Posted On: April 19, 2012 by Patrick A. Malone

Children Whose Hearts Stop

Happily for most parents, heart trouble is pretty well off their child-care radar. When a child succumbs to cardiac arrest, often it’s a shock and a surprise.

But by some estimates, according to a recent story on MedPage Today, there might be warning signs in as many as half of all cases of sudden cardiac arrest in children. Awareness by clinicians of these signs and a thorough understand of family history by both parents and pediatricians can prevent sudden cardiac arrest in youngsters, says the American Academy of Pediatrics in the journal Pediatrics.

A primary point in the academy’s statement was that some symptoms of cardiac problems in children commonly are associated with other, less dire disorders. Pediatricians must remain not only vigilant in observing them, but open-minded about their cause because pediatric sudden cardiac arrest can be lethal within minutes if it goes unrecognized and untreated.

Approximately 2,000 such deaths are estimated to occur annually in the United States.

Symptoms can include chest pain, dizziness, exercise-induced syncope (temporary loss of consciousness) and dyspnea (difficult or labored breathing). Any or several of these symptoms might have been disregarded by the patient and family, the article notes.

A detailed family history that yields knowledge of a sudden, unexplained death of a young relative also warrants scrutiny of any child exhibiting symptoms of what can easily be ascribed to getting tackled on a Pop Warner football game, or too many rides on the Tilt-a-Whirl.

The most common underlying causes of sudden cardiac arrest among children are:

  • structural or functional disorders such as hypertrophic cardiomyopathy, a heart defect in which the muscle wall is so strong that it can’t relax enough to allow sufficient blood flow;

  • coronary artery anomalies, or congenitally malformed heart vessels;

  • primary cardiac electrical disorders, when the heart’s electrical system malfunctions.

An afflicted child most frequently experiences ventricular tachyarrhythmia, which is an abnormal heart rhythm that is rapid and regular. It originates in the lower chamber, or ventricle, of the heart. Sometimes arrhythmias are of short duration, and resemble seizures.

If a doctor or parent believes a child is having a seizure, he or she probably will be referred to a neurologist. If the real problem, however, is heart-related, the delayed diagnosis can be disastrous.

Similarly, if a child experiences breathing trouble, someone might believe he or she has a respiratory problem, and send to a pulmonary specialist.

If your child has experienced any of the symptoms above, was diagnosed and treated for a problem other than a heart issue and has not responded, see a pediatric cardiologist immediately.

The academy advises use of these risk-assessment tools, which haven’t been validated or assessed for sensitivity or specificity; nevertheless, experts emphasize that if any of the following have occurred, the patient should get a cardiac assessment as soon as possible:

  • a history of fainting or having a seizure, especially during exercise;

  • past episodes of chest pain or shortness of breath with exercise; and/or

  • a family member with unexpected sudden death or a condition such as hypertrophic cardiomyopathy or Brugada syndrome (a certain kind of heart rhythm disorder heart rhythm disorder characterized by a specific abnormal heartbeat and detected by an electrocardiogram test).

Although heart screenings have long been overused, in the case of young athletes, the academy advised against following earlier American Heart Association guidelines that did not endorse widespread use of ECG tests. (The AHA rightfully cited the possibility of false-positive and false-negative results, additional cost and associated problems.) The academy advised screening young athletes before they participate in sports.

The academy also recommended that automated external defibrillators be widely available in schools, as well as cardiopulmonary resuscitation training of staff and others. Parents should determine if these tools are present in their child’s school, and lobby for them if they are not.

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