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, so what causes cardiac arrest in children? More importantly, what can we do to prevent it altogether?
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. By 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 SCA in children include:
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. Pediatric cardiomyopathy can cause 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 asthma signs, and some children have no symptoms at all.
A pediatric cardiologist can pinpoint the condition using echocardiogram (echo) and electrocardiogram (EKG/ECG). The condition may be treated using diuretics and 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, a type of heart disease that exists from birth, is the most common example. This type of heart defect changes the way blood flows through the heart and can contribute to irregular heartbeats and other life-threatening conditions.
Marfan syndrome is an inherited disorder affecting connective tissue; people with the 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 patients require corrective surgery.
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.
Children with otherwise healthy hearts can 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 to SIDS in infants).
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 and potentially leading to cardiac arrest.
Blunt Force Trauma
Blunt force trauma to the heart, also known as blunt cardiac injury, can lead to cardiac arrest if the injury affects the anterior chest wall. 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 even in children with no other risk factors.
Other Risk Factors for Cardiac Arrest in Children
For children who are already at an elevated risk for SCA, the following activities and 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 administered 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, 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 cases of irregular or abnormal heart rhythms, your child should see a doctor immediately. These types of arrhythmias 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 vulnerability. 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: abnormal heart rates and heart rhythms, dizziness, seizures, sudden fatigue, 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 CPR. If your child does experience a cardiac event, your quick action could be the thing that saves 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. 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, it’s always important to be prepared.