A Man Collapses on a Football Pitch Once Every Four Days. Is the Threat of Cardiac Arrest Getting Worse?
"That now-familiar scene: the footballers from both sides standing around helplessly while medics work on a player"
“I remember it as a normal day until we had scored. Until the goal, there were no signs that anything was different. I felt really good in the match and the warm-up. After we had scored, everything was pretty black.”
Emil Palsson is reliving the moments when he became the latest professional footballer to need life-saving treatment on a pitch.
It was the 12th minute of Sogndal’s game against Stjordals-Blink in Norway’s second division. Palsson, a 28-year-old midfielder with one Iceland cap, was on loan at Sogndal from Sarpsborg 08. His team-mate, Steffen Skalevik, had opened the scoring in the seventh minute. It was just a normal match, on a normal day.
And then everything, as Palsson says, went dark.
“I just thought he had received a bang,” says Skalevik. “Then the medical staff started to take over. I could see that he was fighting for his life and, after that, we were in a state of shock.”
For four minutes, Palsson was technically dead. His heart had stopped. But the medics refused to give up and managed to bring him back to consciousness before the helicopter arrived to fly him to hospital.
“There were similarities with Christian Eriksen,” says Axel Kryger, another Sogndal player. “I was thinking, ‘This is not going to happen here’. Suddenly a good friend is lying there, completely lifeless.”
Everyone, of course, knows what happened to Eriksen because there has never been another incident like it, in front of a live television audience, during a major international tournament.
There are photographs of the medics working to revive Palsson while the players stand around and, again, there is utter despair on their faces. But there are not the television pictures that flashed around the world after Erikssen collapsed in Denmark’s first game of Euro 2020. What happened to Palsson was still terrifying but it had only a small fraction of the coverage.
— Emil Pálsson (@EmilPals) November 5, 2021
Perhaps you might not be familiar either with the story of Rune Coghe, an 18-year-old who suffered a suspected heart attack while playing for the Belgian club Eendracht Hooglede in August.
That same month, there was the trauma of Jente Van Genechten, a Belgian player, going into cardiac arrest during a game with Lanaken. “Suddenly the lights went out for a while,” he said after waking in hospital. “That’s all I remember.“
In September, a 27-year-old amateur footballer by the name of Jens De Smet died after collapsing during another game in Belgium.
But there have also been other incidents, at all levels of the sport, even before we take into account the threat to Sergio Aguero’s career since the Barcelona striker, formerly of Manchester City, was taken off in a game against Alaves on October 30 with what turned out to be a potentially life-changing heart problem.
When the German newspaper Berliner Zeitung put together a list of recent cases in Europe it found 23 incidents of footballers, coaches or match officials collapsing with suspected heart issues from July 11 to October 15.
That works out, on average, around one incident every four days. Four had resulted in deaths, including the tragedy of 17-year-old Dylan Rich, who collapsed in an FA Youth Cup tie for the Nottinghamshire side West Bridgford Colts in September.
The obvious question here is whether the numbers are abnormal. If so, what are the reasons for this spike?
It is a complex, difficult subject and there are also some challenging issues to address when there is plainly a level of concern among many professional footballers that the COVID-19 vaccinations might be linked to what, on the face of it, seems like an increase in heart issues.
“A lot of players are refusing to be vaccinated,” Professor Sanjay Sharma, one of the world’s leading cardiologists, told The Athletic this week. “They are worried that this vaccine is causing trouble. And they don’t want to run into trouble.
“We have some very, very eminent players in the Premier League who are point-blank refusing the vaccine. I had a call from a very eminent professional athlete this week saying he didn’t want to have it, that they were trying to force him, and wondering what my view was.”
Sharma is the head of research and professor of sports cardiology for St George’s University in London and has an international reputation for his award-winning work.
He is also the chairman of the Football Association’s expert cardiac committee and in charge of the heart screening programme that has been set up to minimise the risks for footballers in England and Wales. Nobody is better qualified to discuss whether the number of recent cases should be a cause for concern.
“My belief is that it is a statistical cluster,” he says. “I look after the London Marathon (as medical director) and we can go three or four years with nothing. Then, in year five, there are three cardiac arrests. You think, ‘Was there something about this race? Was it the weather? Was it the pollution?’. And yet, it could just be a statistical thing.” [In other words, the numbers ARE HIGHER this year, but it could be just a “statistical cluster”, and this is his “belief.”]
At the same time, Sharma does understand why the numbers can seem alarming to many people who remember the death in 2003 of Marc-Vivien Foe in a game for Cameroon, as well as Fabrice Muamba needing life-saving treatment during an FA Cup tie for Bolton Wanderers at Tottenham Hotspur in 2012.
“There are lots of reasons it looks like it’s going up,” says Sharma. [LOL. You said yourself the numbers *are* up just the last time you opened your mouth.] “First, footballers are much more in tune with their cardiac health than they ever were. They have watched the Muamba episode, the Foe episode and the Eriksen episode and many of these players are concerned something like this could happen to them. Many of them have witnessed these cardiac arrests.
“Players are much more likely now to complain of a cardiac problem than ever before. Aguero, for example. He didn’t have a cardiac arrest but he clearly had a cardiac symptom that caused him to stop playing instead of thinking, ‘Gosh, I don’t know what that is, I will just carry on and see if it goes’.”
The second factor Sharma points out is that it is much easier, in the age of the internet and 24/7 news, to find out about similar incidents in other countries. [Did the age of the internet start in 2021?] That, he says, can make them feel increasingly common when, in reality, the numbers might not have changed as drastically as it seems.
But there is another important issue he wants to flag up. “The game has changed. It’s much faster, much more dynamic, and the players are playing far more games than ever before. There are more competitions, more international football, and you wonder for someone vulnerable with a mild predisposition whether all this football takes its toll sometimes.”
Dr Scott Murray is the founder and consultant preventative cardiologist at Venturi Cardiology, a heart clinic in Cheshire that was opened by Muamba earlier this year.
“We’re more aware than we ever have been, with everyone linked up on social media and internet sites, and that’s why we know these days if a lower-division Belgian player has collapsed and died,” says Murray.
“I’ve made the point that this is happening, week in week out, in grassroots and professional football throughout the world and that, unfortunately, there is a certain attrition rate from cardiac abnormalities in young and middle-aged players. I don’t think that has increased dramatically, I just think we are more aware of it.”
Medical analysis has concentrated on looking at male footballers and also found that cardiac issues are more common in black players. One study, published by the New England School of Medicine in 2018, took its data from the screening of 11,168 players (95 per cent of whom were male) in the FA’s system, starting at the age of 16, from 1996 to 2016.
Researchers calculated that the number of sudden cardiac deaths was one per 15,000 whereas it was previously thought to be, at most, one in 100,000.
But there are also cases that are genuinely shocking for even the experts in this field. Eriksen, for example, was routinely screened for heart issues while he was at Tottenham Hotspur, something Professor Sharma knows all about since he was the cardiologist involved. Eriksen, he says, was checked annually and reported “normal” results.
“We knew about his cardiac health, or at least we thought we did,” Sharma says. “This came out of the blue. We don’t know what went wrong that day, whether he was carrying something, whether he’d had a virus recently. Had he had COVID? Had he been vaccinated? We’re still not clear.
“In this pandemic, there are so many people thinking, ‘Is COVID causing some clinical influence in the hearts that has resulted in two or three of these episodes?’.”
The last available data from the Premier League, published on October 19, showed that almost a third of footballers in England’s top division were not fully vaccinated. It is understood that at three clubs, less then 25 per cent of players were double-jabbed. In the English Football League, only 49 per cent of players had been fully vaccinated as of September. A quarter of EFL players had indicated they intend to remain vaccine-free.
“We are still in new territory, but it’s true to say that some males have had inflammation of the heart muscle after the second dose,” says Sharma. “It’s still very early days. If you look at the statistics from America, they reckon one in about 20 million young men who have been vaccinated have run into trouble. The sporting community is much smaller — it would take quite a few of these cardiac arrests before we link them to the vaccine.”
Sharma has several roles within some of the UK’s biggest sporting organisations and, with that, there is a level of responsibility. He chooses his words carefully.
“For me to say the vaccine could be implicated would be the most irresponsible thing in the world,“ he says. “All that happens then is the biggest stars would say, ‘I don’t want this vaccine’. These are role models for thousands and thousands and thousands of young people who would then be saying, ‘If he’s not having it, why should we?’ Then, of course, these guys spread it to the 80-year-olds and we are not containing the pandemic anymore.” [So the chief cardiologist for the Football Association just said that 1.) he is extremely prejudiced against saying anything negative about the shots and 2.) he does not have the player’s best interest in mind but is even more concerned with the big picture of “containing the pandemic.”]
Anyone who has looked this up online or monitored the news will know it is a divisive subject. “The weird thing about the internet is you can’t shut it up,” says Dr Murray. “If you want to look hard enough, you will find enough evidence for one thing. And you could also find enough evidence for the exact opposite.
“That breeds this bewildering theatre where no one can make sense of anything and it leads to apathy. It leads to people switching off — ‘Well, I don’t know what to believe anymore’ — and that allows nonsensical information to be in traction and experts to be belittled. It’s a very strange time.”
All that can be said for certain is that it is shocking, deeply shocking, when a high-achieving athlete in any sport is left so vulnerable to suspected heart issues.
The story, for instance, of Giuseppe Perrino, once on the books of Parma, who died in June playing in a memorial match for his brother, Rocco, who had suffered a fatal heart attack while cycling in 2018. Or the times, post-Eriksen, when it was easy to fear something terrible might be happening again.
There was the panic and confusion of Dimitri Lienard collapsing in Strasbourg’s game against Lyon in September (a false alarm, fortunately, and merely a case of severe fatigue). The previous month, it was the Congo international Fabrice Nsakala who had to be taken to hospital after collapsing during a Besiktas game in Turkey’s Super Lig.
Both have played since. It is still unnerving, however, to witness that now-familiar scene: the footballers from both sides standing around helplessly while medics work on a player who, shortly before, was running about with no apparent problem.
Eriksen, 29, is waiting to discover whether he can play football again and, if so, it will not be with his current club, Inter Milan, since rules in Italy forbid anyone from taking part if they have been fitted with a pacemaker.
Aguero has said he will take expert advice before deciding early next year whether he can play on. He has undergone his own heart procedure and there have been reports in Spain that Manchester City’s all-time record scorer may be advised to retire, aged 33.
As for Palsson, it is too early to say what comes next. “I may not be able to play football anymore, but there are more things than football in life,” he says. “Right now, it’s about living a good life. I try to think about it as little as possible and we will see what happens in the future.”
Source: The Athletic
Editors note: In the short time since this article ran:
“Traore, 26, turned to walk away from the ball, which had gone out for a throw-in, in the 77th minute when he immediately became uncomfortable, clutching his chest before slumping to the turf.”https://t.co/DufNCNEtBM pic.twitter.com/Nfg9JKmXV6
— Chief Nerd (@TheChiefNerd) November 25, 2021
Wigan’s Charlie Wyke stable in hospital after collapsing during training https://t.co/k9w5ynuixb
— Gareth Icke 🇵🇸 (@garethicke) November 25, 2021