Christian Eriksen: cardiac arrest in football
If you were watching the Euros a week ago on Saturday, you’ll have been shocked by the sight of Danish midfielder Christian Eriksen suddenly collapsing to the ground. According to their team doctor, it was a cardiac arrest - and Eriksen very briefly died right there on the pitch. It’s only thanks to some quick CPR and defibrillation that doctors managed to get him back - he went immediately to a hospital to recover. Strangely, they’ve since claimed they don’t have an explanation for the incident, and that examinations of him - in their words - ‘look fine’! So what might cause a person to drop like that, seemingly out of the blue? Phil Sansom went to Rohin Francis, a cardiologist from the Essex Cardiothoracic Centre, to find out whether he’s seen what’s happened...
Rohin - I wasn't watching live. It was my wedding anniversary, and my wife told me that I should be paying attention to her for some reason... but from watching back the replays, Christian Eriksen appeared to just collapse to the ground unprovoked. He wasn't moving, they lost a pulse, and that's when chest compressions started and he also was defibrillated.
Phil - This can't be a usual thing to happen, right? Someone at the peak of their fitness, quite young, even someone who's been screened for heart problems... so what generally could cause something like this?
Rohin - In any 29-year old a cardiac arrest would be a very rare event, but in a very, very fit 29-year old with no medical problems it's a very unusual event. It's about - something in the region of 1 in 50,000 sportspeople will suffer something like this. But because professional athletes do push their bodies much harder than the rest of us, these problems can manifest whilst engaged in competitive sports, so that's sometimes why we see these rather high profile occasions. And no medical test is a hundred percent accurate, and unfortunately there is a false negative rate, and sometimes abnormalities are just not detectable.
Phil - If you had to go into this as a cardiologist and give, for example, three possible explanations for what this might be, what would they be?
Rohin - If we took somebody competing in competitive sport in general, we know that the most common cause of sudden cardiac arrest in athletes is something called hypertrophic cardiomyopathy. And that's an abnormal thickening of the heart muscle itself. The heart is mostly just a big muscle that that's continually beating, and when the muscle starts thickening that can cause problems. However, one would hope that would have been detected with scans. Again, they're not perfect, and sometimes it can manifest a bit later, but at Christian Eriksen's age, you'd imagine that that would have shown up on a scan. It could be any number of other structural abnormalities to the heart; or it could be an electrical abnormality, and that's probably more likely to be the case here, because electrical abnormalities often don't show up on screening tests because the heart can look completely normal. I suppose another possibility is whether this is an inflammation of the heart muscle, which may not have been present when he'd had previous testing. There's no evidence that Christian Eriksen had COVID, but other viruses as well can cause something called myocarditis, which is an inflammation in the muscle of the heart. But again, this is all pure speculation at the moment.
Phil - I mean, presumably all of these are still pretty rare.
Rohin - Yeah. So I think that's an important point to take home - that these are very unusual. It's obviously really shocking to see someone in peak physical fitness suddenly suffer a life-threatening medical emergency, but these are rare things that happen. Perhaps a more positive message to take away is, if this were to occur, you would know what to do. If somebody collapses, we don't typically recommend checking for a pulse unless you are trained in that, and if somebody is not responsive and not breathing normally, and not breathing at all for 10 seconds, to start chest compressions. And I think there's a lot of hesitancy because people worry that that might be uncomfortable or it's not the right thing to do, but it definitely is in this kind of situation, because you can save a life. So chest compressions, and then early defibrillation. And with every minute that passes, someone's chance of having a full good recovery drops by about 3-7% per minute. So every minute counts, and the sooner you start chest compressions and attach a defibrillator, the higher the chance of that person making a full recovery.