A hi-tech scanner which is able to detect deadly hidden heart conditions such as the one suffered by footballer Christian Eriksen is being used by Cardiology students at Middlesex University.
The echocardiogram, also known as ‘Echo’ and similar to the ultrasound for pregnant mothers, can pick up inheritable conditions such as cardiomyopathies, which is a disease of the heart muscle that can make it harder for the heart to pump blood.
This condition can often go undetected in traditional tests, even with elite athletes, and eventually lead to heart failure.
“For correct CPR you have to move someone’s chest by 4cm and you can break a person’s ribs while doing it. But their ribs will heal but death won’t.” Lesley Davies, a Senior Lecturer in Cardio Physiology.
Eriksen, a Danish international who now plays for Manchester United, collapsed during a 2020 World Cup game between Denmark vs Finland after suffering a cardiac arrest.
Another soccer star Francis Muamba also had a cardiac arrest during a game between Bolton Wanders and Tottenham Hotspurs at White Hart Lane in London in 2012, which was diagnosed as cardio myopathy.
Both Eriksen and Muamba were saved thanks to the incredible work of medical and emergency services staff.
The Echo scan is part of Middlesex University’s new development, which includes health, sports science and natural science facilities, in the West Stand of Saracens’ StoneX stadium.
Lesley Davies, a Senior Lecturer in Cardio Physiology, said: “The reasons both those men are still alive is because the first responders did such a fantastic job.
“Often people who suffer from cardiomyopathies don’t have any warning until they collapse for the first time.
“Cardiomyopathy causes an enlargement of the heart muscles. As the ventricles get thicker, they have to work harder to pump blood to the lings and around the body, which in turn adds to the enlargement of the heart muscle.
“Eventually that leads to heart failure because they’re struggling too much and can lead to dangerous arrhythmia (abnormal heart rhythm) when bottom chambers are contracting too fast so not enough blood is getting pumped round.
“This is because there is not enough time for ventricles to fill before it’s squeezing back out again or they quiver so nothing gets pushed out and they’re not getting oxygen to the lungs. That’s what happened to Christian Eriksen, who went into ventricle arrhythmia.”
The Echo test uses ultrasound waves to look at the structure of the heart and can show changes caused by inherited heart diseases which go under the radar, and may have resulted from a previously undetected heart attack.
The operator uses a clear gel on the chest and an ultrasound probe which sends beams into the body, and their reflections are used to generate images of the heart.
Unless these tests are carried out regularly, disease such as cardiomyopathy can go undetected,” adds Lesley. “We can’t just scan people at 23, for example, then never do it again, it has to be on a regular basis – every 2 years.
“The best test for cardiomyopathy is the Echo, which is very similar to an ultra-scan for pregnant women.
“Bouncing sound waves off the heart shows how well the heart is contracting, if the four valves in the heart are working and we can see them moving and whether they’re too stiff or floppy.
“Sometimes people pick up bacterial infections that will settle on the valves and cause a growth.
“We can also measure the size of the chambers and the muscle wall of the heart and tell if the condition is something like cardio myopathy and unless they do that routinely with sports people it can go amiss.”
Even if a person has cardiomyopathy it may take several years before it can be spotted, explained Lesley. “They both (Eriksen and Muamba) ended up with implantable defibrillators so when they go into this arrythmia again, it can use therapies to get them out of it before they collapse.
“For example if you’re exercising, your heart beat will increase gradually but if you have an arrythmia the heart will suddenly get faster and the device looks at that discriminator and says this is a dangerous arrythmia and will go into therapy.
“It is only when it gets to a certain stage when cardiomyopathy causes problems. “Cardiomyopathy can be inherited so if they’re family history there’s more chance of you getting it but if you pick up a virus which attacks your heart you can also acquire the condition, but this is relatively rare so we wouldn’t want people to panicking every time they get a virus.
“Often it can be a genetic mutation and something they are born with, and never have affected anyone in the family previously.
“Christian Eriksen (pictured below) probably had it for quite some time and it was only at a certain stage when it became dangerous for him and started to produce arrythmia so you can live with it for several years before you know anything about it. This is one of the commonest causes for cardiac deaths, particularly among young people.”
There are future plans to possible open up the facilities for the general public.
The testing process followed by students at MDX will include a detailed procedure – described as a “whole MOT” - which first begins to look at medical and family medical history, before a medical examination.
This would be followed by an electrocardiogram (ECG), followed by the Echo scan and tests on a treadmill and exercise bikes, which are used to study any changes in electrical patterns caused by exercise and to analyse any abnormalities.
Alechia Van Wyk, a Senior Lecturer in Cardio Physiology, explained that one rugby athlete’s condition remained undetected only until he put under rigorous stop start walking and running routines, mirroring a rugby match, which exposed a hidden heart condition. Sadly, the individual could never play rugby again.
Students can also test for another more recently established potentially fatal condition known as Brugada syndrome, which affects the way electric signals beat through the heart.
For the heart to conduct electricity, sodium and potassium have to move in and out of the cells but if this is not happening correctly it can cause Brugada syndrome and long QT syndrome, a heart signalling disorder. Alechia added that Cardiology students are quickly taught CPR and prepared for dealing with sudden deaths.
“Our students learn how to do first aid and use the defibrillator from year one, so they are trained from the moment they arrive because this is their bread and butter,” she added.
“We are also getting the students used to the fact that some patients might not come back so they have a well-rounded preparation and are not a 20 or 21-year-old who is having to deal with death at work on their own for the first time, because that’s absolutely not normal for anyone of their age to deal with.
“That is what you see in a cardiology department on a regular basis, so we do our best to make sure they are ready and prepared.”
Both Lesley and Alechia have worked in the prestigious cardiology wing of King’s College London.
They said that unless someone begins CPR on a person who has collapsed from cardiac arrest within minutes they are likely to die.
For people who are treated, they need treatment within six to 12 hours in a hospital. In a 30-year career Lesley saw more than a fair share of cardiac arrests that sometimes could be on a daily basis.
“For correct CPR you have to move someone’s chest by 4cm and you can break a person’s ribs while doing it,” she added. “But their ribs will heal but death won’t.”
Muamba, whose heart is said to have stopped for 78 minutes, was forced to retire from the game.
Eriksen, widely regarded as one of the finest midfielders of his generation, has continued to play at the highest level after being fitted with a defibrillator.
“This is such a positive development in our line of work,” said Alechia. “People can see I can actually have a job and lead a normal live with this defibrillator.
“We see many young patients who get this device and feel as if their life has been ruined.
“Finally, with Christian Eriksen, they are starting to realise this is not a death sentence and you can carry on your life as normal which is amazing.”
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