The leading cause of non-traumatic sudden death in children and young adults is sudden cardiac arrest (SCA). There are numerous causes including structural, electrical, muscle and metabolic causes. Early recognition and diagnosis can be difficult. Many children and young adults who experience a SCA have had warning symptoms or a family history of premature cardiovascular disease. This makes it essential that all children be screened with a comprehensive family history and a thorough physical examination.
The focus during routine well-child visits is not on the detection of cardiovascular warning signs. Most well-child visits focus on health promotion, disease prevention, anticipatory guidance and some level of disease detection. An increased emphasis on cardiovascular disease prevention is essential and this is especially important for pre-participation physical examinations for sports.
Although between 50% and 80% of all athletes who experience a SCA did not experience previous symptoms, those that did have symptoms reported some of the following: dizziness, chest pain, fainting or syncope, palpitations and shortness of breath. For those children and young adults lucky enough to have symptoms these complaints cannot be missed. Similarly, a family history of sudden death from a cardiac cause must be looked for.
Although not everyone who experiences a SCA will have a warning sign those that do must not be missed. It has been reported that if the following risk factors are looked for up to 1/3 of all of those at risk could be detected. The risk factors include: history of syncope (fainting), history of unexplained seizure activity and a family history of sudden death caused by heart disease at an age younger than 50 years.
Many children experience syncope (fainting) that is triggered by prolonged standing, fear, excitement or the sight of blood. This is called vasovagal syncope and is associated with symptoms prior to fainting. Symptoms include lightheadedness, dizziness, sweating, nausea and tunnel vision. Children who experience cardiac syncope do not have these symptoms and usually experience a sudden collapse without warning. This is due to a potentially lethal heart rhythm abnormality. It is important any child with a history of syncope receive an electrocardiogram (ECG) and a thorough history.
Any syncope that occurs during exercise must be treated with caution. These children and young adults require a cardiac consultation and other testing including a cardiac ECHO, stress ECG and possibly advanced cardiac imaging.
Seizures can occur in association with a SCA and is due to the sudden loss of brain perfusion. The child will collapse and then develops some involuntary body movements after several seconds. If the loss of consciousness is due to seizure activity the muscle movements begin at the same time there is loss of consciousness.
It is important everyone is aware of the risk for sudden cardiac arrest (SCA) so that improved aware can allow ominous warning signs to be recognized early and prevent death or injury to many children.