Antonio Jose Puerta Perez was a left wing-back soccer player for the Seville Futbol Club. On August 25, 2007, some 35 minutes into a game against Getafe, he collapsed on the field, first grabbing his chest, then kneeling and finally slumping to the ground:
He regained consciousness and actually walked to the dressing room for further care. There, he suffered cardiac arrest, received CPR, and was transported to the hospital. Although he was successfully resuscitated at least twice, he died 3 days later from multi-organ failure. He was 22 years old.
After autopsy, the cause of death was determined to be arrhythmogenic right ventricular dysplasia (ARVD), a known cause of sudden cardiac arrest in young athletes.
ARVD is characterized anatomically by fibrous and/or fatty replacement of normal muscle cells in the right ventricle, the chamber that pumps blood to the lungs. This genetic condition affects approximately 1 per 10,000 Americans but as many as 40 per 10,000 Italians. A handful of genetic defects affecting the cardiac protein, desmin (involved with connections between muscle cells), have been identified.
The diagnosis of ARVD can be difficult, but the presence of a family history of ventricular arrhythmias or sudden cardiac death may be a clue. The EKG may be suggestive and there may be evidence of right ventricle enlargement or fatty deposition on echocardiogram, cardiac CT scan, or cardiac MRI.
Because of its association with sudden cardiac death, the consensus guidelines from the 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities advise that “athletes with probable or definite diagnosis of ARVC should be excluded from most competitive sports….”