Almost 24 hours after the terrible discomfort of Edoardo Bove, during the definitively interrupted meeting between Fiorentina and Inter Milan on the pitch of the Artemio – Franchi Stadium, the first unfortunate questions were asked in the Italian press. If the first news from the Careggi hospital is positive, fortunately, the rehabilitation will be long and above all cautious, because as in all sports, heart defects are taken very seriously. In the 17th minute of the match, Edoardo Bove, who had just changed his jersey after a blow and indicated to his staff that he was not feeling well, bent down to tie his shoelaces, before getting up, doing a few steps then collapse unconscious on the lawn. It was Inter Milan players Denzel Dumfries and Hakan Çalhanoğlu who were the first to alert doctors and referees, providing emergency medical treatment to Bove. The two Nerazzurri players were joined by Robin Gosens and Danilo Cataldi. The latter put his teammate in a side safety position before sticking his tongue out to prevent him from choking. Transported to hospital, Edoardo Bove had a good night’s sleep and even spoke his first words.
After public remarks by the governor of Tuscany Eugenio Giani and the mayor of Florence Sara Funaro, Fiorentina wrote a long missive to reassure fans, journalists and the world of Italian football in general: “ACF Fiorentina announces that Edoardo Bove, after spending a quiet night, was awakened and extubated this morning. He is currently awake, alert and oriented. He spoke with the family, the Viola management, the coach and his teammates who rushed to see him as soon as they received the good news. In the coming days, more in-depth investigations will be carried out to establish the causes that led to the critical situation that occurred yesterday. From Careggi, doctors treating the footballer confirm that diagnostic investigations continue», Declared the Tuscan club in an official press release published this Monday midday. Emotions aside, one question is on everyone’s minds: could Edoardo Bove, Italian football prodigy and executive of his country’s Espoirs, play football again? And if so, could he stay in Serie A in a country that has been very tough on heart problems in the past?
Italy, a very strict country
Head of the clinical cardiology and sports cardiology unit at the Galeazzi hospital in Milan, Doctor Daniele Andreini answered questions from the Gazzetta dello Sport and analyzed the discomfort of Edouardo Bove and the risks for the health and career of the player in the months to come: “It appears to be a classic cardiac arrest. In 99% of cases, it is a cardiac arrhythmia. He was resuscitated and given cardiac massage. We cannot exclude that the heart restarted with the massage and then had to use the defibrillator, in an ambulance or in the hospital. If there is an underlying cause, the arrhythmia passes, but can then return. It’s too early to tell. If it is a defibrillated cardiac arrest, whatever the cause, a return to competition is difficult. But it is premature to talk about it. The arrhythmia cannot be detected in advance. Sometimes, however, the triggering cause can be intercepted. There are arrhythmias, even malignant ones, that can occur in structurally healthy hearts. These are situations that are only visible on the electrocardiogram“, he said. Italy is a country with very strict medical regulations, especially when it comes to heart problems. As a reminder, Christian Eriksen, then an Inter player, was not allowed to play football again with a defibrillator. And RC Lens defender Kevin Danso saw his transfer to AS Roma aborted last summer due to a slight heart problem. The same goes for Tiago Djaló, also having a medical check-up with the Giallorossi. Italy has a particular system, unique in the world, which requires by law a certificate of fitness for those who train and compete with a federation or body recognized by the Italian National Olympic Committee (CONI). .
Two ministerial decrees, adopted in 1982 and 1983, regulate the mandatory protocol to which those who practice competitive physical activity in Italy must submit. For most disciplines, medical history, clinical examination, electrocardiography (ECG) at rest and during exercise, spirometry (a test for measuring breathing), and urinalysis are required on on an annual basis. Depending on the activity, controls and validity period may vary. The certificate is specific to the discipline practiced and each Federation determines the minimum and maximum age for competitive activity. The sports doctor is the competent specialist in the matter, responsible for carrying out the examinations and issuing the judgment of fitness. The player’s club is then responsible for checking that all members have a valid certificate for health protection, acting as screening from an early age, leading to a reduction in sudden deaths on the pitch. Italian football is still traumatized by the death of Davide Astori, Fiorentina player and Italian international who died suddenly on March 4, 2018. Sports fitness visits have contributed to the development of a branch of medicine called: heart cardiology. sport. Over the years, knowledge of previously unknown pathologies or those relating to early diagnosis and possible therapies has increased. The ECG of those who play sports may show certain changes that the sports doctor recognizes as benign and related to training.
Other types of ECG changes may instead represent an expression of underlying heart disease and are then investigated with second-tier testing. Most cardiovascular diseases responsible for sudden death in young athletes are clinically silent and rarely suspected or diagnosed on the basis of symptoms. And now ? Edoardo Bove, conscious and awake, will undergo new batteries of medical examinations. For Doctor Daniele Andreini, the next results will be decisive: “Careggi is a cutting-edge cardiology center: the most in-depth examinations will be carried out, such as magnetic resonance imaging of the heart, if necessary a coronary CT scan, to make a diagnosis of both cardiomyopathy and coronary artery. Or even for myocarditis which may be linked to a previous infectious event. In the vast majority of cases, the tests reveal what the problem was, whether it was a scar in the heart, a buildup of fat, an abnormal coronary artery. If everything is negative, they will do a thorough study of heart activity. Professional athletes, thanks to their ability, rarely go undiagnosed. For professional athletes, the most common causes of sudden death are either cardiomyopathy, a genetic predisposition disease or a congenital abnormality of the coronary arteries, which are difficult to diagnose.“. While awaiting the results of his new exams, Edoardo Bove therefore sees his future uncertain…
