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Understanding the Causes of Cardiac Arrest in Children

Understanding the Causes of Cardiac Arrest in Children

Causes of Cardiac Arrest in Children

Each year, more than 2,000 children and adolescents in the U.S. die from sudden cardiac arrest (SCA), also known as cardiopulmonary arrest. The condition is responsible for 3 to 5 percent of all deaths in children 5 and over, and 10 to 15 percent of deaths in infants. Cardiac arrest is typically perceived as something that affects older adults, but that is not the case. So, what causes cardiac arrest in children? More importantly, what can we do to prevent it?

Causes of Cardiac Arrest in Children

SCA in adults is typically the result of coronary artery disease or another condition that develops over a period of decades. In contrast, sudden cardiac arrest in children is often the result of an underlying pre-existing condition. Unfortunately, the condition is seldom diagnosed prior to the SCA event. Common causes of pediatric cardiac arrest include:

Pediatric cardiomyopathy

Pediatric cardiomyopathy is the number one cause of ​​SCA in children. Though rare (affecting about one out of every 100,000 children in the U.S. each year), it can be fatal if not treated promptly. Pediatric cardiomyopathy can manifest in symptoms like rapid breathing, dizziness, shortness of breath, irregular heartbeat, fainting, chest pain, fatigue, and abdominal swelling. Symptoms are often dismissed as cold, flu, or signs of asthma. Some children have no symptoms at all.

A pediatric cardiologist can pinpoint the condition using an echocardiogram (echo) and/or an electrocardiogram (EKG/ECG). The condition may be treated using diuretics and/or anticoagulants, and some children may require a pacemaker or implantable cardioverter defibrillator (ICD) to control irregular heartbeats.

Structural cardiac abnormalities

Numerous conditions fall under the umbrella of structural abnormalities, including coronary artery anomalies, Marfan syndrome, and certain postoperative repairs.

Congenital heart disease (CHD) is a type of heart disease that exists from birth. Children with CHD can manifest a range of structural abnormalities that may change the way blood flows through the heart. These structural abnormalities can contribute to irregular heartbeats and other life-threatening conditions.

Marfan syndrome is an inherited disorder that affects connective tissue; people with this condition typically have weaker-than-normal tissue in one or more areas of the body. It can affect nearly any part of the body and ranges from mild to severe, but it becomes life-threatening if it affects the aorta. Blood pressure medication is sometimes recommended to reduce strain on the aorta, and some pediatric patients require corrective surgery.

Pediatric arrhythmias

Pediatric arrhythmias occur when there is an alteration in the heart’s normal electrical conduction system. Examples of pediatric arrhythmias include long QT syndrome (LQTS) and Wolff-Parkinson-White syndrome (WPW).

Long QT syndrome is a heart rhythm condition that can trigger rapid, chaotic heartbeats, potentially resulting in fainting, seizures, or sudden cardiac arrest. These types of episodes are usually triggered by stress or vigorous exercise.

Wolff-Parkinson-White Syndrome is characterized by a malfunction of the electrical pathways between the upper and lower chambers of the heart (atria and ventricles). Signals are sent to the ventricles prematurely, causing the impulses to ricochet back to the atria. This can cause rapid heartbeats and potentially cause the heart to stop altogether.

Other arrhythmias that can affect children include atrial fibrillation, ventricular fibrillation, ventricular tachycardia, and sinus node dysfunction.

Respiratory issues

Children with healthy hearts can also suffer sudden cardiac arrest as a secondary result of a medical issue that cuts off the flow of oxygen. This can occur due to an airway obstruction from a foreign object (such as when a ball or jawbreaker gets lodged in the throat) or from lying facedown on a pillow (this is thought to be a contributing factor in sudden infant death syndrome or SIDS).

This type of obstruction may also be the result of an acute allergic reaction (anaphylaxis). The reaction causes complete swelling and closure of the trachea, blocking the flow of oxygen which leads to sudden cardiac arrest.

Blunt Force Trauma

Blunt force trauma to the chest can cause blunt cardiac injury, which can lead to cardiac arrest. This type of trauma is known as commotio cordis, and it’s not as uncommon as you may think.

Commotio cordis is a sudden and powerful blow to the area directly above the heart (the precordial region). This type of impact can disrupt the normal heart rhythm, leading to sudden cardiac arrest. It’s most commonly seen in children who play contact sports like softball, football, or tennis. This type of SCA can occur more than you think, and even in children without other risk factors.

Children playing football

Other Risk Factors for Cardiac Arrest in Children

For children who are already at an elevated risk for SCA, the following activities and risk factors may exacerbate the problem:

  • Athletic activity. About two-thirds of childhood SCA deaths occur during or shortly after a period of strenuous physical activity. This is due to the added strain placed on an already delicate heart. About 75% of all deaths in child athletes are caused by sudden cardiac arrest.
  • Exposure to drugs. Recreational drugs like cocaine, amphetamines, and club drugs can trigger childhood SCA. Even some prescription medications can elevate a person’s risk, particularly if they’re not carefully dosed and monitored under a doctor’s supervision.
  • Childhood obesity. Childhood obesity is at an all-time high. The CDC notes that obesity affects 18.5% of Americans age 19 and under, or 13.7 million children and adolescents in the U.S. Obesity contributes to hypertension and hypoxia, which further contributes to heart disease and sudden cardiac arrest.

If your child has a family history of inherited heart defects, it’s important that they undergo a full body of tests from a cardiologist. If you’re not sure of any inherited conditions, there are also a number of specific warning signs you can watch out for.

Warning Signs of Sudden Cardiac Arrest in Children

If your child exhibits any of the following signs, they should undergo a complete cardiac evaluation:

  • Excessive lethargy or exhaustion that occurs during or after physical activity. This is the number one warning sign of cardiac-related issues in youth athletes.
  • Unexplained chest pain or discomfort, particularly during physical activity.
  • Lightheadedness, dizziness, near-fainting, or fainting during physical activity.
  • Unexplained seizures that occur without warning, especially during physical activity.
  • Unusually fast heart rate that occurs without warning or cause.
  • Any irregular heart rhythms (the heart changes rhythm without warning, skips a beat, or beats unevenly).

In the case of an irregular or abnormal heart rhythm, your child should see a doctor immediately. These types of arrhythmias are dangerous and can trigger sudden cardiac arrest.

Preventing Sudden Cardiac Arrest in Children

With the right precautions, child and infant cardiac arrest can be prevented. And in instances where SCA does occur, it’s often possible to prevent the emergency from turning into a tragedy.

  • First and foremost, ensure that your child receives a full evaluation from a pediatric cardiologist. Even if your family history is clean and no risk factors are present, it is possible that your child has an undiagnosed issue. Most childhood SCA events occur because the family was unaware of the underlying condition.
  • Heed all doctor recommendations. For children with existing risk factors, a doctor may recommend certain medications, an ICD, or corrective surgery. Certain children may also need to limit or abstain from childhood athletics.
  • Watch out for risk factors. Risk factors include abnormal heart rates and heart rhythms, dizziness, seizures, sudden fatigue, and lightheadedness.
  • Maintain a heart-healthy household. Childhood obesity is a major risk factor for sudden cardiac arrest, so take steps to promote healthy nutrition and daily physical activity for the entire family.
  • Learn pediatric cardiopulmonary resuscitation techniques. If your child does experience a cardiac event, calling the emergency medical services and performing effective chest compressions immediately could be the things that save their life. You can get CPR certified by taking a course from the American Heart Association or the Red Cross.

In addition, you’ll want to purchase an automated external defibrillator (AED). If your child is at an elevated risk, an AED could save their life. These portable medical devices are used to restart a stopped heart when SCA occurs, thereby saving the patient’s life in those critical minutes while you’re waiting for emergency services.

You can even invest in a value package like the HeartSine Samaritan PAD 450P AED package or the Defibtech Lifeline VIEW AED package, each of which includes an emergency-ready defibrillator and all of the necessary accessories at a discounted price.

Treatment of Sudden Cardiac Arrest in Children

Sudden cardiac arrest requires immediate action. Emergency response time is crucial. When the heart stops, blood is no longer pumped to the brain and other vital organs. With each minute that passes, the child’s prognosis declines by about 10%.

If your child experiences SCA, call 911 and begin CPR immediately. If no AED is available, continue CPR until emergency services arrive. Refer to our guide on how to perform CPR.

If an AED is available, turn it on and follow all of the voice prompts. The device will guide you through CPR, instruct you on how to place the electrode pads, and prompt you to deliver an electric shock to the heart if such a response is advisable. Don’t worry if you don’t have experience. Most AEDs are designed to be safe and simple for the lay user.

It’s statistically unlikely that your child will experience a sudden cardiac arrest, but in the event that they do, being prepared makes all the difference.

Disclaimer for information purposes only:

Our website provides information for general knowledge and informational purposes only. We do not offer medical advice, diagnosis, or treatment. Readers should consult with qualified healthcare professionals for personalized medical advice.

While we endeavor to ensure the accuracy and reliability of the information provided, we do not guarantee its completeness or suitability for any specific purpose. The use of this website is at the reader’s own risk.

By accessing and using this website, you agree to indemnify and hold harmless the website owners, authors, contributors, and affiliates from any claims, damages, liabilities, losses, or expenses resulting from your use of the information presented herein.

Picture of Michelle Clark, RN ICU/CCU
Michelle Clark, RN ICU/CCU
As a seasoned Nurse (RN) in Critical Care, CCU (Cardiac Care Unit), and ICU (Intensive Care Unit) with nearly three decades of experience, specializing in Cardiopulmonary care, I've embarked on a new path as a trusted figure in the realm of sudden cardiac arrest and first aid. With a profound dedication to patient well-being honed throughout my nursing career, I now utilize my expertise to enlighten and empower others in life-saving methods. Leveraging my comprehensive understanding and proficiency in critical care, I endeavor to leave a lasting imprint in healthcare by promoting awareness and offering practical guidance.

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