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SINGAPORE - The bodybuilder who died in a celebrity Muay Thai match with YouTube personality Steven Lim had two preexisting congenital heart conditions which had heightened his risk of cardiac arrest, a Coroner’s Court heard on Monday (30 December).
The court heard that Pradip Subramaniam already had two heart conditions, cardiomegaly and cardiac channelopathy, prior to engaging in the bout at the inaugural Asia Fighting Championship (AFC) card held at Marina Bay Sands on 23 September 2017.
The 32-year-old president of the World Bodybuilding & Physique Sports Federation died of cardiac arrest at the Singapore General Hospital at 9pm after earlier losing the bout to Lim. He sat slumped in the ring after the match and was helped off the stage into an ambulance.
Four witnesses testified on the second day of the Coroner’s Inquiry. They included a cardiologist who stated that Pradip’s heart conditions, discovered posthumously through his autopsy report, would have rendered him ineligible for such competitions if they had been known.
Present at the hearing were Pradip’s family members, who were represented by lawyers Sunil Sudheesan and Diana Ngiam.
Pradip replaced former Singapore Idol contestant Sylvester Sim, who had pulled out from the fight the day before due to insurance issues. It was announced on the same day that Pradip, who had only trained some three to five months before the competition, would take Sim’s place.
“A bad heart”
Senior Consultant and Adjunct Associate Professor Tong Khim Leng, who had prepared an independent expert report, highlighted that Pradip had two underlying heart conditions in his autopsy report which would have predisposed him to a high risk of cardiac arrest.
Pradip suffers from cardiomegaly, an enlarged heart, and cardiac channelopathy, which may predispose him to heart rhythm abnormalities. Pradip had a mutant variant of a gene associated with a condition known as Long QT syndrome 1, which can cause rapid irregular heartbeats and may result in sudden death.
"We know that Long QT Syndrome 1 is triggered by severe exertion and emotion,” said Dr Tong, who added there was a lot of tension on Pradip. The extreme situation and adrenaline surge could have contributed in triggering the cardiac arrest, she said.
“We know that if someone has been training habitually, his risk of sudden cardiac arrest is reduced compared to someone which hasn’t been training at all. But the risk is not zero. Particularly if you already have an underlying cardiac (condition),” said Dr Tong, who specialises in cardiology.
While Pradip did fill in a questionnaire and undergo a basic health checkup before the match, he had not done any tests that could have detected his heart conditions, which are inherited.
Asked by Sunil if Pradip could have possibly survived if oxygen was provided early, Dr Tong said, “I looked at the autopsy report, it’s really a bad heart. He has two cardiac conditions working against him. So, just looking at the autopsy, chances of survival was extremely poor, even if oxygen was provided immediately. Two extra minutes of oxygen - I honestly think is not going to change this survival, his outcome.”
While giving oxygen would help mitigate the deprivation of oxygen to the tissue, no amount of oxygen would revive the heart once it gave way, she said.
Sports safety code of practice in the works
Two paramedics who attended to Pradip also testified to administering oxygen to Pradip after he collapsed onstage. However Sunil said that his client, Pradip’s father, had not seen any oxygen mask placed on his son.
After Lim was presented with the title belt by AFC, Pradip seemed visibly weaker and dropped to the floor, a paramedic testified. Pradip was still conscious when brought to the ambulance but seemed to weaken, he added.
Another witness, co-chair of the Sports Safety Committee Benedict Tan, said that the committee had reviewed the overall safety framework in sports and recommended in its March 2019 report that athletes must be able to recognise warning symptoms of sudden cardiac arrest and respond to it accordingly.
Athletes with family history of premature heart diseases or hereditary cardiac conditions should also seek clearance before taking part in sports or competitions, said Adjunct Associate Professor Tan, who is also chief and senior consultant at the Department of Sport and Exercise Medicine at Changi General Hospital.
An edition of the report is expected to be upgraded into a code of practice which will be applicable to all sports events in Singapore. While the report currently acts as a guideline and is not prescriptive, it will be a “stronger statement” once it is adopted as a code of practice, said Dr Tan.
State Coroner Kamala Ponnampalam has fixed for the evidence to be reviewed on 13 January, with findings to be delivered at a later date.