Fabrice Muamba: Heart Attack Should Prompt Mandatory EKGs for Athletes

Timothy RappFeatured ColumnistMarch 20, 2012

LONDON, ENGLAND - MARCH 17:  Bolton Wanderers manager Owen Coyle, Benoit Assou-Ekotto and William Gallas of Tottenham Hotspur (R) look distraught as Darren Pratley of Bolton Wanderers (C) covers his face as Fabrice Muamba of Bolton Wanderers receives CPR treatment on the pitch after suddenly collapsing during the FA Cup Sixth Round match between Tottenham Hotspur and Bolton Wanderers at White Hart Lane on March 17, 2012 in London, England.  The game was abandoned.  (Photo by Clive Rose/Getty Images)
Clive Rose/Getty Images

Thankfully, Fabrice Muamba of Bolton is recovering after his heart stopped beating in a match against Tottenham on Saturday.

Still, the incident should serve as a warning to athletes, coaches and administrators everywhere, especially here in the United States: EKGs need to be a mandatory part of the physical exam required for all athletes.

In the United States, that isn't the case. From the Associated Press (via The Washington Post):

The American Heart Association recommends a thorough physical exam and detailed family and personal medical history for athletes, but not an automatic electrocardiogram, or EKG, which measures a heart’s electrical activity. The idea is to look for red flags — like fainting episodes, a heart murmur or whether a relative died young of a heart problem — that would prompt the doctor to order further cardiac testing.

Now, here's the thing—Muamba probably was screened before. The Premier League has a testing procedure in place, via Gary Morley of CNN:

"Testing is very controversial in the medical community as far as what type of testing, when to screen, how to screen," says [Dr. Chandan] Devireddy, who works at Emory University Hospital in Atlanta, Georgia.

The Premier League, for example, says all players aged 16-18 at its member clubs "must go through a cardiological examination/screening" and then have follow-ups "as early in their careers as possible and again if the annual medical screen shows any results that warrant a further examination."

In that same article, Devireddy wonders whether those examinations include an EKG. 

Dr. Hilary Jones, a medical expert from England, tells Morley she believes athletes should have both EKG and ECHO cardiograms.

"There was a screening program that was very effective in Italy, for example, where all their young professional sports people were being screened," she says.

"They were detecting quite large numbers of abnormality and indeed they were able to reduce their mortality rate by 90%."

Of course, testing doesn't mean any cardiac irregularities could be caught. Genetic disorders that are brought to the surface under the rigors of exercise remains a possibility, according to Dr. Douglas Zipes, a professor at the Krannert Institute of Cardiology at Indiana University:

He said there were a number of genetic heart abnormalities that could have caused Muamba’s heart to stop, and that athletes with such problems were potentially more at risk. Those abnormalities can cause the heart muscle walls to become too thick, causing the heart to become overworked in its attempt to pump enough blood around the body.

“Athletes under the stress of a game have a lot of adrenalin in their bodies,” Zipes said. “That can interact with an underlying congenital problem and cause a cardiac arrest.”

I know, I know, that is a lot of medical speak. But the point is this—the more athletes are monitored on a cardiac level, the better opportunity we have to prevent potential tragedies like the one that almost befell Muamba.

The NFL has begun the efforts to prevent, monitor and carefully treat head injuries because it became a problem that was ignored for too long. The heart should be given no lesser treatment.

With athletes continuing to push the limits of the body with intense training, weight-lifting and intense, year-round schedules, a higher level of physical monitoring needs to accompany the added stress to the body.

And I'm not just talking about the highest levels of sports—I'm talking about on all levels of competitive play. From high school on, athletes undergoing mandatory physicals should also be expected to undergo EKG and ECHO cardiograms.

We like to think of sports as fun and games, but in fact, they are risky endeavors that often require the body be pushed to its limits. I'm not saying we should all develop nervous ticks here, but we do need to be aware that such rigorous exercise can push previously unknown conditions to the forefront.

The more we can do to prevent that from happening, the more incidents like Muamba's we can avoid.

And that should absolutely be a priority.


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