Protecting Children from Sudden Cardiac Death

Over the past month my Google alert set for “Cardiac Arrest - Athlete” has informed me of six incidents involving young athletes dying during or shortly after physical activity. This is a typical month, perhaps even a little on the low side. Bear in mind that these diseases claim many more lives in non-athletic settings, we tend to only hear about the athletes because their deaths are so public. Dr. Andrew Krahn’s research showed two young person sudden cardiac deaths where physical activity was not a factor for every one where activity was noted.

Sudden Cardiac Arrest (SCA) is relatively rare in children but it does claim the lives of nearly 600 young Canadians each year. Most of these deaths occur in children that have an underlying heart rhythm disorder. Heart rhythm disorder is not one disease, but rather a group of diseases. Some diseases, such as Hypertrophic Cardiomyopathy (HCM), affect the muscle structure of the heart while others such as Long QT Syndrome, affect the heart’s electrical system. All heart rhythm disorders leave the child more prone to cardiac arrest and sudden cardiac death.

Many heart rhythm diseases are inherited or genetic. If your family has a history of unexplained early death, that is a warning sign. Look back several generations for deaths of relatives younger than age 35.  If you or your spouse had a history of fainting when you were younger, that is also a warning sign.

It is reported that 1 in 500 children worldwide are affected by a type of heart rhythm disorder.  What does that mean? It means that in a typical high school, there are two or three otherwise healthy kids living with a potentially lethal heart rhythm disorder. The majority of individuals and families are unaware of their condition.

For half of the children that die from these diseases the first warning sign is death, but for the other half there could be other warning signs that occur in the days, weeks or months prior to the cardiac arrest. The most common and easy to recognize warning sign is fainting. The majority of childhood fainting spells are innocent; however, fainting can be a warning sign of an underlying heart rhythm disorder.

Fainting as a Warning Sign

Be most aware of;

·        those that occur during or shortly after intense physical activity

·        those triggered by emotional distress or auditory startle

·        multiple fainting episodes

·        a child with both a personal and family history of fainting

Other Warning Signs:

·        Palpitations or feeling a “racy” heart

·        (New) Extreme shortness of breath during activity

·        Brownouts and/or dizzy spells

If your child has experienced any one of these symptoms, you should visit your doctor or paediatrician. Also, if there are others in your family who died at an early age for unexplained reasons, you should seek advice from a physician that specializes in heart rhythm disorders. Diagnosing these diseases begins with a complete event history of the fainting episode, a detailed patient medical history and a detailed family medical history. Typically two non-invasive tests, ECG and Echocardiogram, are ordered and often result in a definitive diagnosis. Less frequently further testing such as Stress ECG, Cardiac MRI and Genetic Testing are required.

Two very positive things happen if your child is diagnosed with a heart rhythm disorder:

1.      There are a number of therapies which are highly effective at reducing your child’s risk of sudden cardiac arrest. These include surgical options, implantable devices such as pacemakers and ICD’s, pharmaceutical therapy and life style modification. Many patients get excellent protection from cardiac arrest by simply taking a low dose beta blocker. Once on a treatment plan most children can reasonably expect to live long, healthy and productive lives.

2.      Often one diagnosis leads to several family members being diagnosed. When one member of your family is diagnosed doctors will begin testing other family members including siblings, parents, grandparents, aunts, uncles and cousins. Again the good news is that these relatives will also begin treatment that will reduce their risk of cardiac arrest.

Sudden cardiac arrest in young people is a rare occurrence but knowing and responding to the warning signs has the potential to save hundreds of young lives each year. Children that are being treated for a heart rhythm disorder should live long and healthy lives.

When children faint, see a Doctor.