Heartbeat

My company’s 5-a-side team had spent 12 months being taken apart by streetwise sides in one of inner city Manchester’s evening leagues. But displaying the virtues of application, teamwork and finding a ringer or two, the double digit defeats (32-1, 29-0) were behind us and we were competing.

Our rise towards 5-a-side football competence is relevant because I remember feeling excited as I leant against the mesh fencing behind a goal, gulping air and talking to Laurie. Five or six minutes into the game and we were leading. Laurie and I had finished a shift (of five or six minutes) and been substituted – regular replenishment by fresh legs was another factor in our rise.

Laurie, I recall, was about to say something to me. With my attention divided between the continuing game and my colleague, I saw him fall backwards with the rigidity of a felled tree. Within seconds he had people – players from other matches – attending to him. I ran to the office to get an ambulance called.

Laurie didn’t make it. Heart failure. In his mid-40s, he was fit. Thursday evenings he played 5-a-side with us. Weekends, he played on a team with his sons. But there was some impairment in his heart that had been dormant through so many exertions and then emerged to strike suddenly and irremediably.

The last time I recounted this story, I was taking a first aid refresher course to support the junior cricket coaching work I do. The course leader asked if anyone had experienced a situation where emergency first aid had been required. In a group of seven, there were two of us who had witnessed fatal heart attacks playing recreational sport – the other example was from a cricket match. Neither involved someone doing anything more intense or exacting than their routine.

It’s rare, yet common enough to be a story to have touched many families, friends, teammates and opponents. David Epstein, in ‘The Sports Gene’, writes about a fellow high school runner, a state champion, who collapsed and died within metres of crossing the finishing line. Epstein goes on to write about the genetic condition, hypertrobic cardiomyopathy (HCM), which is a kindred, equivalently grave, affliction to that diagnosed for James Taylor this week: Arrhythmogenic Right Ventricular Cardiomyapathy (ARVC).

How could Taylor, I wondered, who has been around the England set-up, with its legion of backroom staff, for almost ten years, not have had this serious condition identified sooner, as part of routine health testing. Epstein may provide an answer; several, in fact.

To begin with, the most telling indicator of HCM is an enlarged heart, which also happens to be common among healthy athletes (AVRC also has symptoms that affect the structure of the heart that can be caused by other factors). Distinguishing between the medical condition and a well-developed muscle requires the input of an expert, of which Epstein wrote, “there are precious few in the world.”

Both conditions are inherited and caused by genetic mutation. Presence of the mutation does not however mean that serious symptoms will be experienced. Moreover the mutations vary greatly with many being restricted to a single family.

These uncertainties create a dilemma for clinicians diagnosing the conditions in athletes – they cannot tell which patients may be at risk of a sudden fatal heart malfunction. Understandably, the advice given will be to avoid physical exertion and so withdraw or retire from competitive sport, just as James Taylor has announced today. Epstein recalls that at his running friend’s funeral, his peers emphasised that the young man died doing what he loved – racing. Epstein demurs: “For me, there is scant solace in the poetic detail that he died running.”

James Taylor will now be deprived of the heightened experience of cricket played at its most intense: duelling with fast bowlers, challenging fielders with aggressive running and steeling himself not to flinch when crouched close at short-leg. Just as Epstein’s friend would have “eagerly rechanneled his competitive energy elsewhere,” and Laurie would have settled for watching his sons play football and to continue his active role in his family’s development and his own career, so Taylor will find another outlet for the ability, poise and commitment that took him, if only briefly, to the top of his sport. I hope he can find that fulfilment somewhere in cricket.

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The material on HCM is drawn from chapter 15 of ‘The Sports Gene – Talent, Practice and the Truth about Success’, by David Epstein.