Young people are “not immune to heart disease”, cardiology specialist Mark Abela has warned, urging those with a family history of cardiac problems to be mindful of their heart health.

Abela spoke to Times of Malta after a 22-year-old died while playing football last week, after suffering what is believed to have been cardiac arrest.  Since then, another young man has been reported dead, although the cause of death has not been confirmed.

NGOs as well as the sports minister reacted to news of the football pitch death by calling for better access to defibrillators – potentially life-saving devices that are designed to help those who suffer a sudden cardiac arrest.

When there are symptoms, I would consider an ECG, even in young people- Cardiologist Mark Abela

There have also been calls for first aid and basic life support training to become mandatory in schools.

But according to Abela, who has a special interest in sports cardiology and inherited cardiac conditions, this is not enough. It is also crucial that those with a family history of hereditary heart problems get screened regularly.

In some cases, doctors might recommend starting screening even in young children, especially in those who experience symptoms or play competitive sport.

“We don’t want to alarm people… a cardiac arrest in a young individual is a rare phenomenon,” Abela said.

“ECGs should, however, be considered as part of a routine evaluation in young individuals. Earlier diagnosis may prevent problems. We can save a life by being more aware that young people can still run into problems.

“The ECG is an excellent tool that can be used to identify individuals at risk. Getting tested is a must if you have symptoms or if there is any relevant family history. Patients should always seek advice from a physician,” he warned.

Symptoms that should never be ignored include loss of consciousness, chest pain, breathing issues and very bad dizzy spells, Abela said, as he urged young people not to brush off such symptoms, especially since many tend to feel invincible and it can be somewhat difficult to convince them to get properly checked out.

“When there are symptoms, I would consider an ECG, even in young people. The ECG is often the first thing that goes off, if there’s a problem,” he said.

“This can sometimes be years before we actually see something on an ultrasound or a cardiac MRI.”

Surveillance is key, even if everything is in order. Heart disorders often progress with time, so false reassurance is a “big problem in the management of these families”.

Unfortunately, Abela has had patients who fail to turn up for follow-up appointments despite him flagging issues, such as an abnormal ECG.

What if you practice sports recreationally?

Abela also highlighted that a lot of emphasis is often put on competitive athletes.

Many often forget that recreational athletes are far bigger in number. A study in France reported over 95 per cent of exercise-related cardiac arrests happened in non-competitive athletes.

These athletes often train alone, he said, in areas which may not be well equipped in case of a cardiac arrest.

“As soon as we speak of sudden cardiac death, we think of competitive athletes,” he said.

“Most sporting bodies now endorse and oblige athletes to get screened. This is, however, only the tip of the iceberg. Most athletes play on a recreational level, they play in the amateur leagues, they go to the gym to get fit, they cycle on a Sunday, they go to play football with friends weekly.

“I’m not saying don’t go play a football match with friends if you don’t do an ECG. Exercise after all has been shown to substantially improve one’s health. People who exercise live longer and have more favourable outcomes for various diseases. It is, however, very important to acknowledge symptoms and a relevant family history.”

The cardiologist is also calling for the introduction of legislation that obliges sporting facilities to have readily available defibrillators and personnel certified in basic life support on site.

This should also be extended to schools that rent out their sporting facilities in the evening.

In Italy, laws on both the availability of defibrillators and delivery of basic life support were introduced in 2016, Abela said, adding that basic life support training is now also mandatory in all Italian schools.

“I do understand people’s concerns…people are scared, and most would never have witnessed a cardiac arrest. Imagine witnessing a family member or a close friend succumbing to a cardiac arrest, would you want a bystander to remain idle?” he said.

“Bad CPR is better than no CPR. I strongly advise everyone to get certified in basic life support. You never know when it may come in handy,” Abela said, quashing concerns one might make things worse by helping.

Heart disease research study... the situation in numbers

Abela and colleagues carried out cardiac screening of 2,708 fifth-form students aged between 15 and 16 during the 2017/2018 scholastic year.

This was part of the research to obtain his PhD, supported by the University of Malta Research Innovation and Development Trust (RIDT) through a scholarship funded by Beating Hearts Malta.

He found 15 students had heart disease despite not having any symptoms.

Nine of these harboured a condition linked to sudden cardiac death, with half being athletes who play at a competitive level. All of these were diagnosed after an ECG came back abnormal.

More awareness and education about cardiac arrest prevention is required- Mark Abela

Most of these individuals, his study showed, had a suspicion of an inherited cardiac condition, and so family screening was also advised to relatives.

When evaluating these individuals, Abela found that 10 per cent of the

family members also had an inherited heart condition, and some included siblings of the patients themselves.

Two schools had documented a cardiac arrest in a 10-year period. The majority of schools, he said, had just one defibrillator and only a third of them said the devices were close to a sporting facility.

A cardiac arrest in a school is most likely to take place during sporting activities, he noted.

“This highlights that more awareness and education about cardiac arrest prevention is required,” Abela said.

“Sudden deaths in young individuals are a reality. We are not immune to this phenomenon. We need to move forward and bring about much-needed change.

“Let us not waste more time.”