DAVID MOYES has revealed that Sunderland defender Patrick van Aanholt was left out of Sunday’s defeat at Tottenham because of a “cardiological issue”.

The Football Association’s Cardiology Consensus Panel got in touch with Sunderland officials around 35 minutes before kick-off at White Hart Lane to discuss the details of some heart tests conducted on van Aanholt last Tuesday.

The FA did not demand that van Aanholt was withdrawn from Sunderland’s starting line-up, but after a discussion with members of his coaching and medical team, Moyes decided to take the Dutchman out of his side.

Van Aanholt will travel to London with the rest of the Sunderland squad ahead of tomorrow’s EFL Cup third-round game with QPR, although it is not yet clear whether he will be involved at Loftus Road.

Moyes said:  “He had statutory checks with the cardiologist and an FA panel looked at it and advised us really late on Sunday that he should not play until further tests had taken place.

“We are just surprised the FA panel did not contact me or the club doctor until five to four on Sunday afternoon. It put us in a really difficult situation. I’ve never in my career been put in a situation like that. We had all that to deal with.

“We just cannot understand why the message would come to us at that time, 30 minutes before kick-off. He has had some further tests and will travel to London today.”

Van Aanholt, who had started all of Sunderland’s previous league games, underwent additional tests yesterday, but at this stage, Moyes does not want to expand on the exact nature of his problem.

The Sunderland boss has also revealed that Jermain Defoe will not be involved in tomorrow’s cup game as he is recovering from a kick to the calf sustained during Sunday’s defeat to Spurs.

With Victor Anichebe still not fit enough to make a first-team appearance, Joel Asoro will be the only striker in the Black Cats' squad, although Duncan Watmore could also be used in an attacking position.

The Van Aanholt issue is the latest difficult situation Moyes has been forced to handle since taking over at the Stadium of Light, and the Sunderland boss said: “I think all managers would say, what everybody turns up and sees on the pitch in terms of watching the football, they do not understand what is happening behind the scenes.

“Whether it is players or agents, the life of being involved in football is much more than just 90 minutes on Saturday.”