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Soccer Fever: "There Are More Heart Attacks Due to Stress“
A game lasts 90 minutes, a cardiac infarction mere seconds. The Soccer World Cup is the marriage of frenzied enthusiasm and great emotions, during barbecues and public parties. With increasing happiness and tension, unfortunately also the number of cardiac incidents increases. During the World Cup 2006, on some match days, there were three times as many suspicious cases for acute heart attacks.
For the kick-off of the FIFA Soccer World Cup 2010, MEDICA.de questions several sport medical stereotypes and tries to get to the bottom of upcoming peak performances with the help of Professor Löllgen, sport medicine specialist and medical specialist for Internal Medicine and Cardiology.
MEDICA.de: Professor Löllgen, we are currently in the midst of exceptional circumstances during the Soccer World Cup 2010. For many fans this is not just a time of increased alcohol consumption and wild partying, but also a time of mental and cardiac stress, be it in front of the TV, in the stadium or during public game viewing parties. The whole thing is usually affecting the heart. Why is that?
Herbert Löllgen: There are several observational studies on this. One research study was done during the World Cup in France in 1998. Another prospectively designed study from Munich was done during the World Cup 2006 in Germany. In France as well as in Germany, it was registered how frequently during the World Cup patients came to the hospital with cardiac emergencies. If Germany played against another team in its own country, an increase of hospitalizations for Angina Pectoris, heart trouble or even heart attacks and fatalities occurred. This study was conducted in the entire Munich region. In the retrospectively designed study on the World Soccer Cup in France we have similar findings. Research shows that during the game of one’s own team, a clear stress situation is given, which can lead to Angina Pectoris complaints all the way to a heart attack for people with a damaged heart.
MEDICA.de: Who is especially affected here?
Löllgen: Mostly it’s patients with a pre-existing condition. A damaged heart and a coronary heart disease present a considerably increased risk. This is comparable to other stressful situations. During earthquakes for example, there is also an increased rate of heart attacks. A damaged heart can lead to a worsening of a coronary heart disease condition. It is assumed that stress compounds plaque deposits in the coronary arteries or makes them permeable and lead to infarct. For a healthy heart there should not be any danger though.
MEDICA.de: What do you recommend for prevention?
Löllgen: Every heart cardiac patient should of course consistently take their medication. It is advisable to use beta blockers during games. In an emergency, nitro spray may help. New investigations show that all statins can lead to a so-called plaque stabilization. This means: Irrespective of lowering cholesterol, statins obviously also have the ability to stabilize the vulnerable area in the coronary arteries. Even before the games of the German team, the statin dosage should be increased to twice the amount for the duration of the Soccer World Cup. In other words, take two pills instead of one.
MEDICA.de: If you don’t have a coronary pre-existing condition, what would you advise?
Löllgen: If there is no known indisposition, yet you quickly get very upset and have heart trouble because of it, a low dosage beta blocker might help.
MEDICA.de: In case you are not a sedentary fan, but a running athlete: Can an amateur soccer player improve his/her fitness or prevent the risk of a heart attack or heart-and circulation problems?
Löllgen: Generally speaking, yes. Playing soccer is a very diversified sport. An older and untrained amateur soccer player, who wants to get back into the sport, should visit a doctor for an exam beforehand, because during exaggerated athletic pressure in the first training phases there is a higher risk for a heart attack. If you exercise regularly, the risk decreases again. If you start slowly and gently after taking a break and you exercise regularly, sport has a preventative impact. Example: Each year there are two to three acute heart attacks among amateur soccer players in the Remscheid region. Those patients for the most part were great athletes in their younger school days. However they have not done any sports in many years. Smoking, excess weight and high blood pressure also count as risk factors that promote a heart attack for people returning to sports starting in their mid Fifties. A preventative medical check-up is often vitally important. To be more precise: You should rather do some stamina training than emulate professional soccer players.
MEDICA.de: About the professionals in South Africa: The players are young, talented and pass through frequent health checks – yet there are still sudden sport incidences that occasionally result in death. What is the reason for this?
Löllgen: There are two types of diseases. With young top athletes, especially African-American players, there is a higher percentage rate of hypertrophic obstructive cardiomyopathy, an abnormal thickening of the heart muscles in the left ventricle. This can lead to sudden cardiac death. However, this can be detected by an echocardiography. For German Soccer League players this is part of a typical health check-up, but in foreign nations this is not always the current standard. This check-up is especially recommended for all African-American players. Studies show that sudden deaths for these top athletes are more prevalent due to hypertrophic obstructive cardiomyopathy. A second type of disease has a somewhat generic name called ionic channel disease, and these diseases are often the reason for a sudden cardiac death. This includes for example the Brugada-syndrome (a rare and mostly autosomal-dominant, but inherited disease of the heart with typically incomplete penetration) and the Wolff-Parkinson-White-Syndrome (the WPW-Syndrome is a cardiac arrhythmia, triggered by an electrical gyrating between atria and ventricles). Occasionally, these syndromes are not clearly detected in a basic ECG. A trained sport medicine cardiologist has his/her first suspicions while looking at a simple resting ECG, but a family doctor might have difficulties diagnosing this straightaway.
MEDICA.de: Is there a generally accepted standardized cardiological check-up at the front end of the Soccer World Cup?
Löllgen: The FIFA has established a regulation. Each athlete who participates in the Soccer World Cup or the European Soccer Cup, needs to run through a standard check-up. This means: A resting-and a stress ECG, cardiovascular ultrasound and laboratory tests are being done beforehand.
MEDICA.de: Which indicators for a serious disease such as these are taken into account to protect athletes from cardiac incidents?
Herbert Löllgen: The keyword here is predisposition, and also the question of whether there were sudden deaths in the athlete’s family, usually when a family member was under the age of fifty or forty years at the time of death. If this is the case, then you start paying close attention. Sport- as well as family medical histories are very effective in this case. A second indicator is if the athlete has so-called cardiac syncopes. Especially for young athletes a close observation is advisable to be able to consider a possible ionic disease. In the clinic where I worked, in total we had over 30 sports related death cases. In these cases there were almost always syncopes in the medical history present. Rarely is there inflammation in the history, meaning Myocarditis or the like. In addition it is advisable to conduct a physical examination. Unfortunately, a simple trick is often not being used: Listening to the heart when the patient is lying down as well as standing up. By doing so, you hear an aortic insufficiency sound with a Marfan-Syndrome as well a hypertrophic obstructive cardiomyopathy more clearly than if the patient was lying down. A next step is a resting ECG. Here close attention should be paid to any changes. A competent diagnosis requires special knowledge in sports cardiology. In addition, most athletes should do a stress ECG. These are all standard procedures. In the case of any clinical findings, an additional cardiovascular ultrasound is recommended.
MEDICA.de: Is there a higher incidence of cardiac disease in professional soccer players?
Herbert Löllgen: No, I don’t think so. Diseases of professionals are always spectacular, because they happen in the public eye, which is why they are more strongly observed. Ionic channel diseases for example are more commonly diagnosed in marathon runners or triathletes. U.S statistics show that most cardiac incidents occur in American Football, Rugby and also in Soccer or Basketball. In the case of basketball players, oarsmen and volleyball players there is another disease added to the mix: the Marfan syndrome (a hereditary abnormality of different organs, where often also aortic defects or cardiac valve insufficiency could occur). Very tall athletes, predominantly basketball players, who are over 1,90 meters tall, are usually struck by this. This is why in the U.S players are routinely checked for Marfan syndrome.
MEDICA.de: Let’s get to the successful soccer women, the German National Women’s Team: How at risk are these top athletes in terms of cardiac incidents during sports?
Herbert Löllgen: Cardiac incidents in women are statistically speaking definitely more rare and they actually are less at risk. However, women fall ill more often due to thyroid hyperfunction and iron deficiency.
MEDICA.de: Doping in sports is an important topic. The illegal intake of stimulants and other harmful substances has a negative effect on the organism. Is this how many cardiac problems develop for professional soccer players?
Herbert Löllgen: Yes, this can happen. Taking in anabolic substances for example in the long run leads to heart damage. In the past you were able to observe this in shot-putters, who all took anabolic substances. Several of these athletes later had severe coronary sclerosis or died prematurely of a heart attack. Initially, an acute danger is not given with anabolic substances, at least not with an extremely low dosage. However, stimulants can trigger cardiac arrhythmia.
MEDICA.de: Which actions should you absolutely take in case of a cardiac incident?
Herbert Löllgen: There are two recommendations: For one there is the heart and lung resuscitation and then there is the possibility to jumpstart the heart. By now, in all German stadiums automatic external heart defibrillators are being used. One example: Doctors discovered a hypertrophic obstructive cardiomypathy in professional soccer player Gerald Asamoah, a condition which is responsible for sudden cardiac deaths in some young people. Following the diagnosis, the German Soccer Association DFB barred Asamoah, who objected the judgment. Now he plays for the German FC Schalke 04 Soccer Club. Placed all around the stadium are now several heart defibrillators, which can be immediately used for players and spectators. Generally speaking, the emergency physician should always quickly on-site.
MEDICA.de: How will fans and MEDICA.de readers pull through the Soccer World Cup healthy and stress-free?
Herbert Löllgen: We should try to relax. If need be with professional help, a stress recovery therapy or anti-stress training, like for example autogenic training. During excitement slow deep breathing always helps. Of course, if a fan is getting too stressed out while watching a soccer game, especially patients with heart diseases, the rule is: It’s best to turn off the TV, go for a walk and have somebody tell you about the game result later.
MEDICA.de: Who is your World Cup favorite in South Africa?
Herbert Löllgen: I am betting on Brazil, and I believe Germany will make it into the quarter-or semi finals for sure.
The interview was conducted by Diana Posth