[misha]

Unfortunately sudden cardiac death is something that has thrown a shadow over football in recent years, the link being seen once again in a Spanish tragedy. In the wake of the recent death of Sevilla FC footballer Antonio Puerta, Goal.com reflects on the sad passing of the player and the reasons behind his death, the similar deaths of other players, what is being done and what can be done to avoid further tragedies in future…

The footage is now hardly bearable to look at knowing what came later.  Twenty-eight minutes into what should have been an enjoyable Saturday of first-class football at the Ramón Sánchez Pizjuan stadium in Seville, Antonio Puerta began to die. 

The 22 year-old was backtracking to defuse the danger of a Getafe move down his flank.  As the ball is crossed weakly and rolls off for a goal kick Puerta slows down and touches the left side of his chest before sinking into a crouch.

Play continues with everyone assuming that he was just catching his breath until number 3 Ivica Dragutinović notices that the slump has become a faint, gesticulates and calls for attention before he sees something alarming and races over.

The Serbian back is clearly distraught and is forcing his fingers into Puerta’s mouth in an attempt to stop the Spaniard swallowing his tongue or to clear his airway. Sevilla goalie Andrés Palop also arrives and yells for medical help.

The Sevilla FC team sprints onto the pitch and lever Dragutinović clear to closely examine Puerta.  With various players arriving to help stretch his legs and check to see exactly what’s happening, fears are in sharp focus but soon seem to be dispelled.

The medical team signal for a substitution, and the player swiftly comes round, sitting down with a look between confusion and annoyance with himself and mouths what looks like an exasperated “Puta Madre” (F***ing Hell) before being escorted off.

A collective sigh of relief was breathed as Antonio Puerta left the field walking steadily and apparently unscathed.  The scare was over – or so it seemed as the match resumed and attention went back to the football rather than the worst fears.

Little did we know but the player had a relapse in the dressing room and was soon stretchered out.  This time he was totally unconscious and with a medical team hurrying the player out to an ambulance that would take him to the Virgen de Rocio hospital.

As cameras filmed the exterior of the ambulance leaving, inside the fight for Puerta’s life was on as the medics tried to restart his heart.  Although the initial battle was won, the war was fought in vain.  Despite hope held out that he may recover, Antonio Puerta passed away.

His body couldn’t withstand the repeated heart failures and the oxygen starvation robbed his brain and other vital organs of life.  The fear and shock have turned into profound sadness and mourning for a young life so tragically lost to sudden cardiac arrest.

Attending doctor Francisco Murillo specified that Puerta was a fatal victim of something known as arrhythmogenic right ventricular dysplasia (ARVD) also called arrhythmogenic right ventricular cardiomyopathy (ARVC).

Cutting through the medical terminology, ARVD is basically a malfunction of the lower right part of the heart: This pumps deoxygenated blood to the lungs where it is refreshed with oxygen before returning to the heart and being pumped around the body.

If this right ventricle is arrhythmic (has rhythm disturbances, doesn’t beat correctly) there is a danger that the heart will seize up and the supply of oxygen to the vital organs is stopped.  It appears that the twenty-eighth minute of the Sevilla-Getafe match was when that happened to Antonio Puerta.

Those who follow football can’t help but seeing flashbacks to other players such as Marc-Vivien Foé and Miklós Fehér, both of whom also died in front of our eyes from heart attacks on a pitch – sudden cardiac death now haunts football.

28 year-old Foé collapsed near the centre circle during the Confederations Cup semi-final between Cameroon and Colombia on June 26th 2003, his chest heaving and indicating the worst: cardiac arrest.

His autopsy later revealed an enlarged right ventricle (the other lower part of the human heart that pumps the oxygenated blood out to the body) that led to his death. Doctors said the condition may have been congenital, and would have been virtually undetectable.

Miklós Fehér died when memories of the tragedy at the Stade Gerland where Foé suffered his heart attack were less than seven months old.  The Hungarian striker was playing against Vitoria de Guimarães for Benfica and collapsed after smiling at a yellow card.

‘Miki’ was another victim of a heart malfunction, the Benfica staff immediately recognising the condition and giving him CPR (Cardiopulmonary resuscitation; commonly known as heart massage) straight away as his team-mates looked on in impotent horror as their friend died at just 24 years of age.

There have been others as well, the next widely-reported victim being in Brazil.  São Caetano defender Paulo Sérgio de Oliveira Silva (a.k.a. Serginho; ‘little Sergio') died just a week after his thirtieth birthday: another victim of sudden cardiac arrest during a match.

It may seem like a sudden plague, but back in 1992, Daniel Yorath, the son of Terry Yorath (former Leeds United player and manager of the Welsh national team) died while playing football with his dad in the back garden at the tender age of fifteen.

This terrible grief was followed by the death of sixteen year-old Ian Bell, who had just signed for Hartlepool.  John Marshall, also 16, died the day after he signed for Everton, and Jason Erics, 17, a Tottenham Hotspur youth team member, also passed away prematurely – all due to heart attacks.

These were all young men who were at peak physical fitness, not couch potatoes or chain-smokers, not wobbling mounds of wheezing obesity or over-stressed pallid office denizens who never get enough exercise.  That’s what hits so hard: it seems so unfair, so awfully unjust that it simply beggars belief.

It’s a sad fact, but, although the cardiovascular benefits of regular exercise are well established there is a downside.  On one hand it improves stamina, helps weight reduction, controls blood pressure, regulates blood fats and enhances insulin sensitivity, thereby actually reducing the risk of coronary artery disease and sudden cardiac death.

On the other, unfair, unjust, iron hand a significant minority are at risk of sudden death, usually during or shortly after a session of intense physical training.  Data from the USA and the UK suggest a 1 in 50,000-67,000 chance of death (Journal of American College of Cardiology).  The bad news gets worse: those who compile these stats stress that the real figure is likely to be even higher.

More than 80% of sudden deaths in young athletes are due to inherited (congenital) defects of the heart, resulting in structural and/or functional abnormalities such as those we believe killed Puerta, Foé and Fehér; to name just the three we have seen on professional football fields recently.

It seems that surges of adrenal hormones that accompany competitive vigorous physical activity – that adrenalin ‘buzz’ – incite these fatal cardiac arrhythmias and sudden death. According to one study from the US (by the Journal of the American Medical Association), the average age of sudden cardiac death is a stunningly young 17 years old.

Most who have these potentially lethal cardiac abnormalities are capable of incredibly high levels of performance. Sudden cardiac death has been reported in many sports such as rowing, running and cycling – but most reported deaths in the UK have been in football. Some who play O Jogo Bonito (The Beautiful Game) have an ugly, hidden time bomb ticking away in their chests.

So how can we prevent these tragedies from happening?  Is there something that we can do or are we as powerless as the players who stand around as their team-mates and friends die right in front of their eyes?  Can our clubs prevent these young men (males are far more likely to suffer sudden cardiac arrest) from dying?

One thing is to look for the symptoms: central chest pain during exertion (angina), extreme breathlessness, palpitation, and syncope (fainting). This helps to identify high risk cases but there is a horrible kicker: some don’t present any symptoms – and sudden death may be the first time the problem is witnessed.

An ultrasound test can detect the problem, but some players slip through the cracks and pass the test with flying colours.  Marc-Vivien Foé was reportedly seen by club staff as fitter than most of his fellow team-mates and he never, ever complained of anything that could be interpreted as a heart problem before to his sudden death in Lyon.

The other problem is that players themselves and their entourages – that unholy combination of agents, managers, advertisers…etc – can try to mask symptoms knowing that their career could be at an end.  Some are willing to risk their own – or another – life for financial gain.

The case of Ronaldo Fenômeno (albeit not cardiac) on the eve of the World Cup Final in 1998 is often seen as a sign of how commercial interests may interfere with medical common sense.  It’s still a controversial issue, but some allege that he suffered a fit the night before the decider and shouldn’t have been fielded the next day. 

His performance was below par and the allegations – never proved, but still lingering almost a decade later – contend that the multinational clothing sponsor and the player’s agent put their interests before health and insisted that Ronaldo played.  Nobody knows, and we’ll probably never know the truth, in this and other cases, but also players themselves do push limits: it’s a part of their psychological make-up.

Try telling a person with little else going for them but their skill with a ball that they should stop from aiming for their dream…just because something ‘might’ happen.  It’s a gamble that some players and their entourages are willing to take as the potential payoff's so big.  The current tests are an indication, but, like most exams, cheating isn’t an impossibility.

Nevertheless, most clubs have a heart that protects their players’ hearts and most agents aren’t just two-dimensional schemers obsessed with money to the point of exposing their clients to an early death.  Daniel Yorath’s untimely death meant that Leeds United have comprehensive cardiovascular evaluations.

These include a physical examination, ECG and echocardiography for all junior recruits before acceptance into the squad. Everton followed suit John Marshall died. It’s not just in England, but in many other countries that screening is being turned from an optional extra into a basic need.

Family histories should be checked out as often the cardiac problems are hereditary, but this is an area that is often hamstrung by a lack of proper medical records – particularly in developing countries – and a tend to deliberately overlook or hide things that could hurt a budding career.  Nevertheless, screening and family histories are a way forward.

This was part of the conclusions made by the FIFA Sports Medical Committee in March 2005, building on a series of guidelines established in 2004 (The Lausanne Guidelines that include monitoring family histories), although the Swiss body steered clear of making anything obligatory to the point of washing their hands of overseeing anything more than a statement of intent.

"It is neither feasible nor possible for FIFA to organise preventative screening....but should, however, support the call for preventative screening through participation in congresses, publications and other forms of communication to inform its member National Associations, clubs and athletes of the necessity of a preventative screening."

The FIFA document ends with "The FIFA Sports Medical Committee promotes the preventative screening of all athletes in all FIFA member nations, associations and clubs.  You will save lives!"  Good intentions, but hardly something that obliges action - more of a passing of the buck than the sort of regulations FIFA regularly imposes in other areas.

The eagle eyes of fellow players are also needed.  Sevilla’s Brazilian striker Luis Fabiano spoke to São Paulo radio station Jovem Pan and explained that the Antonio Puerta’s fainting problem was well-known before it led to his eventual death. "He’d already fainted twice before, although the others weren’t as serious as this one”, he began.

“He’d fainted like that once at half time at the end of last season. It was a friendly [Luis Fabiano didn’t specify the match] and it was really hot, but as he recovered later on we all put it down to the heat.”  This is a major problem as heat and altitude can often be seen as the culprits and cardiac symptoms are assumed to be due to these factors.

“The other time was during training and he fell in exactly the same way he did on Saturday. But he walked away and we thought it was heat exhaustion again as it was boiling then as well", Luis Fabiano added.  These words were uttered before Puerta died, but do point out that the symptoms were there.

It’s far too early to pass judgement on the Sevilla medical staff as too many blank spaces need filling in, but the cold hard facts are there for all to see.  Another young footballer is dead, victim of a heart complaint.  It may have been avoidable or it may have been a cruel twist of fate that would have taken Puerta’s life anyway: we simply don’t know.

The fact is that modern football is more stressful and pressurised as each season goes on.  The envelope is being pushed harder than ever and physical limits tested to breaking point.  Players may be in peak physical shape, but, then again, Formula 1 racing cars are state-of-the-art and their engines can explode when pushed too far.

The death of Antonio Puerta, may he rest in peace, is a tragedy and fans around the world are united in mourning and sorrow.  We all feel heartbroken over the loss of a young man with so much life ahead of him and we all cross our fingers and pray to whoever or whatever that this will be the last time. 

Hopefully it was, but there may be others who add their names to the sad list for reasons that are sometimes impossible to see or detect even with the finest tests.  What we can all realistically desire is that the list of those who suffer cardiac death in football is kept as short as possible in future.

Aaron Marcus  (APM)

[agenth]

another player died on the pitch... RIP.

Zambian Chaswe Nsofwa the 27year old player for Israeli club Hapoel Beer Sheva

[misha]

another player died on the pitch... RIP.

Zambian Chaswe Nsofwa the 27year old player for Israeli club Hapoel Beer Sheva

Yes, he swallowed his tongue during the training. He had wife and a daughter. RIP.

[agenth]

Yes, he swallowed his tongue during the training. He had wife and a daughter. RIP.

really?

i didnt see anything mentioned here

Zambian soccer player collapses, dies during practice session

August 29, 2007

JERUSALEM (AP) -- Chaswe Nsofwa, a forward who played for Zambia at the 2002 African Cup of Nations, collapsed during a practice session Wednesday in the Israeli city of Beersheva and died minutes later in a hospital, the Israeli rescue service said.

Nsofwa was with Hapoel Beersheva, which plays in Israel's second division. Israel TV reported he collapsed during a practice game in the desert city. Rescue workers tried to restart his heart for several minutes on the field before taking him to Soroka Hospital in Beersheba.

Nsofwa was 26, according to the roster Zambia gave FIFA when he played in the 1999 World Youth Championship, which listed his date of birth as Oct. 22, 1980.

Paramedic Carmel Cohen told The Associated Press he rushed to the field when he received the emergency call.

"When we arrived we found the soccer player lying on the grass. We found his friends trying to help him," he said. "We gave him first aid, electric shocks and an external pacemaker, but despite all our efforts, he was declared dead at the hospital."

It was unclear why Nsofwa collapsed, but temperatures on the field approached 100 degrees with low humidity. Nsofwa, who joined Hapoel Beersheba during the offseason, scored in his team's 3-0 win over Hakoach Amidar Ramat Gan on Saturday.

Nsofwa appeared as a second-half substitute in all three of Zambia's games of the 2002 African Cup. He scored in a World Cup qualifier against Cameroon in July 2001.

On Tuesday, Antonio Puerta, a midfielder for the Spanish club Sevilla, died three days after collapsing during a league game.

[misha]

really?

That's what reported here in local site.

[Rossoneri7]

another player died on the pitch... RIP.

Zambian Chaswe Nsofwa the 27year old player for Israeli club Hapoel Beer Sheva

OMG !! RIP (IMG:http://cyrus.medialayer.net/~m1ke/milanfan.com/forums/style_emoticons/default/sad.gif) (IMG:http://cyrus.medialayer.net/~m1ke/milanfan.com/forums/style_emoticons/default/sad.gif)

These players .. So young !!! This really is a tragic week in football !!

[kurtsimonw]

OMG !! RIP (IMG:http://cyrus.medialayer.net/~m1ke/milanfan.com/forums/style_emoticons/default/sad.gif)   (IMG:http://cyrus.medialayer.net/~m1ke/milanfan.com/forums/style_emoticons/default/sad.gif)

These players .. So young !!! This really is a tragic week in football !!

Yeah, it's been a horrif week for football. RIP. (IMG:http://cyrus.medialayer.net/~m1ke/milanfan.com/forums/style_emoticons/default/sad.gif)

[dst]

What is going on!??

Rest in peace...