Todays Herald report

DOUGLAS LOWE, Golf Correspondent January 05 2008
Screening for heart disease should be freely available to all high-performance sportsmen and women in Scotland according to a leading medical expert, who cautioned that he would stop short of making such examinations compulsory.

Dr Brian Walker, head of sports medicine at the Scottish Institute of Sport, urged the extension of screening programmes to all those performing to district level or higher and also a wider provision of emergency medical equipment.

The Scottish Football Association are considering the introduction of compulsory screening following the sudden death from heart failure of Phil O'Donnell, the Motherwell captain, in their match against Dundee United at Fir Park a week ago.

advertisementWalker was not taking issue with that move, but he did point out that in the wider medical world there is an ongoing debate about whether anything at all should be enforced.

"If you go for an operation nowadays there has to be full consent. You are given a list of benefits and risks spelled out to you in big flashing lights so that an informed decision can be made," he said.

"That principle should apply to screening for heart disease. If an apprentice footballer is picked up as positive - remember it is one in 200,000 so let's keep that in perspective - then he will be out of a job.

"He perhaps hasn't trained for anything else and later on in life it will be difficult to get insurance or a mortgage, so that has to be mentioned in discussion as well."

In the broader sporting sense, Walker related a theoretical case that was discussed at a CRY (Cardiac Risk in the Young) conference he attended last year concerning an Ethiopian marathon runner and an Olympic gold medal prospect in his mid-30s.

"If he wins he will set up himself, his family and extended family, and perhaps provide drinking water and sanitation for his village. Life expectancy in Ethiopia is late-40s. If he is found to have a heart defect, what right does anyone have to stop him running?" he asked.

Walker, a Dundee United supporter, was at last Saturday's game at Fir Park. "I never want to hear a silence like that again," he said, and as a match doctor at rugby matches - he was on duty last night at Firhill for the Glasgow Warriors v Gwent Dragons fixture - he was acutely aware of what was happening.

"The medics were on very quickly and so was the oxygen," he noted, adding that it was an improvement on the incident in 2003 in Lyon where Marc-Vivien Foe, the Cameroon midfielder, died suddenly in the Confederations Cup semi-final against Colombia.

"I studied the video of that. It was not well done and people have learned from that. At Fir Park, the response was much quicker and tonight beside me and the team doctor at Firhill will be oxygen and a defibrillator.

"Provision of emergency equipment has greatly improved in my lifetime. Away from sport you find them nowadays in places like shopping malls. They should still be much more available at all sports grounds, sports halls and even golf clubs. The modern defibrillator is very simple to use and a first-aid person can be trained to use it in an afternoon."

In addition to 200 high-performance sportsmen and women at the SIS, Walker looks after the medical interests of Scotland under-19 rugby players and encountered another death on the field - an Irish player - at the under-19 world cup in South Africa three years ago. He is also personally aware of the sudden death in 2006 of former Glasgow Hawks player Craig Hodgkinson, a school friend of his daughter's.

The Craig Hodgkinson Trust, set up by his parents, has contributed to the provision of new equipment.

"Although it is a very rare occurrence you do come across it," said Walker, "and I would strongly recommend that screening is freely available. That is the policy here at the institute and it would also be my personal policy.

"It is close to compulsory at the institute as part of a joining medical examination, but I would have no problem accepting someone who didn't want to be scanned."

Walker clarified a misconception about enlarged hearts among the super-fit. "Every high performance sportsman has an enlarged heart,"

he assured, "and that is inevitable. It is also desirable and healthy.

"The confusion is that the most common cause of sudden death of sports people in Britain is hypertrophic cardiomyopathy.

In that case the muscle wall of the heart becomes enlarged and solid and not as elastic as it should be.

"This is an unhealthy enlargement and people with this congenital abnormality who have never been near a sports field could die watching Coronation Street. But if you are a sportsman there is a slightly greater risk, so the sooner you know the better."

All eyes in this respect are on the most advanced project in the world of its kind, in northern Italy, where screening is free to every active sports person.

"I think screening should be freely available when sports people get to district level, but in the Italian study it has reached the amateur footballer and even Jill Jogger," said Walker.

It costs between £100 and £200 per person depending on the detail required and each diagnosis in Italy has been costed at about £20,000. Walker reckons if that were extended to Scotland there would have to be government support because otherwise it would cost sporting bodies hundreds of thousands of pounds, if not millions, every year.

This article was originally posted on 5-Jan-2008, 10:51 by Hugh Barrow.
Last updated by Hugh Barrow on 5-Jan-2008, 10:51.