Christian Eriksen collapse: the hidden dangers of heart troubles on the sports field

Footballer’s cardiac arrest during match has many thinking of the hidden danger of heart troubles on the sports field.

Denmark's players react as paramedics attend to Denmark's midfielder Christian Eriksen after he collapsed on the pitch during the UEFA EURO 2020 Group B football match. Picture: Liselotte Sabroe / Ritzau Scanpix / AFP

Christian Eriksen, the Denmark midfielder who collapsed at the weekend, is a lucky man. If you are going to have a cardiac arrest outside hospital then a football match attended by well-equipped, trained staff is as good a place as any. However, it is his misfortune to have collapsed in the first place that has got most of us thinking, “Could that happen to me?”

Well, if you are an older person, then yes. One in three of us will die of some form of heart disease, many ending in cardiac arrest. Predicting who is most at risk, and when it is likely to happen, is largely based on lifestyle and physiological parameters used in calculators such as qrisk.org.

Yet I want to focus on younger people like Eriksen, whose hearts should be in peak condition. The chance of a younger person collapsing and dying from an undiagnosed electrical or structural problem with their heart is tiny — about 1 in 50,000 a year. This still means that every week in the UK about 12 young men and women under 35 will have a cardiac arrest and die. And the harder they push themselves, particularly during sporting events, the more likely they are to trigger an arrest.

Hard to spot

Spotting which hearts are affected is difficult. The most important clues are a history of “funny turns” that may suggest disturbances in normal heart rhythm. Others are picked up because they have a relative who had a cardiac arrest, but for the vast majority the first sign of trouble is when they collapse.

Most elite athletes are routinely screened for heart problems, but even this is not perfect. It is highly likely that Eriksen would have passed his tests with flying colours, as Fabrice Muamba probably did before he collapsed while playing for Bolton Wanderers in an FA Cup match at Tottenham Hotspur in 2012.

Another problem with screening is that it can detect issues that may never endanger a young person but which could change their lives, not least by ending their sporting aspirations. The charity Cardiac Risk in the Young has screened many tens of thousands of young people and turns up an electrical or structural glitch in the hearts of about 1 in 300 tested, many of whom would never go on to have a problem no matter how hard they train or play.

Double-edged sword

So, as ever, screening is a double-edged sword. This said, most cardiologists agree that all elite athletes should be tested, so why not keen amateur runners or cyclists, who may push themselves nearly as hard? And there is much more to spotting problems early than telling someone not to over-exert themselves.

Christian Eriksen is wheeled off the pitch, and bound for hospital after CPR in the wake of his collapse. Picture: Friedemann Vogel / various sources / AFP

Screening can pick up myriad issues. It is impossible to generalise, but some of the better recognised electrical glitches that can result in cardiac arrest — such as long QT and Wolff-Parkinson-White syndromes — are aggravated by commonly used drugs such as the antihistamine diphenhydramine, which is used in over-the-counter sleeping aids, and the antibiotic clarithromycin. Knowing that someone has an issue can protect them from inadvertent harm caused by self-medication or a well-meaning prescriber.

In more extreme cases, medical intervention such as fitting a pacemaker-like implantable cardiac defibrillator (ICD) can be lifesaving. Many years ago I spotted in an ECG done on a patient* I was looking after an anomaly that was subsequently diagnosed as Brugada syndrome, an electrical glitch in the heart that carries a significant risk of an early cardiac arrest.

Subsequent testing of the patient’s family picked up the same problem in her daughter. Both were fitted with ICDs and I think they thought we were overreacting. A decade later an annual check-up revealed that the mother’s device had fired in the night while she was asleep. I still have the letter she wrote to thank me.

* Some details have been changed

The Times