Sudden cardiac arrest in children - Children's National

When it comes to kids' health, nothing is scarier than the thought of the heart suddenly stopping. Although sudden cardiac arrest in children is rare, it's important for parents, caregivers, and coaches to understand the risks, recognize warning signs and know how to respond. Pediatric cardiologist Elizabeth Sherwin, MD, breaks down some of the terms you may be hearing about and what you need to know about cardiac arrest in children.

Cardiac arrest vs heart attack vs heart failure

Many people use these terms interchangeably, but they mean different things:

• Cardiac arrest happens when the heart suddenly stops beating normally, often due to an abnormal rhythm (arrhythmia). This can be fatal without quick treatment.
• Heart attacks usually result from blocked blood flow in the arteries supplying the heart.
• Heart failure means the heart isn't pumping as strongly as it should.

All three affect how the heart works but for different reasons.

How common is sudden cardiac arrest in kids?

Sudden cardiac arrest is very rare in children and young athletes, but it does happen. Each year about 2,000 people under the age of 25 die from sudden cardiac arrest in the U.S. While the chances are extremely low, awareness and preparation save lives.

What causes sudden cardiac arrest in young people?

Even healthy kids can experience sudden cardiac arrest. Some of the most common heart-related causes include:

• Structural heart disease (differences in the heart's anatomy)
• Cardiomyopathy (heart muscle problems)
• Arrhythmias (irregular rhythms)
• Myocarditis (infections of the heart muscle)

Non-cardiac causes such as breathing issues, certain medications or accidents can also play a role.

Warning signs to watch for

Parents, coaches and kids themselves should pay attention to red flags:

• Chest pain during exercise
• Fainting or loss of consciousness while active
• A family history of unexplained fainting, seizures or sudden death

These signs should never be ignored.

What to do in an emergency

If a child or teen collapses:

1. Call 911 immediately
2. Start CPR right away
3. Use an automated external defibrillator (AED) if one is available

Quick action can double or triple survival rates.

Family history and risk

Some heart conditions run in families. If a relative has had sudden fainting episodes, a pacemaker or defibrillator at a young age or unexplained sudden death, your child should be evaluated by a cardiologist. Sharing family history with your pediatrician is a powerful step in protecting your child's heart.

Should young athletes get heart screenings?

The American Board of Pediatrics recommends that all children-athletes and non-athletes-are asked heart health screening questions by their primary care provider every three years or at sports physicals. These questions cover symptoms and family history. If concerns arise, the provider may refer your child to a pediatric cardiologist for more detailed evaluation.

What does a typical heart screening involve?

Depending on your child's history, a cardiologist may order:

• Electrocardiogram (EKG/ECG): checks heart rhythm
• Echocardiogram: ultrasound to see heart structure and function
• Holter or rhythm monitor: tracks the heartbeat over days or weeks
• Exercise stress testing

Insurance typically covers these if recommended by a cardiologist.

Are EKGs recommended as part of routine sports physicals?

There's ongoing debate about whether every child athlete should have an EKG. While helpful, EKGs can sometimes miss conditions or falsely suggest problems. Misinterpretation, unnecessary worry and extra costs are also concerns. That's why individualized evaluation by an expert is so important.

Can lifestyle factors like diet, hydration or overtraining increase the risk of cardiac issues?

Lifestyle factors can definitely affect the risk of sudden events and cardiac issues. A healthy diet and excellent hydration are great steps to building a healthy life and reducing many heart risks. For some people with underlying heart conditions, dehydration and electrolyte imbalance can be life-threatening and increase the risk of a sudden cardiac event. High caffeine intake, particularly energy drinks, can also be very dangerous and lead to a sudden cardiac arrest.

The bottom line for parents

Sudden cardiac arrest in children is rare but knowing the warning signs, understanding your family's heart history and encouraging open conversations with your child can make a life-saving difference. If you ever have concerns about your child's heart, talk with your pediatrician or ask for a referral to a pediatric cardiologist.