A cardiologist who has worked for four Premier League sides said last night that clubs' decisions not to put young players through annual heart screening meant that the symptoms which could lead to chronic heart failure, as suffered by Fabrice Muamba, were going unchecked.
The enlargement of the heart, which is the most common cause of such catastrophic collapses, tends to occur from the age of 13 to adulthood. But Dr Amanda Varnava, who has worked with Tottenham Hotspur (who yesterday stated they would offer their players extra heart checks), Fulham, Stoke City, West Ham and Watford, said that the current system could see a player go unscreened for long periods beyond an initial academy cardiological test at the age of 16 or under.
Dr Varnava, a cardiologist for HarleyStreet.com, said that annual cardiological examinations, which have not been introduced at any of the clubs where she has worked, have cut incidence of sudden death by 90 per cent in Italy – where every young player between the ages of 12 and 18 completes a questionnaire and undergoes an ECG and echocardiograph each year.
The London Chest Hospital said in a statement yesterday that Muamba was showing "small signs of improvement" and that his heart was beating without the help of medication. The statement also said that Muamba was moving his arms and his legs, though his long-term prognosis remained unclear. The fact that Muamba underwent cardiac screening at Bolton Wanderers at the start of this season, demonstrates that there can be no failsafe where the heart is concerned.
"It is possible to go through screening process and still harbour a lethal condition," said Dr Varnava.
Premier League mandatory annual checks include team doctors listening for heart sounds, murmurs, pulses and arrhythmias. A special cardiological examination must also be carried out as early as possible in a player's career.
The Premier League said that it would re-examine the testing system with other authorities in the coming weeks and hope that something might be learnt from Muamba's case, as was the case when Chelsea's Petr Cech sustained a head injury during a match at Reading's Madejski Stadium.
Muamba remains critically ill, but a friend said yesterday he had "spoken minimal words in English and French".