A frightening scenario in the world of sport: a young athlete – who just moments ago fought for the ball or sought a new record – falls to the field in shaking agony. Shouts echo across the team, doctors rush to the fallen athlete, stretcher comes into view, oxygen mask on a pale face, resuscitation… Help arrived within minutes, but often following this uncanny series of events: death from sudden cardiac arrest.
Who exactly falls under the risk group? Why is it impossible to prevent these types of scenarios in time? Is this just unfortunate destiny? Which we cannot influence?
The famous Swiss cardiac surgeon, and founder of the EurAsia Heart Foundation, Professor Paul Vogt, is certain that many of these tragedies could have been avoided. He is especially concerned about the fact that almost all cases of sudden cardiac arrest in young athletes result in death, despite the adherence to current healthcare standards. This is exactly what needs to changed. What follows is our discussion with professor Vogt about the prevention, but particularly about the modern and more sophisticated treatment of sudden cardiac arrest.
– With each year of the FIFA world cup, the topic of sudden cardiac arrest among football players becomes increasingly prominent: young, athletic, healthy people die right on the field.
– Exactly, football players are the number one population at risk of sudden cardiac death. If we were to sort populations on highest risk factor, football players would be first, then basketball players, runners, swimmers, and other sport forms would follow.
– Why – in your opinion – does football take this unfortunate leadership position?
– It is difficult to say. Without any doubt, it is connected to the characteristics of the dynamic and rapid physical load on the body. Football is also the most large-scale and popular sport in the entire world. Furthermore, every case becomes noteworthy, especially when the death occurs within a famous club. I believe that death rates in sports are much higher, we just don’t hear about them in the news.
– As a rule, before a tragedy an athlete had no symptoms or complaints, he trained with full effort and felt exceptionally healthy. But sudden cardiac arrest in the majority of cases cannot happen without reason, right?
– Yes, of course. Behind it stands a concrete medical diagnosis. More specifically, there are about 10 medical conditions that manifest especially in athletes. They are can be diagnosed and thoroughly treated, it is simply a matter of finding the problems early and taking effective preventative measures. Speaking in general terms, athletes below the age of 35 suffer from congenital heart diseases, and athletes above the age of 35 present with coronary artery disease resulting in acute myocardial infarction or fatal arrhythmias. A good specialist would identify such issues with the help of an electrocardiogram, a physical stress test, or an echocardiogram.
However, it is very important to note that in – according to different studies – 40% up to 96% of athletes who die from sudden cardiac death, the causal reason is unknown. Therefore in these cases there is no such possibility of preventing the tragic event. The only possible solution would be fast and effective resuscitation; in other words: optimal treatment at the time of the sudden cardiac arrest is the only option to survive.
– How come athletes, who have access to world class diagnostic methods, still suffer significantly from cardiac arrest?
– The problem lies in the methodology and actual system of diagnosis. What happens in the standard visit to the cardiologist? The medical history of the patient’s family and the patient themselves is recorded, clinical examinations are conducted, plus an electrocardiography – an ECG. And all of this is done to make a convincing argument for the athlete’s health. Together, these tests carry with them a certain level of formality. However, many pathologies are not identified with an ECG. A person may have very serious heart problems, but a completely normal ECG.
– So what type of examinations are lacking?
– Many heart problems can only be diagnosed with the help of an echocardiography, also called sonography of the heart. This broadens the typical medical examination of the heart.
Italian researches collected very interesting data on young athletes under 25 years of age. Athletes who underwent a more comprehensive medical examination were found to suffer significantly less heart problems than athletes who were examined using standard procedures. Theoretically, timely diagnosis would help save the majority of athletes who suffered from serious heart problems. However, echocardiography is seen as an expensive and complex methodology, and is not included in important international standards of medical examination as a standard screening method for the majority of athletes. There is a simple cost-effective analysis which prevents the widespread use of a more comprehensive and in-depth cardiac examination.
– What are the chances of survival for someone whose heart suddenly stops?
– Using standard medical measures for sudden cardiac arrest outside of the hospital, one can save 2—3 percent of patients. If there are specialists in the vicinity who know how to deliver high-quality resuscitation and immediate defibrillation, and all action is taken quickly, then chances of survival raise to up to 30 percent. If there is access to special devices, such as artificial blood circulation, and the doctor has time to identify the cause of the cardiac arrest, one can save up to 70 percent of patients. Having well-trained specialists and proper equipment is the determining factor. Surprisingly, most of the time only orthopedists are present during large international competitions. Specialists who can perform high-quality resuscitation are usually nowhere to be seen. At the same time, within the organization of such massive competitions, it is necessary to have precise algorithms: what is the process to be followed in case of sudden cardiac arrest? Where is the proper equipment available? Who can connect the patient to the life support system such as extracorporeal circulation devices? Where is the next cardiology, respectively cardiovascular surgical department providing all kinds of treatment options?
– Have you contacted FIFA regarding these issues?
– FIFA usually accepts «Italian recommendations», which state that an analysis of the patient’s medical history, a physical examination, and an electrocardiography satisfactorily identify the potential risks of death due to sudden cardiac arrest of a given athlete. These are simple preventative measures.
However, we are taking about the treatment of sudden cardiac arrest in young athletes. With the upcoming FIFA world cup, as well as future major competitions, we are discussing the necessity of additional medical assistance in the case of a sudden cardiac arrest on the playing field. In such emergency situations we recommend establishing the following precise algorithm, which would reduce the death rates which are close to 100% today.
Firstly, immediate professional continuous high-quality cardiopulmonary resuscitation and immediate defibrillation has to be delivered; mechanical compression must be applied without any interruption; secondly, in case of treatmentrefractory cardiac arrest, connection to extracorporeal life support systems (ECLS) is indicated which can be done percutaneously with the patients still being inside the emergency room of the football arena; thirdly, with the patient being on ECLS, rapid transfer to the nearest cardiology/cardiosurgery sector will be performed, where modern equipment for operational medical diagnosis is available; fourth, emergency cardiological intervention or emergency cardiac surgery can be performed as indicated; fifth, appropriate post-arrest intensive care treatment including brain protection will be provided after cardiological or surgical intervention. Currently, we are in discussions with FIFA with regards to the implementation of the algorithm as described here.
– You mentioned there was a difference in causes for sudden cardiac arrest between athletes above and below 35 years of age.
– Yes. If you are over 35 years old, one of the reasons may be coronary artery disease. The other is stenosis of the aortic valve. Approximately 1.5–3 percent of the population has an aortic valve that has anatomical abnormalities. For athletes this is an additional risk of sudden cardiac arrest. There are well-known football players with such a diagnosis – they are undertaken by more careful medical control.
Congenital anomalies of the coronary vessels of the heart can lead to insufficient supply of oxygen to the heart muscle during physical stress. There are a number of anomalies that need to be corrected surgically. Or different types of arrhythmias: some of them cannot be treated, some can be cured interventionally and some treated by the implantation of a internal cardioverter-defibrillator.
– Is coronary artery disease relevant for professional athletes?
– Yes. In ordinary people not related to professional sports, stenosis of the coronary vessels is the main cause of death, especially for men aged 35 to 55. This also applies to athletes over 35 years of age.
– Are there any preventive measures to reduce the risk of heart disease?
– There are standard recommendations: do not smoke, monitor the level of cholesterol and do not gain excess weight. This is especially important for those who have a family history of coronary heart disease, as these people are at risk because of genetic predisposition. However, the most important risk factor for heart disease is the lack of exercise. People who have been practicing cardiovascular exercises for many years, prolong their lives for 10—15 years; besides, they have less than 50 percent malignant tumors. That means, regular exercise reduces the risk of cancer by 50 percent. An exception is prostate cancer, which is not influenced by physical exercise.
– How much training is ideal for the prevention of cardiovascular disease?
– It is necessary to distribute 150 minutes of endurance exercise for seven days. It can be cycling, running or anything else. And during these 150 minutes the heart rate should stay above 120 beats per minute. 150 minutes a week – it’s about 20 minutes a day – not that much. But I am talking now about people whose lives are not related to constant physical activity. For athletes, this recommendation will not yield tangible results.
– Is endurance training helpful for every person?
– These figures are confirmed by several large studies, in which more than 1.5 million people were involved. Patients were observed for up to 30 years. So, the data is quite reliable.
However, if a person has never engaged in sports and suddenly decides to start such training, he must first be examined by a cardiologist. In the case of coronary artery disease of the heart in addition to physical exercises, it will be necessary to take a couple more medical products – aspirin, something to lower the level of cholesterol in the blood as well as treatment of arterial hypertension.
– Is it possible to choose yoga or intensive walking tours as physical activity?
– Yes, walking is also physical activity, but the effect is less. As for yoga, it is known that it has a positive effect on the cardiovascular system. But what does not bring results is a sauna. Just lying and sweating is not an option. Perhaps, people feel better after the sauna, but it has no training effect for the cardiovascular system.
– If to sum up, how to protect yourself from sudden cardiac arrest?
– The formula is simple – timely examination with the study of the medical history, clinical examination, stress test on a bicycle, with mandatory echocardiography, a healthy lifestyle and regular endurance training.
Paul R. Vogt
Doctor of Medicine, Professor of Cardiovascular Surgery, President of the EurAsia Heart Foundation («The Heart of Eurasia»). In 1983 he graduated from the Medical Faculty of the University of Zurich. He worked as an assistant physician in the field of cardiosurgery and vascular surgery at the University Hospital of Zurich under the guidance of Professor Marco Turina. In 1992 he defended his thesis. In 1997, he headed the Department of Cardiac Surgery and Vascular Surgery at the University Hospital of Zurich as Deputy Chief. Between 2000 to 2006 he worked as Chief Surgeon and Director of the University Hospital Giessen, Germany. He is an invited professor at clinics and universities in Russia, China and Myanmar, Honorary Doctor of St. Petersburg State Medical University. acad. I.P. Pavlova and Professor of the Department of Neonatal Surgery and Cardiac Pathologies of Newborn and Premature Children of the State Medical Pediatric University of St. Petersburg, Russia.
Information about the foundation
The humanitarian medical organization EurAsia Heart was founded in 2006 in Zurich. Leading cardiac surgeons in Europe under the leadership of Professor Paul Vogt joined forces to train colleagues from the countries of Eurasia in the field of cardiology and cardiovascular surgery. EurAsia Heart operates in Russia, Uzbekistan, Myanmar, Cambodia, China, Vietnam, Eritrea, Armenia, Bulgaria, etc.
The international group of experts of EurAsia Heart consists, among others, of specialists from Yale University, the University Clinic of Vienna, the German Children’s Center of St. Augustine, the Children’s University Clinic Zurich and the University Hospital Zurich, Switzerland. EurAsia Heart’s trusteeship committee includes businessmen, entrepreneurs and doctors. Ex-President of Switzerland Dr. Adolf Ogi and former German Chancellor Gerhard Schroeder are co-Presidents of the Patronage Committee.
The activities of the Heart of Eurasia are monitored by the Swiss Interior Ministry and supported by the Swiss Agency for International Cooperation and Development.
Russia is one of the most promising partners of EurAsia Heart. For twelve years EurAsia Heart has been active in St. Petersburg, Novosibirsk, Penza, Petrozavodsk, Tomsk, Yaroslavl and Voronezh. Support for the president, the government, implemented in the national Russian project “Health” in conjunction with the international educational and scientific activities of EurAsia Heart, could bring Russian federal centers of cardiovascular surgery to the world level and stop the outflow of patients abroad.
CH‑8038 Zürich, Switzerland
Tel. +41 44 209 25 14
How to help
Donation account EurAsia Heart Foundation – A Swiss Medical Foundation
Bank: St. Galler Kantonalbank AG
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IBAN: CH92 0078 1509 1392 0020 1
Post account: 61-980375-6
IBAN: CH65 0900 0000 6198 0375 6