Issue 222

October 2025

Figure out how your fighting your heart works by following the medical advice from Dr Asoka Wijayawickrama, who is a cage-side medic and jiu-jitsu black belt who contributes to the medical charity Safe MMA.

You’re used to pushing through pain, grinding through exhaustion, and thriving under pressure. But even elite fighters aren’t invincible when it comes to the heart. Chest pain, palpitations, or fainting in training isn’t just fatigue. It can sometimes signal life-threatening cardiac conditions. Dr. Asoka Wijayawickrama, GP Partner, Imperial College tutor, Brazilian Jiu-Jitsu black belt, and cageside medic for Cage Warriors, has a unique perspective from the intersection of fight sport and medicine. “We see chest pain across all age groups,” he explains. “While most cases in younger people aren’t dangerous, cardiac conditions can affect fighters, and early recognition is crucial.”

FIGHTING FIT, BUT NOT INVINCIBLE

Many fighters shrug off chest tightness or shortness of breath as “just pushing hard.” Yet high-profile cases prove the real risks. Dan Hardy famously had his MMA career cut short by Wolff-Parkinson-White syndrome, an electrical heart condition. Meanwhile, although sudden cardiac death (SCD) is rare, estimated at roughly 1 in 50,000 athletes under 35, the consequences are catastrophic and make headlines. Long QT syndrome is one potentially fatal condition that caused a cardiac arrest for Bellator fighter Cris Lencioni in 2023 during training, sending him into intensive care. It also provided the underlying cause of death for UFC heavyweight Shane Del Rosario in 2013.  

“The numbers might seem small, with black athletes and those in explosive, stop–start sports appearing to be more prone,” Dr. Asoka explains, “but most of these conditions can be detected early, and interventions can reduce the risks significantly.”

Indeed, while citing Rosario’s use of recreational drugs in FightMD.com, cardiologist and Associate Professor Dr. Sabe De drew attention to Rosario’s underlying heart issues as the key but fully detectable denominator. Dr. De categorizes the main potential heart issues pertaining to fighters as:

·               Coronary artery disease, which is a blockage or an anomaly in blood vessels, and is most common in athletes over 35.  

·               Structural heart disease, which is often congenital, affecting heart pumping, valves, or thickness, with Hypertrophic cardiomyopathy (HCM) being the most common cause of cardiac death in younger athletes

·               Arrhythmias, which are electrical disturbances such as Long QT syndrome, Wolff-Parkinson-White, or Brugada’s syndrome, can trigger fatal rhythm problems.

MMA-SPECIFIC HEART RISKS

MMA brings unique stressors to your cardiovascular system. The sport combines explosive bursts with sustained, high-intensity exertion. Grappling, striking, and wrestling involve intense static contractions and dynamic cardiovascular demands, significantly increasing heart rate and cardiac output. Performance-enhancing drugs (PEDs) add another layer of risk. “Anabolic steroids, testosterone, and other PEDs raise blood pressure, thicken the heart, and negatively affect cholesterol levels,” Dr. De explains. Rapid weight cutting, common in MMA worldwide, creates dehydration and electrolyte imbalances that can trigger life-threatening arrhythmias. Stress-related hypothermia during extreme cuts can also be fatal, even in otherwise healthy hearts. For fighters with pre-existing conditions, such as hypertrophic cardiomyopathy, ARVD, Marfan syndrome, or Long QT syndrome, these risks are magnified. “Those athletes should avoid MMA entirely,” Dr. De warns.

The COVID-19 pandemic has added another challenge. Long COVID can lead to cardiac complications such as myocarditis, clots, and heart failure. Fighters with prior COVID infection may be at higher risk, particularly young men under 30. Symptoms include chest pain, fatigue, and breathlessness. Women are over 50% more likely to develop long COVID, and pre-existing conditions like asthma, diabetes, or anxiety increase that risk.

CHEST PAIN: WHEN TO WORRY

Not all chest pain in fighters is cardiac in origin. Common culprits include things like musculoskeletal injuries, such as Costochondritis, rib bruising, or overuse injuries from heavy bag work and grappling, and Gastroesophageal reflux (GERD), where acid reflux can mimic cardiac pain, especially after intense training. However, certain symptoms demand immediate attention: Chest pain during exertion, palpitations or irregular heartbeat, fainting or collapse, turning blue, or experiencing shortness of breath

“If you notice any of these during training, stop immediately and seek medical advice,” Dr. Asoka stresses. Sharp, localised pain that worsens with pressure is usually musculoskeletal and less concerning, but exertional symptoms are red flags.

SCREENING: GLOBAL PRACTICES

Many US state athletic commissions, including Nevada, require ECG tests as part of pre-fight medical clearance for professional athletes, and promotions such as UFC and ONE Championship follow similar protocols worldwide. These tests help ensure a fighter’s heart is fit for competition and form part of annual medical evaluations. UK-based medical charity Safe MMA requires heart rate and blood pressure checks, a cardiovascular exam (heart sounds, apex beat position, murmurs), and a detailed family and medical history during its annual fighter medical examinations. 

According to Dr. De, interpreting athlete ECGs can be tricky, however, because intense training can mimic abnormalities, there are medical guidelines that can help differentiate normal training adaptations from true pathology. Ultimately, Dr. Asoka notes, “Early detection is everything. An ECG and echocardiogram together can identify most high-risk conditions for sudden cardiac death.” He adds that family history, particularly sudden death under age 50, is a key factor in deciding whether further cardiac evaluation is necessary.

PREVENTION: WHAT FIGHTERS CAN DO

Prevention is always the best medicine, and these steps include:

·                Avoiding PEDs, extreme supplements, and drastic weight cuts. 

·                Seeking prompt medical attention for unusual chest pain or palpitations.

·                Following pre-fight screening protocols, including ECG and echocardiography.

·                Ensuring AEDs are available at gyms and competitions.

Dr. Asoka advises fighters recovering from myocarditis, post-COVID, to refrain from significant physical activity for at least three months. “This rest period greatly reduces the risk of long-term cardiac complications,” he explains. “Competitions worldwide should prioritise safety,” Dr. De stresses. “While MMA is generally heart-safe and serious complications are rare, high-profile cases show why thorough screening and safe training practices are essential.”

Many fighters underestimate the threat. 

“People think heart disease only happens to older people,” Dr. Asoka notes. “That’s not always true.” Yet there’s also a balance: over-caution can jeopardize a fighter’s livelihood, while ignoring warning signs can be deadly.

LISTEN TO YOUR BODY

Fighters are wired to grind through pain, but when it comes to health, true strength includes knowing when to stop. “If something feels wrong, it’s better to take one day off now than risk everything later,” Dr. Asoka advises. Early recognition, proper screening, and preventive practices can save a career and a life. Your heart is what keeps you in the fight, inside the cage, and for life. Paying attention to warning signs, getting the right tests, and taking preventive measures aren’t weaknesses - they’re essential for a long, healthy MMA career.