Mitchell Cohen, MD, FACC, FHRS, is a board-certified pediatric cardiologist specializing in pediatric arrhythmias, electrophysiology and hereditary causes of sudden cardiac death in children, adolescents and sometimes their parents. He is the co-director of the Children’s Heart Program and director of Pediatric Electrophysiology at Inova Children’s Hospital.
The horror stories pop up every so often in the news: A previously healthy, active child dies suddenly on the athletic field or in their sleep from a cardiac arrest. The tragedy is often the result of an undiagnosed heart problem. While many children are saved with an automated external defibrillator (AED), not all children are so fortunate.
Sudden cardiac arrest occurs when a person’s heart suddenly stops working. It can lead to death within minutes. Fortunately, this event isn’t very common in young people. However, when it does happen, it’s devastating to friends, family members, the school and the entire community.
Sometimes there are no clues or warning signs to suggest a child is at risk of a sudden life-threatening cardiac event. But often, if we investigate their clinical history, we identify red flags that might have helped prevent the tragedy.
Here’s what we know about sudden cardiac death – and the potential warning signs we should all be aware of.
Heart Health Clues
Most children and adolescents who experience sudden cardiac arrest have underlying heart disease. That disease falls into one of two categories:
- Electrical disturbances (arrhythmias), which cause the heart to beat too quickly, too slowly or in an irregular way.
- Structural problems (congenital heart disease or cardiomyopathies), such as an unrecognized heart defect or a thickening or dilation of the heart muscle (myocardium).
Many of these heart problems are inherited, so knowing your family history is extremely important. Sometimes physical symptoms also provide clues.
Is your child at risk? Here are some potential warning signs that should be evaluated by a cardiologist with experience evaluating children at risk for sudden cardiac death.
- Fainting with exercise
- Chest pain with exercise
- Palpitations (a fluttering heartbeat) with exercise
- Unexplained seizures
- Unexplained fainting episodes
- Fainting in the midst of a fever
Having a close family member with any of the following conditions is also a risk factor:
- Sudden death under age 40, including death from sudden infant death syndrome (SIDS or crib death)
- Unexplained fainting or seizure episodes
- Death from an unexplained car accident or drowning
- Long QT syndrome (LQTS)
- Brugada syndrome
- Arrhythmogenic right ventricular dysplasia (ARVD)
- Catecholaminergic polymorphic ventricular tachycardia (CPVT)
- Hypertrophic cardiomyopathy
Awareness and Action
If any of the risk factors sound familiar, it’s extremely important to have your child evaluated by a pediatric cardiologist. We may use noninvasive tests such as echocardiograms, electrocardiograms (ECG or EKG) and cardiac stress tests to evaluate a patient for cardiac problems. Sometimes we can use genetic testing to look for hereditary abnormalities that are associated with heart disease.
Many heart problems can be treated and managed – but only if we know they exist. Our goal is to help kids get back to being kids and participate in the activities they love.
Research shows that only about 25 percent of sudden cardiac death cases in youth occur while playing sports. It is important that an expert evaluate any child with risk factors, whether or not he or she is an athlete.
Unfortunately, we’ll probably never be able to prevent 100 percent of sudden cardiac arrest cases. That’s why it’s also critical that we have AEDs in as many public places as possible. I also advocate for more CPR training for adolescents and adults. Someday, I hope CPR training will become mandatory for all sports captains and all high school graduates.
Above all, though, the most important thing we can do to prevent sudden cardiac death is to pay attention to the warning signs. Don’t dismiss them as a fluke, or say you’ll check it out if it happens again. When it comes to a child’s heart, it’s always better to be safe than sorry.
Learn more about the nationally recognized Children’s Heart Program at Inova Children’s Hospital.