For the last two weeks, the world has been following the recovery of Bolton Wanderers midfielder Fabrice Muamba, who collapsed in the March 17 match against Tottenham. The fact that Muamba is alive following cardiac arrest, where he was shocked 15 times in the 78 minutes he was without a pulse, is astounding ─ very few people are able to survive such an incident. In fact, nine out of ten people who suffer a cardiac arrest outside a hospital setting do not survive.
Precisely what cardiovascular complications or abnormalities led to Muamba’s cardiac arrest is presently unknown to the public. That information may only be known by his doctors and very close relatives. Several unsuccessful attempts were made to contact the doctors that treated Muamba. In a message via his secretary, London Chest Clinic head cardiologist Dr. Sam Mohiddin declined to be interviewed. There remains very little information coming out of the hospital on the status of Muamba’s medical condition and the underlying causes that lead to his collapse. Dr. Sanjay Sharma, a well known British cardiologist among athletes, who may or may not have information about the case, but who did not treat Fabrice Muamba, also, did not return my requests for an interview.
However, according to Dr. Barry J. Maron ─ a world-renowned cardiologist at the Minneapolis Heart Institute and the leading authority on hypertrophic cardiomyopathy (HCM), who has authored more than 800 research articles ─ there are approximately 20 conditions that could have precipitated the cascade of events that led to Muamba’s cardiac arrest, with the most common being HCM.
Hypertrophic cardiomyopathy is a genetic disease in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood. In the not-so-distant past, several known footballers like Marc Vivien Foe, Miklos Feher, and others have suffered deaths attributed to HCM.
All the facts surrounding Muamba’s incident make a fascinating story, but there is another angle that has been given very little attention by the press. Even though there is currently no public information about which cardiovascular tests the player was subjected to, it has been reported that Muamba had been previously screened in the past for potential cardiovascular ailments.
Assuming that he was subjected to screening, it would be interesting to know what type of examinations were performed and, if he had a cardiac abnormality, why it was not accounted for. It is very likely that at one point or another he must have been subjected to one or more electrocardiograms (EKGs). An EKG is a noninvasive test that records the electrical activity of the heart over a period of time as detected by electrodes attached to the outer surface of the skin. The procedure is used to measure the rate and regularity of heartbeats as well as the presence of any abnormalities to the heart.
The use of an EKG to screen footballers and other athletes in the UK is not uncommon. Italy and Israel actually have laws in place that makes it mandatory for every athlete to be screened with an EKG.
It may very well be possible that Fabrice Muamba may have had completely normal results in all the cardiovascular tests, including one or more EKGs. If one believes that an EKG is the cure-all and tell-all of cardiovascular diagnostic procedures, then one may be in for a surprise. False negatives in an EKG are not uncommon and such procedures, when administered without an echocardiogram, can sometimes be flawed. In fact, 10 percent of patients that suffer from HCM may have a normal or near normal EKGs.
The medical condition he suffered could also be more related to an electrical or electrolyte imbalance or an ion-channel abnormality, one of those rare genetic problems that can present in this way. These conditions are difficult to diagnose. It's important to note that less than 1 percent of cardiac arrests that occur out in the community will be this healthy-heart/ion-channel electrical-abnormality group. At this point this is solely a conjecture.
But what if there were red flags in the screening process that were deliberately ignored? When I raised this possibility in a phone conversation with Dr. Maron, he told me it was a fair question and an issue that must be considered.
“It is not uncommon for a physician’s judgment to be impaired by external pressure from those with a vested interest in the career of a player”, he said. When confronted with unwarranted diagnosis players may even shop around for a verdict that does not place their careers in jeopardy. However, Dr. Maron made a point of saying that we do not know if this was actually the case.
“We do not want to jump to any hasty conclusions,” he cautioned. “We do not have any results from the cardiovascular tests that this player may have performed in the past and, at the moment, no evidence of negligence or wrongdoing is evident.
“But nevertheless, some of these issues are important and must be further looked into.”
The fact of the matter is that Fabrice Muamba almost lost his life, despite being an elite footballer playing at the highest level with high fitness levels and an alleged history of screenings. This is a very serious matter. The fact that he is alive is extraordinary and a tribute to the immediate treatment he received on the field. But at this point, we don’t know how fully he will recover ─ he may have suffered substantial neurological damage.
We should not be timid in seeking clarification about his medical condition prior to the collapse because it could cast a spotlight on medical issues beneficial to the public at large and the sporting community in particular. Until now, the results of the screenings conducted on Muamba have not been released to the public.
Although Muamba has a medical right of privacy, this case raises imperative medical issues both inside and outside the game. Therefore, Muamba should make this information immediately available. Unfortunately despite a great deal of effort, I was not able to get more clarity on Muamba’s pre-existing and current medical condition.
(Ricardo Guerra is an Exercise Physiologist. He has a Masters of Science in Sports Physiology from the Liverpool John Moores University. He has worked with several clubs and teams in the Middle East and Europe, including the Egyptian and Qatari national teams. He can be reached at: email@example.com)