After Christian Eriksen’s collapse, Dr VK Srinivas, part of the core group of Sports Ministry’s Central Athlete Injury Management System, spoke to Eagles Vine about why seemingly healthy athletes suffer cardiac problems, and how it can be caught early
Four days after Danish footballer Christian Eriksen collapsed on the pitch during a Euro 2020 match, the reason why the, seemingly healthy, footballer suffered a cardiac arrest at 29 remains unknown.
The player’s cardiologist at his former club, Tottenham Hotspur, has been quoted as saying that Eriksen had no history with heart issues.
On Monday, Indonesian shuttler Markis Kido — another sportsman who lived the bulk of his life as a high-performance athlete — died due to a heart attack at the age of 36. Kido, a men’s doubles gold medallist at the Beijing Olympics in 2008, was known to suffer from hypertension.
The two instances have raised questions about why athletes, who were at the peak of their physical fitness, had suffered cardiac problems.
“Most of the deaths which happen on the field are related to cardiac events. And a majority of them are due to cardiomyopathy (a disease of the muscles of heart, where the muscles are too thick or too thin), or a hole in the heart from birth, or they might have arrhythmia (irregular rhythm). In case of arrhythmia, the heart will suddenly start beating fast, or very slow. Otherwise, the heart is healthy. It’s an electrical problem of the heart,” Dr VK Srinivas, one of the country’s top cardiologists, told Eagles Vine on Tuesday.
Elaborating further, he said: “Most of the times it (instances of athletes collapsing on the field) is something to do with arrhythmia, which is an electrical disturbance that happens with violent exercise. People who have cardiomyopathy are prone to arrhythmia. These people, if they run, for example, a 100m or 400m dash, they precipitate arrhythmias. This can lead to instantaneous death. Whereas angina heart attack usually gives you a warning in the previous few days. If you neglect it, you can have a heart attack on the field.”
He also pointed out that the COVID-19 virus has made athletes more vulnerable towards having issues with their heart.
“Nowadays because of COVID-19 , the chances of athletes having heart diseases is going to be there. COVID-19 can affect heart diseases on a long-term basis. They can have things like myocarditis. A normal, healthy-looking person can have inflammation of the heart. This causes weakness of the heart muscle, which could lead to heart failure. So we need to evaluate athletes for these factors due to COVID. An athlete may not have congenital heart disease, they may not have cardiomyopathy. But they can have COVID (which can cause complications).”
Taking cue from Italians
Based in Bengaluru, Dr Srinivas is a pioneer in primary angioplasty and managing acute myocardial infarction. Given his experience, he was recently included in the central core team of the newly-launched Central Athlete Injury Management System (CAIMS), an initiative of the sports ministry to streamline sports medicine and rehab support offered to athletes.
As part of his role in the central core team of CAIMS, Dr Srinivas would help with pre-participation evaluation of Indian athletes.
Pre-participation evaluation (PPE) in common in countries like USA and Italy. In the case of the former, PPE is carried out for youngsters competing in sports, with states deciding how frequent these tests need to be. In Italy, on the other hand, law makes it compulsory for every athlete to undergo PPE tests each year. As per research, these PPE tests reduced cases of sudden deaths among athletes in the Veneto region of Italy by as much as 89 precent in the 21 years that the law was in force.
“We can do what is done in countries like Italy and USA. They screen athletes at young age. That way you have an easy way of identifying people with heart diseases,” said Dr Srinivas.
While the costs of putting every young athlete through PPE tests each year sounds expensive, Dr Srinivas said there was an easy way to streamline testing.
At first, all athletes will be given a questionnaire to fill out, where they will fill out their symptoms. They can mention whether they have experienced palpitations, giddiness, or chest pain. An athlete who mentions these symptoms will be given extra attention. The questionnaires will help separate some people with heart diseases. Then, athletes can undergo clinical examination and ECG tests.
“These can give us 90 percent of cardiac illnesses. These are simple, non-expensive ways of diagnosing if anyone has heart conditions,” he said. “If ECG changes are there, then those athletes will need further check-ups, like echocardiogram, or threadmill. With this, we can identify a majority of high-risk individuals.”
Football Association — the governing body for the sport in England — has also run a mandatory cardiac screening program for adolescent athletes in UK which starts with a simple but detailed questionnaire (page 6, 7). The program, which has run since 1997, has screened over 11,000 athletes since its inception.
Teaching athletes CPR
Eriksen’s life was saved by the timely intervention of doctors and his teammates. Denmark captain Simon Kjaer, one of the first players to get to Eriksen, is said to have cleared his teammate’s airways. Doctors then resuscitated the footballer with a combination of CPR (repeated pushing down on the chest) and an electric shock from a defibrillator.
“Athletes need to taught CPR, and how to use a defibrillator,” said Dr Srinivas.
As it turned out in case of Eriksen, it was the difference between life and death.