Why African Soccer Players Continue To Die on the Pitch?

On June 15th, hundreds of mourners gathered at Abidjan’s international airport to receive the body of Ivorian soccer star Cheick Tiote following his sudden death in China earlier this month.

The former Newcastle United midfielder was later honored with a military funeral on June 18th at his home in Abidjan, Ivory Coast, with a host of notables and fellow teammates in attendance.

Tiote, 30, collapsed and died during a training session with his Chinese club Beijing Enterprises. His untimely death was a shock to millions of his fans around the world and has left many people concerned about the overall health and safety of African soccer players at home and abroad.

Tiote’s passing follows another painful and sudden death of Patrick Claude Ekeng, a Cameroonian defense midfielder who collapsed during a live match in Romania and died two hours later while in hospital. At the time of his death in 2016, 26-year-old Ekeng was playing for Dinamo Bucuresti in Romania.

Three days after Ekeng’s death, Cameroonian female goalkeeper Jeanine Christelle Djomnang collapsed and died during a warm-up session before a match in Cameroon.

In August of that same year, Michael Umanika, a Nigerian midfielder playing for Zaqatala PFK in Azerbaijan, collapsed during a team training session in Zaqatala and died.

Dozens of other African soccer players have died on the pitch, with the majority of these incidents being linked to sudden cardiac arrest (SCA), a common heart problem.

Some reports indicate that 26 of the 64 players who have died in the last 10 years are from Africa. Of the 26, 25 have died from SCA.

From the statistics, it appears that African soccer players may be prone to this heart problem.

Are African Players Prone to Sudden Cardiac Arrest?

In a recent interview with Face2Face Africa, Dr. Harun A. Otieno, a Kenyan cardiologist and the current chair of the Task Force on Interventional Cardiology for Pan-African Society of Cardiology (PASCAR), explained extensively what causes SCA and whether African players are more prone to it than players from other parts of the world.

According to Dr. Otieno, SCA is a serious medical condition that occurs when the heart suddenly develops an irregular, accelerated heart rhythm that cannot support normal heart pumping or mechanical function.

This interruption leads to collapse or fainting with no breathing or recordable blood pressure.

“In most cases, there are no warning symptoms, but a few cases in those who have been revived report complaining of chest pain, fainting with exercise, palpitations, dizziness, [and] shortness of breath a few minutes to hours before the episode of SCA,” Dr. Otieno says.

He also cites ventricular fibrillation as the most common cause of SCA, saying it’s a sudden chaotic, very fast, but ineffective heart rhythm disorder arising from the lower chambers of the heart known as the “ventricles.”

According to Dr. Otieno, who has worked in Cardiology for 10 years, there may be an underlying heart condition known as hypertrophic cardiomyopathy, especially in young players.

Hypertrophic cardiomyopathy is a genetic condition that causes the abnormal thickening of the heart muscle that makes the player more prone to developing ventricular fibrillation.

Other abnormalities of the heart valves, arteries, or the electrical system of the heart can cause ventricular fibrillation and hence a sudden cardiac death.

“In the general public, coronary artery disease is the leading cause of sudden cardiac arrest as a result of ventricular fibrillation occurring in the setting of a heart attack,” Dr. Otieno adds.

“Those who have risk factors for heart disease, including hypertension, diabetes, and high blood cholesterol, or those who smoke are also at increased risk of sudden cardiac arrest occurring in the setting of sudden cardiac arrest.”

A dangerous blood clot traveling from the leg veins to the lungs can also lead to Sudden Cardiac Arrest if it is very large. It can completely obstruct blood flow through the heart and lungs, a condition known as pulmonary embolism, according to Dr. Otieno.

On the question of whether African players are more prone to SCA than players from other parts of the world, Dr. Otieno said, “SCA/sudden cardiac death occurs in all players, but the lack of pre-competition screening for heart conditions may put African players at more risk.”

He also mentioned “commotio cordis,” a rare condition that occurs when a player is hit hard on the chest during a very brief but vulnerable period of electrical activity, as another likely cause of ventricular fibrillation.

“Severe head injuries can also lead to major brain injuries, which can lead to bleeding and sudden death,” he says.

Prevention & Treatment

According to Dr. Otieno, the best way to prevent SCA is to go for regular checkups. He, therefore, advised players to ensure that they have comprehensive heart checkups regularly in order to exclude some of these dangerous heart conditions that can go undetected for many years.

An echocardiogram (ECG) is the most common method used to check for heart problems, since it can immediately detect the heart’s abnormal electrical activity and abnormal heart thickening.

A Holter monitor or loop recorder can also record the heart’s electrical activity for 24 hours or longer if implanted under the skin, while other dangerous heart problems can be detected through a special scan of the heart through a cardiac MRI or CT scan.

“Additionally, close evaluation of family history, risk factors, and symptoms can also lead to early detection and prevention,” Dr. Otieno says.

Meanwhile, the most effective remedy for SCA is immediate cardiopulmonary resuscitation, also referred to as chest compressions and electrical defibrillation.

“While the heart is not beating effectively, it is critical to provide effective chest compressions that can circulate blood to the rest of the body. This is followed by applying an electrical shock to the heart to restore the normal heart electrical activity. All players should have immediate access to CPR and defibrillation,” says Dr. Otieno.

He added that if a serious heart condition is detected, correction of the underlying problem can prevent a sudden cardiac death.

For example, implantation of a special device known as the Implantabel Cardioverter Defibrillator (ICD) under the skin of the chest can help to detect ventricular fibrillation and quickly deliver an electric shock to the heart to correct the heart rhythm.

Dr. Otieno has a private practice, Africa Heart Associates, with offices at the Aga Khan University Hospital, Nairobi, and also sees heart patients at the MP Shah Hospital, Social Service League, in Nairobi.