A 17-year-old dies while running track. A 12-year-old collapses while playing football. Sudden cardiac deaths claim the lives of 6,000 to 8,000 children and teenagers in the United States each year. About 25 percent of those deaths happen while children are playing sports.
The most common cause of sudden death in young athletes is hypertrophic cardiomyopathy, a genetic disorder that leads to heart muscle that is thicker than normal. Other common reasons are abnormal coronary arteries, an infection of the heart muscle, a genetic disorder that leads to abnormal muscle of the right pumping chamber, genetic changes in the heart cells that lead to life-threatening rhythms, genetic abnormalities of the wall of the aorta leading to rupture, and congenital abnormalities of the heart and its valves.
As a parent, the question you might have is, “How can I detect these problems before a tragedy happens?”
Many children with conditions that put them at risk for sudden death do not have any symptoms, but some do. You should have your child evaluated by your pediatrician if:
▪ Your child faints, has chest pain or gets dizzy during or after exercise.
▪ Your child has a heart murmur that your pediatrician is worried about.
▪ Your child tires more easily than his or her friends when exercising.
▪ A relative dies suddenly or dies of heart problems at a young age, under 50.
While your first stop will likely be your pediatrician if your child is exhibiting any of these symptoms, the doctor may decide that your child needs to see a pediatric cardiologist to diagnose a condition. Testing done during a cardiology visit typically includes an electrocardiogram and an echocardiogram, an ultrasound of the heart that can diagnose hypertrophic cardiomyopathy, abnormalities of the coronary arteries and abnormal heart structures like blocked or leaking heart valves. Additional tests that may be done are a cardiac MRI, a stress test or heart monitors used to record the heart rhythm.
Most people with hypertrophic cardiomyopathy and many people who are at risk for an abnormal heart rhythm will have an abnormal electrocardiogram, a quick and painless test that records the electrical activity of the heart. Parents may choose to have their children get an electrocardiogram prior to playing sports, especially competitive sports, to screen for these problems.
Many of the genetic defects that cause abnormal heart muscle or life-threatening rhythms are known, and testing can be done on a blood sample to look for these abnormal genes. This is very helpful if someone in the family has tested positive for a gene defect that causes a heart problem. Other family members can be tested to see if they have the same condition.
Treatments vary based on the diagnosis. Children and teenagers with hypertrophic cardiomyopathy, abnormal heart rhythms and abnormalities of the aorta are treated with medications. People with abnormalities of the coronary arteries can often be helped with surgery. Those with blocked heart valves can be helped with cardiac catheterization or surgery.
For people at high risk of sudden death, a defibrillator can be implanted. An implanted defibrillator is a device similar to a pacemaker that can detect a life-threatening rhythm automatically and can deliver a shock to the heart to stop the abnormal rhythm.
Sometimes, however, symptoms are not present and so a diagnosis cannot be made in advance of a cardiac event. So, what else can we do to prevent a tragedy?
If someone suffers cardiac arrest, the chances of surviving are improved with early defibrillation, shocking of the heart that can stop deadly abnormal heart rhythms. Automated external defibrillators (AEDs) are made for people without a medical background to use on a person in cardiac arrest. How to use an AED is part of CPR training.
To have the best outcomes, it’s critical that we decrease the time to defibrillation. This is accomplished by having AEDs in public places, such as high schools and youth athletic events. Parents, coaches and caregivers should also learn CPR.
If you suspect your child might have a cardiac condition, you can have him or her evaluated by a UHealth cardiologist. To schedule an appointment, call 305-585-6683.
Mary Sokoloski, M.D., is a pediatric cardiologist at UHealth – the University of Miami Health System, which is nationally and internationally acclaimed for education, research, patient care and biomedical innovation. For more information, visit UHealthSystem.com/patients/pediatrics.