannot just eliminate someone unless we have more data,” said Babwah.
Omardeen explained if the swelling is not as a result of training, it would then be described as hypertrophic obstructive cardiomyopathy, a condition that causes the heart muscle to thicken, which makes it harder to pump blood efficiently. He said with exertion during intense activity like sports, one can suffer a heart attack as the blood is not pumping as quickly as it needs to.
Symptoms related to heart attack
Chest discomfort. Most heart attacks involve discomfort in the centre of the chest that lasts more than a few minutes, or goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Palpitations: the sensation that your heart is skipping a beat or beating too rapidly
Dyspnea: difficult or laboured breathing.
Other signs may include breaking out in a cold sweat, nausea or lightheadedness.
As with men, women's most common heart-attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. (American Heart Association)