Fabrice Muamba

Given the lack of luck the Irish have with the game of soccer (football if you’re one of those imperialist pigs) St Patrick’s Day was never going to be a good omen. Tragedy first struck when Kaizer Chiefs left a bucket of KFC behind their goal, giving Bennie McCarthy the impetus to score twice. Of course the second tragedy of the day occurred in the league in which Bennie used to be good enough to play.

In the 41st minute of the Tottenham – Bolton game Fabrice Muamba collapsed on the field. According to media reports the first medical responder turned him onto his side after which he was reassessed and then resuscitated. The details are quite sketchy and the TV footage is ‘respectful’ so it’s difficult to say what exactly was done, but it appears as if CPR (Cardio Pulmonary Resuscitation) was performed along with Defibrillation (that ‘cool’ shock thing House does every chance he gets).

The media have largely reported that Mr Muamba suffered a heart attack although some of them later changed this to say that he had suffered cardiac arrest. This is perhaps less informative than telling you that the sky is blue or that Lady Gaga is psychotic. While not impossible it is highly unlikely that a 23 year old fit athlete would suffer a heart attack, kind of like Superman suffering from impotence.

In general an athlete’s heart is stronger and more powerful than that of the average person.  Simple examples of this exist with people like Lance Armstrong and Miguel Indurain, who reportedly had resting heart rates of below 30 at their peak fitness (normal is 60 to 100).

Of course a heart attack is still a possibility if anyone exercises when sick, but given the environment of the Premier League it’s unlikely Fabrice would have been let out of his cotton wool had he been suffering with a cold, or even an ingrown toenail. One, or a top flight club, does not simply take chances with multi-million dollar investments.

So if not a heart attack then what explains cardiac arrest, which literally means ‘heart stop’, in a young healthy athlete?

There are several possibilities and no doubt those who want to take umbrage with this article will find some obscure congenital defect that may have caused the problem. However any good doctor will tell you that common things occur commonly. In this case the likely cause is what’s termed an Arrhythmia. The simple explanation is that your heartbeat, and the electrical impulse that governs it, is as well organized as a North Korean military parade. It is sharp, precise, and repetitive.

If for some reason this rhythm becomes interrupted it will change and become an Arrhythmia. The degree of change depends on a number of factors, and the ability to return to normal depends on several physiological inputs. However the more disorganized the rhythm becomes the less blood your heart pumps out, potentially making it a useless piece of hardware and causing you to fall unconscious and possibly die.

Over the past number of years there has been a lot of research around Sudden Cardiac Arrest (SCA) amongst athletes. In the run up to the 2010 FIFA World Cup (apologies for using the F word) several articles were published in relation to this topic and it was brought to the forefront of discussions in the emergency medicine community.

While the research remains ongoing there are several hypotheses as to why athletes seem to be at risk for SCA. A well established hypothesis is that certain individuals have what is known as channelopathies. Effectively this means that electrolytes (salts like Sodium and Potassium) are not transported as efficiently as they should be into and out of cells. This predisposes a person to abnormal and potentially deadly heart rhythms (Arrhythmia). In these cases genetic testing has been shown to be useful in families where there is a history of SCA, especially among young family members. Often several people in a family are affected, but once this is known a Cardiologist can offer treatment options.

As a rule making a diagnosis becomes more and more difficult the further away one is from a patient. That said based on current evidence it seems possible that Fabrice Muamba may have an undiagnosed channelopathy which then caused an abnormal heart rhythm and ultimately cardiac arrest. It should be noted that Muamba is still alive because he received CPR and Defibrillation very soon after collapsing. These are skills which are proven to save lives and can be performed by people who are not medically qualified but have been on a straightforward 4 hour course.

The message here is to know how to spot these ‘tragedies’, know how to provide the necessary emergency assistance, and to pretty much ignore any diagnosis made by the news media.

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