Following the death of three footballers on the pitch in less than 10 days, FIFA is considering introducing cardiac testing. Nashwa Abdel-Tawab describes the threat here and abroad Clive Clarke, the ex-Stoke skipper, suffered a heart attack in the dressing room at half-time and lost consciousness while playing for Leicester in the Carling Cup last week Tuesday. Paramedics had to restart his heart before rushing him to hospital, although the signs are that he is on the road to recovery. Clarke's ordeal is just one of a number of incidents to have rocked the football world recently -- some of them with more tragic conclusions. Walsall apprentice Anton Reid, Sevilla midfielder Antonio Puerta and Zambian striker Chaswe Nsofwa have all died in the last 10 days after collapsing on football pitches. Last year, on 31 August Egypt was rocked by one such calamity. Mohamed Abdel-Wahab's death at the age of 23 during training shocked the nation. He was young, seemingly healthy and at such a tender age, on top of his game. He played for Africa's best football club, Ahli, and had helped Egypt win the Africa Cup of Nations six months earlier. The players had just finished their warm-up stretches and had begun their usual pick-up game. Abdel-Wahab had the ball, passed to a teammate, then froze. He fell to his knees, held both sides of his head with his hands, then fell on his back. A teammate who approached him asked if he felt dizzy. Abdel-Wahab nodded but did not speak. Seconds later his body contorted in a violent spasm. He died before reaching hospital. Life-threatening heart attacks seems to happen everywhere but when it comes to sports it rocks the image. When solicitors, businessmen and journalists suffer a heart attack you don't hear a thing about it but in the high-profile world of sports, especially football, they make headlines news. Is sports a matter of art and recreation or life and death? The so-called super athletes are dying young at an astounding rate Why do such healthy sportsmen like Antonio Puerta and others have heart attacks? Weren't their hearts in good condition? Or are they human after all? FIFA said it been shocked and deeply distressed by the news of the sudden and premature death of three young players on football pitches. Puerta died as a result of a generally rare (1:1,000) weakness of the right ventricle, which is, however, a significant and common cause of sudden cardiac arrest among athletes. In such cases, an alteration of the cardiac muscle tissue leads to an expansion of the right ventricle, which can cause fatal changes in heartbeat and can ultimately lead to cardiac arrest. Israel-based Zambian international Chaswe Nsofwa recently collapsed after a training session in the southern Israeli town of Beersheba and died shortly afterwards. The exact cause of his death is not yet known. And just over a week ago, England's Walsall's 16-year-old youth player Anton Reid also passed away after collapsing on the pitch. Andy Scott, whose 13-year career was ended by heart problems, called on the Football Association and Professional Footballers' Association to introduce mandatory cardiac testing for all players. "There is clearly no reason why a young person should die when they are in the prime of their career," said Scott, Brentford's assistant manager. "It's complete ignorance that this has not been taken further. This is an ideal opportunity now to make it compulsory for all players to be screened. How many times is it going to have to happen? Everyone knows it's going on but it's getting someone at the top to get off their backsides." The FA described such a move as a "strategic decision for the whole game". Generally, the most common causes of sudden cardiac arrest can be identified in young athletes during thorough consultations that take family history into account and by conducting a physical examination that also focuses on the heart. In the build-up to the 2006 FIFA World Cup Germany, concerns about player health and preventing such tragic incidents prompted the FIFA Sports Medical Committee to demand not only a general medical check-up but also thorough cardiovascular tests including electro- and echocardiograms from all teams. "We know that thorough preventive examinations can reduce the risk of sudden cardiac arrest," said FIFA chief medical officer Prof Jiri Dvorak in March 2006 at FIFA's team workshop in Dèsseldorf as he presented a questionnaire and form for preventive examinations developed by the FIFA Medical Assessment and Research Centre (F- MARC) to the team doctors. Consequently, all players who participated in the 2006 FIFA World Cup Germany were required to pass through this thorough preventive programme with specific examinations. The depersonalised data was then analysed by specialists including a cardiologist. FIFA's preventive measures have since been detailed in a report on the 2006 FIFA World Cup Germany in a scientific journal and praised by the publishers as an important signal from a major sporting organisation. The programme, which has been expanded to cover issues specific to women, will also be the subject of debate at an international symposium that will be held to coincide with the FIFA Women's World Cup China 2007. FIFA will be discussing this issue, as well as other medical matters such as doping, at the next meeting of the Executive Committee in Zurich on 30-31 October. Heart attacks in athletes are largely due to genetics. They may train every day, have the best conditioned hearts, have an efficiently beating heart rate, but if there is a family history of heart disease or high cholesterol, they risk a heart problem. One of the first cases that brought light to heart disease in athletes was that of Jim Fixx. A marathon runner who ate well, ran every day, but chose to ignore the symptoms of a heart attack and died. Renato Curi suffered a heart attack on 30 October 1977 while playing for Perugia in a Serie A match against Juventus. Perugia's ground is named after him. Samuel Okwaraji collapsed and died while playing for Nigeria against Angola in a World Cup qualifier on 12 August 1989. An autopsy showed that the 24-year-old had an enlarged heart and high blood pressure. David Longhurst suffered a heart attack on the pitch while playing for York City against Lincoln on 8 September 1990. He was pronounced dead on arrival. He was the first player to die in a football league match in 69 years. To honour Longhurst's memory, York City named one of the stands at the Bootham Crescent stadium after him. The Persebaya Surabaya's midfielder, Eri Irianto, passed away on 2 April 2000 in hospital after heart failure. Irianto was taken to hospital during half-time of Persebaya's league match against PSIM Yogyakarta because he said that he was having trouble breathing. He was treated in the hospital but there was nothing the doctors could do to save his life. Marc-Vivien Foe collapsed while playing for Cameroon on 26 June 2003 whilst playing in the FIFA Confederations Cup semi-final between his country and Colombia, and died shortly afterward in hospital. An autopsy later revealed the cause of death was a heart attack caused by an enlarged right ventricle. Miklos Feher died while playing for SL Benfica against Vitoria SC on 25 January 2004. When physicians realised he had heart failure they performed immediate CPR on him, by which point the spectators realised the gravity of the situation. An ambulance entered the field to take Feher. His condition was covered by the Portuguese media throughout the day, and before midnight Feher's death was confirmed. The public prosecutor (the Portuguese agency responsible for the release of autopsy details) announced that Fehér died from cardiac arrhythmia brought on by hypertrophic cardiomyopathy. In memory of Feher, Benfica retired the number 29 shirt which he wore during his time at the club. He was remembered by many and his death caused profound shock in Portuguese sport. Serginho of Brazil died of a heart attack while playing for Sao Caetano against Sao Paulo on 27 October 2004 Matt Gadsby of Hinckley United collapsed on the pitch on 9 September 2006 during a conference north game against Harrogate Town and died soon afterwards in Harrogate District Hospital. Medical tests revealed Gadsby died from a heart condition known as arrhythmogenic right ventricular cardiomyopathy, an inherited condition that affects the muscle of the right ventricle of the heart. Sports should be seen as an outlet for fun, artistic display and recreational time but not as a stressful win or lose game.
