THE COLUMN: The heart stops the dream for Olympic champion and world football star Sergio Agüero, and encourages more debate in professional sports

The retirement of Argentine Sergio Agüero from football due to heart problems has been the story of international sports this week, and returned the focus on the physical demands of professional athletes.

At the age of 33, he had been in first division football for more than half his life, since, at the age of 15 years, one month and three days, he became the youngest debutant in Argentine football.

Together with Lionel Messi he won the gold medal at the 2008 Olympic Games, the 2005 and 2007 U-20 World Cup and the 2021 Copa América. He played in the last three FIFA World Cups and says goodbye as the third best scorer in Argentine history.

Agüero, one of the best strikers in world football, said goodbye Wednesday in an emotional ceremony at the Camp Nou stadium in Barcelona, to close a history of 685 official matches and 385 goals with clubs Independiente of Argentina, Atlético Madrid, Manchester City and Barcelona, with whom he only played four matches.

He became a legend for Man City in 2012 when he scored the decisive goal in a 3-2 win over Queens Park Rangers, on the last day of the season, which clinched their first Premier League title since 1968. With 184 goals, the South American is far and away the top scorer in the history of Man City.

Roberto Peidró, cardiologist and doctor of the former footballer, recalled that Agüero first had signs of arrhythmia in 2004. “What appeared now, in Barcelona, is another type of arrhythmia,” he told an Argentine radio station.

“I was talking to the doctor in Barcelona simultaneously while I was studying him. In medicine the risk is never zero. Being absolutely sure you don’t have other incidents is going to take a long time.”

“For now all the tests were normal, but we told Sergio we have to wait to undergo the high performance and he is already 33-years-old. It is not worth the risk. You made the right decision. If it was my son who had this, I would have told him not to play anymore.”

Peidró is confident there is no relationship between the former player’s condition and the coronavirus he contracted in January of this year. “Nothing to do with COVID-19 or the vaccine,” said Peidró

According to medical research, it is estimated between one to three of every 100,000 apparently healthy young athletes develop a sudden arrhythmia which causes their sudden death during exercise. Males are affected up to 10 times more often than females.

The same advice from Peidró was given by the doctor who treated Agüero in Barcelona, Josep Brugada, a standout in the field of world cardiology. In 1992 he discovered a heart disease causing sudden death called “Brugada syndrome”.

“When a person does highly competitive sports, with very high physical demands, the requirements to be sure everything is fine are higher,” he told La Vanguardia.

“The affected person can rebuild his normal life, but the return to competition, to hard training, requires an assurance this will not be repeated.”

“A person who has a normal life has a much faster recovery than one who has to put his heart to high demands.”

“With such a high physical demand, we must be careful and absolutely certain everything is fine and that makes it necessary for more time,” said Brugada.

The specialist recognized that in the case of people who have already suffered an arrhythmia, like Agüero, they should be more attentive.

Agüero underwent ablation of a supraventricular arrhythmia, a procedure in which, usually by puncturing veins from the groin, catheters are inserted into the heart to locate the focus of the arrhythmia and eliminate it.

Although the doctors and Agüero himself gave each other a period of three months, until February, the moderate effort tests to which he has been subjected advised him to end his career as a footballer

The first cardiac fatality of the season did not occur in football.

In February, the handball goalkeeper of the Portuguese club FC Porto, Alfredo Quintana, of Cuban origin, suffered a cardiorespiratory arrest while training. He died five days later. He was 32-years-old.

During Euro 2020, in the game between Finland and Denmark, the Danish and Inter Milan midfielder, Christian Eriksen was briefly dead of a heart attack until the medical team could revive him. At the hospital they placed an implantable cardioverter defibrillator (ICD) on him. The ICD is connected to the heart by wires and sends an electrical pulse to correct irregular rhythms.

According to La Gazzetta della Sport, his contract with Inter could be terminated soon as a result of the cardiac arrest.

Rules in Italy state that people with a defibrillator like Eriksen’s cannot play contact sports. But the 29-year-old could theoretically continue his career in another country with different rules.

Eriksen has yet to officially confirm his plans to return to professional football.

Among other footballers with defibrillators, Belgian defender Anthony van Loo, retired in 2018 at the age of 30. Former Arsenal midfielder Fabrice Muamba, whose heart stopped for 78 minutes, said goodbye to football five months later without ever having stepped on the pitch again. However, he did play 15 minutes in the 2015 tribute match to Jamaican Ian Goodison.

Striker Daniel Engelbrecht from Stuttgarter Kickers in Germany collapsed on the pitch against Erfurt but returned to professional play at age 24, 17 months after his incident, against the advice of numerous doctors.

He scored against Wehen Wiesbaden, and became the first footballer to score with a defibrillator. He retired in 2018 to become a coach when he discovered the device had brought him back to life three times.

Daley Blind of Ajax in Holland received a pacemaker when arrhythmia was detected after complaining of dizziness in a Champions League game in December 2019. He fainted during a friendly in August 2020, but has continued to play top level football.

Football has been one of the sports in which the most cases of players who have suffered heart failure have been recorded, but it is also the sport which receives the most attention.

Abdelhak Nouri, a player from the Netherlands of Moroccan origin, in an Ajax friendly match against Werder Bremen on July 8, 2017, collapsed. Although they were able to revive him, the 20-year-old athlete was left with serious and irreversible brain damage.

Nigerian Nwankwo Kanu was close to retirement at age 20, when Inter Milan bought him from Ajax and discovered he suffered from aortic valve insufficiency, which could be successfully operated on. He continued his career with Inter and Arsenal for many seasons.

Goalkeeper Iker Casillas won everything with Real Madrid and the Spanish national team, including two European Cups and the FIFA World Cup in 2010. After leaving Real, he finished his career at Porto where he suffered a heart attack during training on May 1, 2019.

The goalkeeper had to undergo urgent surgery and never again competed as a professional. A year later he announced his retirement as a footballer.

Defender Liliam Thuram, world champion with France in 1998, played for top level clubs Monaco, Parma, Juventus and Barcelona. After leaving the Catalan team in 2008, he tried to sign with Paris Saint Germain, where he hoped to close his career, but in medical examinations they discovered a heart malformation, which accelerated his retirement.

Other victims died on the playing field, including Marc-Vivien Foe from Cameroon. He died in June 2003 during the semifinal against Colombia in the FIFA Confederations Cup. The Nigerian Samuel Okwaraji was the first known case of an African footballer to die on the pitch, which occurred in 1989 during a World Cup qualifying match in Lagos between Nigeria and Angola.

Romanian Catalin Hildan died of a heart attack in a friendly match between Dinamo Bucharest and FC Oltenița in 2000; Hungarian Miklos Feher lost his life in 2004 due to a cardiac arrhythmia in a Benfica game against Vitória de Guimaraes; Italian Piermario Morosini died in 2012 of a heart attack during the game between Livorno and Pescara of the second division of Italy.

The record also shows, in various sports, athletes who managed to thrive despite the condition.

Major League Baseball’s Los Angeles Dodgers pitcher Kenley Jansen underwent corrective heart surgery in November 2018, the second since 2012, after being diagnosed with atrial fibrillation in 2011. He is a three-time All Star and World Series champion.

Dana Vollmer, a swimmer from the United States, underwent heart surgery in 2003 for supraventricular tachycardia. She kept swimming, won five Olympic gold medals and set world records, but needed to have a defibrillator nearby as a precaution while competing or training. She was the first woman to beat 56 seconds in the 100 butterfly event.

Javier Gomez Noya, the first Spanish Olympic triathlon medalist who won a silver medal in London 2012, and is a five-time world champion, suffers from congenital aortic valve disease, a serious heart problem, but that has not kept him from competing.

In April 2021, veteran Brooklyn Nets center LaMarcus Aldridge, a seven-time National Basketball Association All-Star, suddenly announced his retirement from the game, after 15 seasons, after feeling an irregular heartbeat during his final game.

Aldridge had had other heart problems in the past. In 2007, during his debut with the Portland Trail Blazers, he was diagnosed with Wolff-Parkinson-White syndrome, which can cause a racing heartbeat, and missed the final stretch of the season after undergoing minor surgery to correct the problem.

Arthur Ashe had to quit tennis after suffering a heart attack at the age of 38 in 1979. He was the first African-American player to win three Grand Slams: Wimbledon, United States Open and the Australian Open.

After the Agüero case, which occurred on October 30 in the Spanish League, Adama Traoré, a 26-year-old forward for Sheriff Tiraspol, had to leave the field during the game against Real Madrid at the end of November. He had not received a blow, but he put his hand to his chest and lay down on the pitch. He was out for a week, but has returned to play with apparent normality.

Recently the Swede Victor Lindelof from Manchester United and the Pole Piotr Zielinski from Naples pointed to their chests and left the field of play. They have been passing tests every day, and no problems have been detected.

The early retirement of Sergio Agüero has once again stirred up the debate on the table of cardiovascular diseases and the practice of high-performance sports, now with the unforeseen addition of COVID-19.