How many players will have to die before stringent medicals are enforced?

The recent passing away of Swansea’s Austrian striker Besian Idrizaj served to remind us of the worrying prevalence of sudden deaths amongst those within the football fraternity. The former Liverpool forward, just 22, died in his sleep with reports suggesting he suffered a heart attack. Idrizaj is the latest in a string of high-profile unexpected footballer deaths, with Dani Jarque, Antonio Puerta, Miklos Feher and Marc Vivien-Foe also having passed away in similarly unanticipated circumstances over the last seven years. With the exception of Idrizaj and Jarque, the aforementioned footballers were all struck down by cardiac problems and collapsed whilst in the midst of a competitive match. Although I am no medical expert, I will attempt to look at the reasons for these occurrences and what can be done to avoid it happening again in the future.

Exercise is accepted as providing a wealth of cardiovascular benefits to the body. Given the amount of physical activity footballers involve themselves in, most would expect footballers to be in peak physical condition, and subsequently less susceptible to heart problems than most. It is this assumption that makes the premature deaths of footballers all the more baffling. Having conducted some rudimentary research, I have learned that a third of sudden deaths amongst seemingly healthy young sportsmen are due to hypertrophic cardiomyopathy (HCM), which means pathological enlargement of the heart muscle. This disorder can manifest itself by way of various symptoms, including central chest pain during exertion (angina), breathlessness that is disproportionate to the amount of exercise being performed, palpitation, and syncope (fainting).

Unfortunately, sportsmen are known to be poor at recognising and reporting symptoms, with Alison Cox, a former Wimbledon player, warning that, “Often people relate pains to over exertion, or a drop in power to ‘an off day’, but sometimes these are the body’s warning signs of heart conditions.” On a note more worrying than that of sportsman ignoring symptoms of cardiac unrest, sudden death may be the first presentation of HCM in the case of asymptomatic individuals. In the case of such individuals, it seems that there isn’t very much that can be done to prevent such tragic occurrences.

The strain placed upon footballers by the nature of the modern game has to some extent contributed to the increasing prevalence of such cardiac problems. The game’s governing bodies have recognised the need for increased monitoring of players’ health accordingly. A spate of measures have been introduced, starting with the introduction of preventive examinations developed by FIFA’s chief medical professor Jiri Dvorak. These examinations were used on every single player during the 2006 World Cup. Domestically, the 2007/08 season heralded the introduction of new regulations requiring the presence of an ambulance and two fully equipped paramedics at each Premier League game, entirely for the use of players and officials. Similarly, each Football League match requires the attendance of a registered medical practitioner and one paramedic.

Away from the match-day scenario, the PFA and FA continue to fund a scheme that provides every 16-year-old on the books of a professional club with cardiological screening, indicating a desire to find congenital heart defects before they’re given the chance to manifest themselves. Amongst most top clubs it is common practice to frequently screen players before and during training, allowing them to pick up on any cardiac anomalies.

Despite these advances, many are unhappy with the provisions currently in place. Dr. Dorian Dugmore, member of the European Society of Cardiology, proposes more stringent testing using electrocardiograms (ECG) to assess heart performance during physical activity. Bemoaning the inadequacy of existing screening measures, Dugmore argues that testing players whilst they are at rest is not the best way of gauging their condition, arguing that, “That doesn’t tell you what’s happening when a player is pushing himself to exhaustion. People should be stress-tested to their maximum . . . they [the authorities] should seriously consider doing this with all players on a regular basis.”

Clearly Dr. Dugmore’s suggestions seem to offer a much needed method of minimising the risk of sudden deaths amongst footballers. I have failed to learn why such measures have yet to be implemented, whether it is due to cost or lack of feasibility I am not sure. However, if it is for either of these two reasons, I do wonder how many more players will have to die before such stringent medicals are enforced.

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I would like to cite the work of Sanjay Sharma (, which was of great assistance when writing this article.