James was a typical teenage boy. He was very energetic, loved sports and was girl crazy. He was a starting forward on his school’s varsity basketball team and was recently featured in the local newspaper as Athlete of the Week. From the outside, he seemed to be a very healthy, All-American boy. Then one night during the first half of a basketball game, he suddenly collapsed while running down the court and died. The autopsy demonstrated that James had a previously undetected heart abnormality.
Nothing is quite as devastating as the unexpected loss of a child, especially when the death occurs so unexpectedly and in someone who appeared to be so healthy. The family will always wonder: “Could his death have been prevented?”
What is Sudden Cardiac Death?
Sudden cardiac death (SCD) is defined as an abrupt, unexpected death due to a cardiovascular cause. Death typically occurs within minutes to one hour of the onset of symptoms. If the individual is successfully resuscitated, it is called “aborted sudden cardiac death.”
How frequent is SCD in children?
Unfortunately, there is no centralized or mandatory reporting system in the United States, so the precise incidence of SCD in children is unknown. But we do know that it is rare. The CDC estimates that about 2,000 persons under the age of 25 will die from SCD each year. Several studies have estimated the frequency of SCD in persons less than 18 years of age to be in the range of 0.8 to 6.2 deaths per 100,000 children per year. About 25 percent of these deaths will occur during sports participation.
What causes SCD in children?
The cardiac causes of sudden death can be grouped into three categories: (1) Abnormal structure or function, (2) Abnormal cardiac rhythm and (3) Other causes, including drugs and stimulants, primary pulmonary hypertension and sudden death after being hit in the chest.
Can SCD in Children be Prevented?
Since most sudden deaths have a cardiovascular cause, it is theoretically possible to identify some of the people at risk for SCD prior to the event and to prevent it. In many, but not all cases, signs or symptoms may be present that can identify individuals who are at risk for experiencing SCD. Unfortunately, sometimes the first symptoms are also the last symptoms. As of yet, we do not have a strategy that allows us to prevent every case of SCD.
What Can You Do?
Since many cases of SCD occur during sports participation, it is important to have your child carefully evaluated by their primary care physician prior to participating in competitive athletics. You should also be familiar with symptoms that might indicate an increased risk for SCD. In addition, you should investigate your family history and identify anyone who experienced sudden cardiac death, since some of these conditions have a genetic basis and “run in the family.” Finally, ensure that your child’s school has an automated external defibrillator (AED) and that school personnel are trained to provide Basic Life Support and use an AED. The AED and trained personnel should be available during all athletic events.
Potential warning signs and symptoms:
- Dizziness or fainting during exercise
- Chest pain during exercise
- Difficulties breathing or extreme shortness of breath during exercise
- Unusually fast or forceful heart beats during exercise
- Unexplained dizziness, fainting or seizures
- Unexplained or excessive fatigue
- Family history of an enlarged heart or heart muscle disease (cardiomyopathy)
- Family history of sudden unexplained death in the young (< 50 years of age)
A risk assessment form is available here.
A tool to help you to document your family history is available here.
Last reviewed 8/2018