The case of the Danish football player, Christian Eriksen , who fell unconscious to the ground after 42 minutes in the match of his national team against Finland, in Euro 2020, managing to survive in the sequence of resuscitation manoeuvres with defibrillator, came to draw attention to the importance of sports cardiology, for both professional athletes and amateurs or recreational sport practitioners. Hélder Dores , the responsible for the area of Sports Cardiology at Hospital da Luz Lisboa and the present secretary-general of the Portuguese Society of Cardiology, explains why cases such as Eriksen’s happen, how come potential cardiovascular diseases are not previously detected, and what future lies ahead for these athletes. What can cause a situation similar to what happened to Christian Eriksen? The exact cause of what happened to the Danish footballer can only be determined subsequently, after specific complementary exams. But the majority of cases of cardiorespiratory arrest in athletes is due to cardiovascular disease . We might even say that 80% of cases of cardiorespiratory arrest, or even sudden death, in athletes, result of cardiac diseases. In athletes under 35, the causes are generally hereditary, diseases that affect the heart muscle (the so-called cardiomyopathies) or the heart rhythm. How come the causes of cardiorespiratory arrest are not detected in the exams that athletes are subject to? Most cardiovascular diseases are generally detected in routine exams – that is why athletes must take a regular sports medical assessment, including several exams, such as the ECG, and in certain contexts a transthoracic echocardiogram and stress test. However, some diseases are impossible to detect in such exams and, quite often, their first clinical manifestation is precisely a situation like this, of cardiorespiratory arrest, or even sudden death. This is why, besides the periodical sports medical assessment, it is essential to ensure in sports grounds resuscitation capacity , medical emergency and defibrillation, for it is the only way to save lives. After a cardiorespiratory arrest with successful resuscitation, what exams should the athlete take? It is necessary to proceed to the analysis of what has already been done – namely the exams taken before the competition, such as the ECG and transthoracic echocardiogram –, check if there is a family history of cardiovascular disease, and then decide what to do. After such an event, exams should be much more comprehensive , including for instance: Cardiovascular magnetic resonance, to check if there is any alteration to the cardiac structure and function; Angiography exams (such as CT angiography or even catheterization), to check if there is any alteration to the coronary arteries; Long-term monitoring devices to identify eventual arrhythmias; Other specialties exams, namely Neurology and Pulmonology, to detect eventual non-cardiac causes. Are athletes that have suffered a cardiorespiratory arrest in a position to resume sports competition? It all depends on the cause and the severity of the disease that is detected. To obtain an absolute answer, that must be previously established. In Eriksen’s case, I would say that there are 99% chances that Euro 2020 is over for him. In fact, there is a high probability that the career is over for him, if the cause of the cardiorespiratory arrest is a cardiac disease. It should be recalled that this happened in an apparently healthy athlete that was subject to all the required exams – otherwise, he wouldn’t have been considered fit to compete. If one of the most serious diseases associated to cardiorespiratory arrests is now diagnosed, some of them imply a contraindication for the practice of sport at competitive level . Depending on the severity of the problem detected, the athlete may be able to do some type of physical exercise, but never with the intensity required at the competitive level. The seconds of unconsciousness may have left brain sequels in Eriksen? Based on what was reported in the news – the football player left the playing field with his eyes open, conscious and communicating –, the indicators are good . Many of the most severe and instable diseases do not allow such a quick resuscitation. The time between the cardiorespiratory arrest and the initiation of the resuscitation manoeuvres is, in fact, crucial. We usually say that “time is myocardium” and “time is brain” – meaning that the longer we take to initiate those manoeuvres, the higher the probability to have brain sequels. Above 5 minutes of cardiorespiratory arrest, there is high probability of brain sequels, and above 10 minutes, there may be brain death.
