Two Cost Comparison’s for Cardiac Arrest Prevention Programs

 

Brock Reuther died as a result of a sudden cardiac arrest experienced while playing volleyball at his Alberta High School in May of 2012. Since that day Brock’s mom Kim has been advocating for programs to prevent other families from experiencing the pain the Reuther’s have gone through and it has been, to say the least, an uphill battle.     http://projectbrock.com/

I was speaking with Kim this week and shared with her two comparators that I often use when speaking about preventing sudden cardiac arrest in youth. She asked if I could send them to her in writing so here they are.

The HPV (Gardasil™) Vaccine vs. ECG Screening for Heart Arrhythmia

In August of 2007 the Government of Ontario announced it would spend $39 million to provide every Grade 8 girl in the province with the vaccine for Human Papillomavirus (HPV) which is known to be a cause of many cervical cancers. That works out to a little over $400.00 per child. Cervical cancer claims the lives of 150 women of all ages in Ontario each year and is the second most common type of cancer in women between ages 22 and 44.  This is an expensive but worthwhile prevention program that will assuredly save young lives.

For many years patient advocate groups in Canada have been seeking funding and support for a pilot study into ECG screening of young teens. Many advocates would like to see the screening process include Echocardiogram as well. Published studies show that ECG alone can be over 80% effective at identifying children at-risk for sudden cardiac arrest and when Echo is added screening will identify over 90% of those at-risk.  The tests are non or minimally invasive and very inexpensive. The Ontario Health Insurance Plan billing code for an ECG to be acquired and read by a physician is $11.05. A targeted Echo is a little more expensive at $33.50.  For 10% of the cost of an HPV vaccine we could protect all young people from a far more prevalent and preventable cause of death – Sudden Cardiac Arrest.

A $250,000 grant would easily fund a pilot study that could gather, study, analyze, weigh the values and publish the results of screening tests for over 5,000 youngsters. Every year 700 young people die suddenly of cardiac causes in Canada - 200 in Ontario, 65 in British Columbia, 60 in Alberta, etcetera.   An ECG/ECHO screening program for teenagers is relatively inexpensive and assuredly would save hundreds of young Canadians from sudden death.

Note: ECG screening of elite athletes in northern Italy has reduced sudden cardiac arrest deaths in that population by 89%.

Anaphylaxis Awareness vs. Sudden Cardiac Arrest Awareness

In the spring of 2012 I gave a talk on Recognizing and Managing Cardiovascular Emergencies to 250 Human Resources professionals from across Ontario. A portion of the talk included a discussion of cardiac arrest in youth.

·        I asked for a show of hands to the question “How many of you know that you cannot send a child to school with peanut products in their lunch?”

o   Virtually every hand in the room went up.

·        I then asked “How many of you know that “fainting” is a common warning sign of a potentially lethal heart rhythm disorder?”

o   Perhaps 10 hands went up.

·        I then asked “How many kids in Ontario will die this year from peanut allergies?”

o   The answer is probably none, perhaps one and if it is a very bad year two.  Note : 2 deaths in ON since 2010

·        Finally I asked “How many young people will die in Ontario this year as a result of Sudden Cardiac Arrest?”

o   The answer is 200 – a palpable buzz went through the room.

It is fantastic that the Provincial Government and the School Boards that it funds have invested so much money, time and effort into creating universal awareness and compliance for strategies for preventing two or three peanut allergy deaths each decade. It is frustrating and nonsensical that the same Government and the same School Boards have invested virtually nothing into awareness and prevention strategies for the most common cause of death on school properties and the most common medical cause of death amongst Ontario children.

Every patient advocate probably believes that research and programming for their disease is underfunded. Those of us working to protect the lives of children at-risk for Sudden Cardiac Arrest can look around and see tens of millions of dollars being spent on prevention strategies for diseases that cause less than 1% of the suffering brought on by Heart Arrhythmia Diseases. We would never want or ask Governments to cut back that spending, we are simply asking them to listen to our story and act on our requests for similar consideration. Again this year 700 young Canadians will die suddenly of cardiac causes, many of those deaths should be prevented.

Mandatory ECG for Paediatric Syncope - MEPS

ECG’s acquired when a child faints provide lifesaving data

Every Paramedic in Ontario, and probably where you live, is trained and equipped to take an ECG (Electrocardigram) and do basic heart rhythm interpretation. When Paramedics respond to a call for a child that has fainted it should be mandatory to get an ECG and to provide the strip to the Doctors in the ER, even if upon arrival at the scene the child has regained consciousness and “seems” fine.

Of the 700 young people that die suddenly of cardiac arrest each year in Canada about half had a fainting episode in the days, weeks, months or years prior to their death. These sentinel events provide the best opportunity to identify an underlying heart rhythm disorder and initiate treatment and prevention therapies.

Important information about what was happening to the child’s heart at the time of collapse is lost as time passes. The sooner the first or "presenting" ECG is taken the greater the understanding that Doctor’s will have of what triggered the event.  As time passes the heart returns to baseline and important clues may be lost.  

It is not essential for Paramedics to interpret these early ECG’s, they simply have to acquire the strip. Once acquired the ECG strip can be shared with the physicians in the ER or the Paediatric Cardiologists for analysis. Once acquired the ECG becomes part of the electronic call record and can be accessed weeks, months or even years later perhaps making an important contribution to a future investigation.

Studies estimate that roughly 1 in 20, about 5%, of all childhood faints are a warning sign for an underlying heart rhythm disorder. For faints occurring during or shortly after physical activity, while swimming or as a result of a loud unexpected noise (auditory startle) that number may go as high as 1 in 3, or 33%. Building communities that are more sensitive and responsive to childhood fainting can only result in young lives being saved.

There are some questions around the ability of Paramedics and the equipment they work with to collect accurate ECG’s from prepubescent patients. Two things occur to me - first, get the strip and let the physicians decide if it contains useful information – second, perform more ECG’s on children and get better at it which may also require additional training and equipment software upgrades with better paediatric programs.  As taxpayers we are paying for our Paramedics to be equipped and trained to gather ECG data, this toolkit has its greatest potential value when it is applied to our children.

Currently at least 14 states and provinces have legislation passed or pending designed to increase sensitivity to the warning signs of paediatric heart rhythm disorders in our communities. If Teachers and Coaches call 9-1-1 every time a child faints and Paramedics acquire an ECG for every child that faints and ER Doctors do a thorough work-up including event history, patient history and family history (and consults with appropriate specialists when required) for every child that faints, many young lives will be saved.

When a youngster has one or more fainting episodes and then dies an opportunity to save that child’s life has likely been missed. I have listened to the stories from dozens of families that have lost children to sudden cardiac arrest and far too many of those stories include anecdotes of fainting episodes that educators, sport officials and most concerning healthcare professionals have overlooked, brushed off or misdiagnosed.  Paramedics and the EMS system can play a vital role in ensuring that potentially lifesaving information is recognized and acted upon whenever our children experience a loss of consciousness faint.

Mandatory Arrhythmia Awareness in all CPR Classes

This year, like every year, more than 7,700 people age 35 and under will die suddenly of cardiac causes in the US and Canada. Roughly half of them will experience fainting episodes or exhibit other warning signs in the months, weeks and days prior to their death. If these sentinel events are recognized and acted upon a great number of at risk young people will not die.  Several of the diseases that underlie paediatric Sudden Cardiac Arrest are genetic, with a dominant gene transmission pattern, and therefore many asymptomatic first degree relatives might also be saved.

All properly taught certification level CPR training includes a discussion on Heart Attack and Stroke warning sign recognition and management. It is time to include a discussion on recognizing and responding to the warning signs of paediatric heart arrhythmia diseases in every CPR class with extra attention being given to the discussion for classes being taught to educators, coaches and any adults that are responsible for the well-being of children.

The basic warning signs of inherited heart rhythm disorders are as follows:

·        Fainting (syncope) or seizure during or shortly after physical activity, especially if it happens repeatedly

·        Fainting (syncope) or seizure resulting from emotional excitement, emotional distress, or auditory startle

·        Family history of unexpected sudden death during physical activity or during a seizure, or any other unexplained sudden death of an otherwise healthy young person

Other warning signs include; brown outs (near fainting); a strong sensation of palpitation or racing heart; extreme shortness of breath (new) with exertion - more so than other children.

The recommended response to all loss of consciousness fainting is to Call 911, even if the child quickly regains consciousness and “seems fine”. For both fainting and all other warning signs parents should be advised of the event, provided with information (a pamphlet or a link to a web page) on heart rhythm disorders and encouraged to consult a physician that is trained to recognize paediatric arrhythmia. 

Every CPR Training Agency, both not-for-profit and private, should be required by state or provincial law to include a discussion of the warning signs of Paediatric Inherited Heart Rhythm Disorders in every class.  Special attention should be given to the topic when the audience is educators, coaches or any other group that works directly with young people.  Already eight states have passed or are considering legislation that will make awareness training of paediatric heart rhythm disorders mandatory for coaches, sport officials and physical education teachers. We need every state and province to mandate this training as a required component of every CPR class.

The evidence to support the inclusion of Arrhythmia Awareness in every CPR class is abundant und unequivocal. The International Liaison Committee on Resuscitation (ILCOR) was asked to consider a recommendation to include Arrhythmia Awareness in all Basic Life Support training classes as part of the 2010 BLS Guideline Recommendations.  They chose a softer position regarding the follow-up by coroners of all potentially cardiac related deaths of young people. Even if ILCOR chooses to ignore the evidence state and provincial legislators can still choose to act in the best interest of at-risk young people.

A Five Point Cardiac Arrest Prevention Strategy for Canadian Schools

Here is an excerpt from an article written on research presented by Dr. Andrew Krahn at the 2012 Canadian Cardiovascular Congress.

“Our research gives us an idea of the scope of the problem – there are almost 200 young people who die suddenly every year in Ontario. A good proportion of them have unrecognized heart disease. So the question is: How can we catch this before it happens,” says Krahn.

He suggests that more attention be paid to possible warning signs such as fainting. He believes that teachers, coaches and an aware public may be key to detecting risk, ensuring prevention and formal medical evaluation and therapy.

“I would advocate for careful screening of people who faint, using questionnaires and education of healthcare professionals so that when warning signs present themselves, they recognize them and this information gets passed on to the right people,” he says.

http://news.bioscholar.com/2012/10/hidden-disease-sports-sudden-cardiac-arrest.html

With virtually no hard cost every School Board could implement Dr. Krahn’s recommendations for preventing sudden death in children. The five key elements of a Cardiac Arrest Prevention Strategy are: 

A 20 Minute Arrhythmia Awareness Training Program that provides some background on Inherited Heart Rhythm Disorders (IHRD) and explains the warning signs and how to respond appropriately to those warnings. It should be available on-line to all staff and families but should be mandatory for all staff taking AED/CPR certification training and for all Physical Education Teachers and Coaches

A Pre-Participation Screening Questionnaire that would be completed by all parents/guardians at the time of enrolment at a new school. When there are positive answers in both the patient history and family history sections of the questionnaire the family should consult a physician immediately.
http://leadingcause.blogspot.ca/2013/05/inherited-heart-rhythm-disorder-pre.html

Mandatory 9-1-1 Calling  for Loss-of-Consciousness Fainting (syncope) It may be mandatory 9-1-1 for all syncope or at the very least mandatory 9-1-1 for all syncope occurring during or shortly after physical activity. In most communities ambulance are equipped with ECG monitoring equipment and paramedics are trained in heart rhythm recognition. Our tax dollars paid for this equipment and training it only makes sense to use it. 

Mandatory Notification of Parents/Guardians of all Syncope including providing them with information about IHRD’s. Parent's must be informed on the day of the event and must be provided with information that will help them understand the significance of fainting and other warning signs and the importance of physician follow-up. 

Mandatory Medical Clearance for Return to Play Post Syncope Perhaps the most tragic teen deaths are those where there is one or more fainting episodes in the weeks or months prior and the child is allowed to continue to participate in physical activity and dies because of it.

Pennsylvania has passed a law that includes several of these elements. Many other states including Maryland, Ohio and Indiana have pending Sudden Cardiac Arrest Prevention Legislation. Ontario allowed a bill to die on the order paper and it has yet to be revived despite having unanimous support at first and second reading.

If provincial or state legislation is not pending in your jurisdiction go ahead and implement these policies and best practices in your School Board. Work together with local paediatric cardiologists/electrophysiologists to develop the messaging around warning signs. Work with local EMS and ER Physicians to develop policies and practices around 9-1-1 calling for syncope. Trust that mandatory 9-1-1 calling for syncope (especially a child's first faint) occurring on school property will not create an avalanche of unnecessary "nuisance" calls, it won't. Remember that Automated External Defibrillators don't always work, it is better to prevent cardiac arrest than to try and reverse it with an AED.

One in twenty paediatric faints are sinister (the good news is that 19 in 20 are benign) but that number goes up if physical activity was the obvious trigger.  From a risk management standpoint it makes sense to be proactive on fainting and for the well being of our children it is imperative that all fainting be investigated.

Preventing the Leading Medical Cause of Paediatric Mortality

In his paper presented at the 2012 Canadian Cardiovascular Congress Dr. Andrew Krahn showed that in Ontario in 2008 almost 200 young people, under age 40, died suddenly from cardiac arrest resulting from an underlying Inherited Heart Rhythm Disorder (IHRD). These numbers are consistent with the reported incidence of sudden unexplained death amongst otherwise healthy young people from other countries and jurisdictions around the world. These numbers suggest that taken together the group of heart arrhythmias known as IHRD’s may be the leading medical cause of death in the paediatric population in developed countries.

The challenge in reducing the toll that these diseases take is that in most cases the patient is otherwise healthy making identifying at risk patients difficult. For roughly half of the young people that die from an IHRD related cardiac arrest the first indicator of the disease is death. Of the other half many present with warning signs in the weeks or months prior to their death. The most obvious warning sign is fainting (syncope) others include; palpations, racing heart, extreme shortness of breath, brown outs, and dizziness; with any of these episodes being triggered by physical activity, emotional distress, excitement, auditory startle or no obvious trigger.

Two strategies for identifying at risk individuals and protecting them from cardiac arrest are;

1.      Raising awareness of the warning signs of IHRD’s and encouraging parents, educators and minor sport officials to be diligent in following-up on syncope and other warning signs with a knowledgeable physician. This approach can be very effective for diagnosing disease in the half of the affected population that exhibit warning signs.

2.      Screening programs which include a pre-participation screening questionnaire and a resting ECG. This option is the most cost effective method for identifying patients in the half of the affected population that present with no obvious symptoms of disease.

Note: Most IHRD’s are heritable diseases transmitted by an autosomal dominant gene. Therefore the yield from any awareness or screening programs must be far greater than the total number of index patients identified. Dr. Joel Kirsh, Sick Kids, Toronto, suggests that he typically identifies five or six first degree relatives in addition to the index patient.

Once diagnosed, most patients with an IHRD can expect to live a long and productive life. Excellent prophylaxis from lethal tachyarrhythmia can be provided by implantable devices, pharmaceuticals, surgical procedures, lifestyle modification or a combination of the above.

PACED - Parents Advocating for Cardiac Education

PACED (Parents Advocating for Cardiac Education) is loosely structured group of families affected by IHRD’s advocating for greater awareness and identification of these diseases. PACED calls upon a number of cardiologists and electrophysiologists to advise us on how best to direct our efforts.  To date those efforts have been focused in two areas;

1.      Putting on seminars in our communities to educate; primary care physicians, educators, sport officials on understanding these diseases with a focus on recognizing the warning signs and responding to them.

2.      Developing and advocating for Bill 81, The Inherited Heart Rhythm Disorder Awareness Act, 2012. This legislation unanimously passed second reading in the Ontario Legislature and unfortunately died on the order paper when the provincial parliament was prorogued in October 2012. The bill would have been the first in Canada and the second in North America (Pennsylvania) to address awareness of IHRD’s

A Proposal for Finding Children Living with an IHRD

PACED is interested in implementing both an awareness and screening campaign running concurrently within a defined geography. One jurisdiction which we feel would be an ideal incubator for IHRD awareness is the Hamilton/Niagara/Haldimand/Brant LHIN (Local Health Integration Network). This LHIN features a manageable, yet statistically significant population, a respected teaching hospital and Children’s Hospital at McMaster University, a Cardiac Imaging Technicians program at Mohawk College and a number of organizations such as Heart Niagara that may be supportive of the initiative.  Equally important is potential for researchers from McMaster Children’s Hospital and McMaster University to become involved should one of the objectives be publication. By working with stakeholders in a defined region we hope to be able to produce measurable and quantifiable change in the recognition of IHRD’s and the prevention of paediatric sudden cardiac death.

The Awareness Campaign

Over a decade of working to raise awareness of IHRD’s we have identified three key target audiences that need to hear and act on the awareness message

1.      Primary Care Physicians. Much of the current understanding of IHRD’s has come about in this century with the first genes connected to Long QT being identified in 1995-96. Awareness campaigns are designed to have parents take their children to see a Family or ER physician anytime warning signs are observed. It is therefore critical to the success of a campaign that these key partners are equipped with the latest knowledge and tools for diagnosing and managing these patients

2.      Community Leaders in Education and Sport. The efficacy of an awareness campaign is contingent upon post syncope patients being seen by a physician. School Board Directors of Education and Superintendents and Minor Sport Organization Executives and Directors have the authority to mandate medical follow-up for all syncope and other warning signs. They also have the authority to implement and enforce return to play policies for post syncopal children. In our experience most are willing to do so once they understand what is at stake.

3.      Parents, Teachers and Coaches. Everyone that spends time with young people needs to know the warning sign and be prepared to either get the patient to a physician or advise a parent or guardian of the importance of doing so.

There is a vast array of communication options available to assist in spreading the IHRD awareness message to the target audiences. It may seem a little old fashioned, but bringing target audiences together for a brief (one to three hour) seminar with information delivered by Electrophysiologists and other subject matter experts and with ample time for dialogue, is still highly effective. A series of a dozen or more seminars, with three or four aimed at each target audience, would be the cornerstone of an awareness campaign.

This information could be supported and enhanced by development of a teaching video and other on-line tools. Stakeholder organizations could provide links to this information on their respective websites and direct members with questions or concerns to the online material. Another longstanding vision of PACED is funding for a traditional electronic media (television and radio) public service announcement (PSA) campaign.

The messaging in the awareness campaign will be designed to initially steer at risk children to their family physician and ultimately to the regional centre of excellence for paediatric cardiology where a comprehensive work-up and definitive diagnosis will be completed. A few of the measurable outcomes of this initiative will include:

1.      An increase in the number of patients being appropriately referred to the regional centre of excellence.

 

2.      A decrease in the number of patients being inappropriately referred.

3.      An increase in the diagnosis of IHRD’s in the regions paediatric population

4.      A decrease in incidence of sudden cardiac arrest in the paediatric population

A Canadian Pilot in ECG Screening

There is a worldwide movement toward ECG screening for teenagers, especially competitive athletes, for the purpose of identifying underlying heart rhythm disorders including both cardiomyopathies and channelopathies. To date we are unaware of any ECG screening projects conducted in Canada. It would be instructive to complete a pilot that includes enough subjects to give the study horsepower, a minimum of 1,000 and perhaps even double that number. From the very beginning we wish to state that we would want no more than one third of study participants to be competitive athletes. Genetic diseases do not recognize athletic ability and will visit any child without discrimination.

The most referenced screening program was completed in northern Italy and attributes an 89% decrease in sudden cardiac arrest deaths amongst competitive athletes in the region to a comprehensive screening program. A more recent and equally compelling study from Switzerland was presented at the 2012 ESC Congress in Munich. The study found 1:250 athletes screened ultimately received a diagnosis of a potentially lethal heart arrhythmia http://www.medicalnewstoday.com/releases/249534.php

In order to simplify the inclusion process we propose that study be conducted with subjects that have attained the age of majority. A university would be an ideal place to complete the study. The magnitude and the endpoints for a screening program would be determined by funding levels and in-kind contributions. The barrier that we have encountered when proposing ECG screening programs in Canada has been finding qualified Cardiologists willing and/or able to read the ECG’s. Many screening programs in the US and UK have cardiologists that donate their time to the program.

Both of the programs outlined above could be completed as research projects with publication being a core objective or they could be done simply as community awareness and screening programs. The first option would give the programs far greater credibility. The second option would allow for faster, lower cost implementation and perhaps a greater reach at the grassroots level. In either case children and families affected by IHRD’s will be identified.

The prevalence of IHRD’s is debated amongst Electrophysiologists with numbers above and below a rough mean of 1 in 500 being commonly used. If we use the mean it suggests that there are 28,000 Canadians under the age of 35 living with an IHRD.  There are likely two students in every typical Ontario High School living with an IHRD. Identifying these children and their affected family members and getting them the treatment that they require is the endpoint of this proposal.

A Long QT Story from March 2013

A Plea to Parents and Family Physicians

The problem of misdiagnosis of Long QT Syndrome, often as a seizure disorder or epilepsy, has long been recognized and Electrophysiologists (EP's) have wrestled with how to solve the problem. Attached is a link to the abstract for Dr. Judith MacCormick's 2009 study of a cohort of 31 Long QT patients in New Zealand.

http://www.annemergmed.com/article/S0196-0644(09)00113-9/abstract

A parent reading this abstract might sum it up in one word, frightening. Four years on there has been marked improvement in the management of these patients but the misdiagnosis problem is far from being solved.

This past week I delivered an AED with training to a family in a town that is about a half hour drive from Toronto, Ontario, Canada, a part of the world where paediatric medicine is second to none. Their young teenager had just been diagnosed with Long QT type 2, and in addition to other therapies the patient's EP prescribed an AED for home and school. Multiple fainting/seizure episodes when the child was less than five years old had been misdiagnosed as a seizure disorder. Ten years on a near death event, triggered by physical activity, led to a proper diagnosis of Long QT Syndrome. Thankfully, the patient and the family cheated the odds for sudden cardiac death, but now they are faced with the challenge of ending a promising athletic career.

This close to (my) home story mirrors much of Dr. MacCormicks data from half a world away including a 10 year delay in diagnosis after an initial misdiagnosis of epilepsy. The greater concern of course is the significant number of preventable deaths in both the probands and their first degree relatives occurring during the long diagnostic delay, four in the NZ Study.

One of the common confounding factors is that fainting (syncope) associated with Long QT Syndrome and several other Inherited Heart Rhythm Disorders, often presents as seizure like activity. The likelihood that these types of events are neurological in origin is far greater than the likelihood that they are of a cardiac origin. However if a definitive neurological cause cannot be determined testing to rule out cardiac origin should be completed and interpreted by a physician that understands paediatric arrhythmia.

If you are the parent of a child, or know of a child or any person, that has ever been diagnosed with epilepsy or seizure disorder after experiencing one or more seizure/syncope episodes,   

• especially if the diagnosis was one of "idiopathic" epilepsy
• or if the diagnosis was made without an ECG and other testing to rule out cardiac origin
• or if the ECG was not interpreted by a Paediatric Cardiologist or EP
• or if the physician seemed in anyway non-committal or unsure in their diagnosis
• or if other first degree relatives have experienced seizure/syncope episodes
• or if your "instincts" tell you that the diagnosis should be revisited

you should work with the Family Physician to arrange for cardiac testing that will provide an accurate and up to date picture of the patients cardiac health

If you are a Family Physician that has a patient on your roster that meets any of the above criteria perhaps you would consider doing a new investigation of both the patient and other family members. Diagnosis and testing completed in the 20th century is particularly suspect and as the case noted above points out even a diagnosis from the 21st century can be incorrect and putting a patient at unnecessary risk of sudden death.

Whether you are family member or a Family Physician if you know of a person with a diagnosis of epilepsy or seizure disorder and it just doesn't seem to add up or sit well, consider circling back around to revisit possible cardiac origin. It may save a life, or two .....

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.