The headlines blare that New Orleans Saints defensive tackle Nick Fairley has a career-threatening heart condition.

A medical issue involving the heart sounds worrisome, but there are many benign conditions that can be treated or dealt with.

Although I haven’t examined Fairley, I am optimistic he will be fine to safely continue playing.

Years ago when I was a team physician for the Chargers, a big free agent signing (name purposely withheld for privacy/HIPAA) passed out before a preseason game due to a heart condition. We were playing in an overseas game and he was rushed for care and full cardiac work-up. With the help of my primary care team doctors and cardiologist, the player was treated with no meaningful games missed. In fact, the public never even knew about the issue.


With today’s media scrutiny and social media, very little goes unnoticed. Just because the heart evaluation has become public, that doesn’t mean Fairley’s cardiac condition is worrisome. He and the Saints are smart to get a full work-up.

Without having seen Fairley’s records, the two main possibilities are an arrhythmia (abnormal heartbeat) or myopathy (heart muscle abnormality. The most likely possibility is a hypertrophic (enlarged heart) over a dilated (expanded/weakened) myopathy. Doctors are very aware to avoid a “Len Bias” type sudden death. The markers are set very low to detect even potential mild cases as the goal is to prevent every sudden death.

A couple players a year are caught with this low threshold level screening. Star Lotulelei was famously ruled out of working out at NFL scouting Combine in 2013 but has had no issue in his career with the Panthers. Players are followed with yearly echocardiograms. Most likely, Farley had some questionable enlargement and is undergoing further workup for safety and will be ultimately cleared for football.

There are certain injuries that team doctors simply document. For others, players are downgraded medically. If there was any serious potential heart issue that involved even a one percent chance of catastrophe, Farley would have been ruled out long ago.


There is an entire field of study on the athlete’s heart and sudden death syndrome. A degenerative knee is something teams might take a chance on a player; however, if there is a serious condition and risk of a disastrous outcome like paralysis from a neck issue or sudden death, even the most minimal increase in risk is not tolerated.

The current secrecy with Fairley is somewhat worrisome. However, given that it is the offseason, clubs have no duty to disclose any injury or medical information. Perhaps there is no increase of cardiac myopathy at all and the Saints are just being careful given his new four-year, $30million contract. There is also the outside possibility of buyer’s remorse from team management.

Fairley was detected to have a heart condition at the Combine in 2011. He was projected to possibly be a first overall pick, but after his measurables was downgraded slightly and ended up being selected by Detroit with the 13th pick in ‘11. Perhaps the heart issue played a small role in the slight fall. Perhaps not.

Since then he has undergone yearly physicals with the Lions and then passed a physical with the Rams in 2015 and Saints in 2016. Multiple doctors were aware of the heart issue detected at the Combine and would be careful to follow up.


This is Fairley’s second year with New Orleans. Certainly, he had a full physical before signing. He played with the condition at Auburn and then for six NFL seasons without issue while other orthopedic ailments have landed him on injured reserve. Perhaps something changed with his annual team physical, or it is possible his previously detected heart condition has changed or worsened.

The hope and expectation is that the additional tests are all precautionary. Chances are excellent that Fairley’s career is not over and the headlines are overstated.

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