Trigger, yes, cause, no: update in Casillas v FC Porto case | OneFootball

During the second session of the trial underway at the Porto Labour Court, Natália António, then an expert appointed by the Medico-Legal Council — the executive body of the National Institute of Legal Medicine and Forensic Sciences — argued that the physical exercise carried out by Casillas during a training session in May 2019 was intense enough to act as a precipitating factor in the rupture of an atherosclerotic plaque (a build-up of fat and cholesterol), but rejected the idea that it was the main cause of the heart attack.

“The level of intensity is a ‘trigger’, but not the cause. The underlying cause is coronary arteriosclerosis disease [build-up of fatty plaques],” said the current Clinical Director for Hospital Care at the Coimbra Local Health Unit (ULS), adding that “the plaque could also have ruptured during recovery.”

According to the specialist, around 10% of myocardial infarctions may occur in the context of physical exercise, although the prior presence of coronary atherosclerosis is decisive for the onset of the cardiac event.

Questioned by lawyer for the insurer Fidelidade, the doctor admitted that if Casillas had not suffered the heart attack that morning, he might have had it “the previous day, at rest, even without physical exercise.”

“If there is dyslipidemia [high cholesterol levels], it means there was a likelihood that the disease would continue to progress and manifest itself even without physical exercise. Most cases happen at night, during rest,” she said.

The expert also explained that it is not possible to establish an immediate relationship between the exertion and the rupture of the plaque, admitting that there may be a time interval between the two.

“Physical exercise can act as a trigger, but it may not have an instantaneous effect. It can happen when the person is already recovering,” she said.

At the first session of the trial, held on June 8, Casillas said he began to feel unwell during an FC Porto training session, describing chest pain, difficulty breathing and intense fatigue, before being taken to hospital, where he underwent catheterization to clear a coronary artery.

According to the former Spain international, the heart attack brought his professional career to an end and left him with permanent limitations. “I can’t run, I can manage some 20 or 50 metres. No more than that,” he said in court at the time.

Today, when confronted with Casillas’s description of the training session, the cardiologist considered that the set of exercises performed, although routine, involved an increase in heart rate and that, in a patient with coronary disease, it could function as a triggering factor.

“There doesn’t have to be a temporal coincidence. There may be a delay between physical exercise and the rupture of the plaque,” she reiterated.

Asked by the judge about symptoms recorded in a hospital clinical report relating to the day of the heart attack — which allegedly occurred the day before, but which Casillas denies — the expert said they are compatible with a case of angina and already indicate “some vulnerability of the plaque.”

Even if those earlier symptoms had not existed, she added, the conclusions would remain unchanged, stressing that physical exercise may have acted as a “trigger”, “but the underlying disease, which progresses slowly, already existed,” she said.

For Natália António, the exertion “doesn’t even have to be intense” to function as a trigger, a position that contradicts that of the president of the Medico-Legal Council, who signed the expert report and who, according to the judge, validated it on the grounds that the exercise would only be a trigger if it exceeded the usual level.

The expert also explained that after the heart attack, Casillas went from being in a low cardiovascular risk situation to one of very high risk, and believes he does not meet the conditions to return to elite competition.

“I would say no, because he went from low cardiovascular risk to very high risk,” she replied when asked by Iker Casillas’s lawyer about the possibility of the former goalkeeper returning to compete at the highest level.

The specialist said the disease entails an increased risk of arrhythmias and a higher risk of sudden death, in addition to functional limitation.

In the case, which has dragged on since October 2021, Casillas is claiming around €3.7 million from insurer Fidelidade and FC Porto for inability to work resulting from the heart attack he suffered during a training session with the ‘Dragons’.

The insurer and the club argue that it has not been proven that the physical effort made in training was the cause of the cardiac episode. Fidelidade has already paid €1.5 million, corresponding to the maximum annual limit provided for workplace accidents, while FC Porto says it paid more than €1 million in wages during the period in which the player was inactive.

This article was translated into English by Artificial Intelligence. You can read the original version in 🇵🇹 here.