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 screening system could see a player go unscreened for long periods beyond an initial academy cardiological test at the age of16 or under, as he works his way through the system.
Dr Varnava, a cardiologist for HarleyStreet.com, said that annual cardiological examinations, which have not been introduced at any of the clubs with which she works, has cut incidence of sudden death by 90 per cent in Italy – where every young player between the ages of 12 and 18 complete a questionnaire and undergo 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, whom doctors hope has not sustained brain damage, did undergo 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.
"Some clubs screen once and don't repeat it, but the incidence of sudden death is particularly high in football and in those of Afro-Caribbean descent, added Dr Varnava. "During adolescence there should be annual checks, certainly up to the age of 18 and possibly 21. There is a complete misunderstanding among the public that symptoms are important. There is no link between symptoms and sudden chronic death. The absence of symptoms is no reassurance."
The cost of annual heart screening for an individual player is around £250, which, as Dr Varnava observed, is relatively cheap by Premier League football standards.
The most common heart defect – cardiomyopathy – an inherited condition that causes thickening of the muscle in the heart wall, leaving no space for the blood to be pumped – can be hard to distinguish from "athlete's heart", the enlargement of the heart that occurs as a result of training, which is natural and a sign of fitness. This is especially so in black athletes who tend to have thickened heart muscle and abnormal ECGs. Half of Premier League players have naturally enlarged hearts but two per cent of white players have thickened muscle compared with 15 per cent of black players. Though Muamba remains critically ill, a friend who had visited him – Curtis Codrington– said he had "spoken minimal words in English and French, which is better than nothing".
Muamba's team-mate Kevin Davies spoke of the enduring agony of the Bolton players, who are desperate that he will continue to respond positively as the adrenaline which was helping to keep his heart going was gradually withdrawn. "With what we all witnessed on the day, you are half expecting a phone call with bad news," Davies said.
"We are all amazed that Fab is still in there fighting. It just makes you appreciate life a little bit more. It is pretty sad really that it takes something like that to trigger it. Sometimes you sulk around. I have been sulking at times because I have not been in the side. But when something like that happens it puts everything into perspective."
As of last night, there had been no dialogue between Bolton and the FA over whether the club would resume their involvement in the FA Cup by playing the re-scheduled FA Cup quarter final with Tottenham, possibly next Monday, on the White Hart Lane pitch where the 23-year-old Muamba collapsed.
Asked if any of the players had considered the re-match, Davies said: "No. Not really. There are loads of questions flying about: where's the club going? Are we competing in the Cup? When is the next league game? What has happened to Fabrice is obviously something that is very rare."
Davies had discussed Muamba with the specialist treating him. "Sometimes, [the patient] may well have a normal functioning heart but he may have picked up a virus which can trigger it off," he said. "It sometimes happens with sportspeople. Because they are so fit, when they pick something up they tend not to notice because they are so fit and can shake it off. That can be one of the downsides of being a sportsman. Sometimes these things can happen."