Sudden Cardiac Death Warning Signs

Sudden cardiac death (SCD) should not be a surprise. The young athlete who drops dead duringa game and the teen who is found dead in bed one morning seldom die without warning signs. Theproblem is the physicians, coaches, and parents who fail to recognize the warnings.

"We can do a much better job of preventing sudden cardiac death if we pay attention to thedetails," Robert M. Campbell, MD, of the Children's Hospital of Atlanta's (CHOA) Sibley Heart Center,Emory University School of Medicine, told the AAP National Conference & Exhibition Monday afternoon."The pre-participation exam could work."

One problem is that SCD is a rare event in young people. About 300,000 older Americans dropdead from sudden cardiac events every year, Dr. Campbell said, but only about 1,000 children andteenagers die of sudden cardiac failure.

Typical causes of SCD include hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Long QT Syndrome, congenital coronary artery abnormalities,catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada Syndrome. Clues such asfainting during exercise, and a familial history either SCD or fainting during exercise, are strongindicators for elevated SCD risk.

The pre-participation exam, or PPE, is an attempt to screen for SCD risk. Unfortunately, Dr.Campbell said, most PPE forms ignore the strongest risk factors, including AAP's own form, lastrevised in 2005.

"We can do better," he said.

CHOA has developed its own cardiovascular risk assessment form. Questions focus on dizziness,fainting, extreme shortness of breath, and chest pain during or after exercise, as well as duringperiods of emotion or after being startled. Other questions focus on episodes of near-drowning andseizure, as well as any family history of dizziness, fainting, drowning, near-drowning, and sudden orunexplained death before the age of 50.

"At least half of children have signs before SCD," Dr. Campbell said. "It is just that thesigns are subtle and nonspecific. We should screen all of our children for SCD risk."

Fainting is the most important sign to look for. Not just any faint, said Michael Ackerman,MD, PhD, Professor of Medicine, Pediatrics, and Pharmacology at the Mayo Clinic, Rochester, Minn.Specifically, fainting during exertion.

"It is the faint that occurs 90 meters into a 100 meter dash that you need to worry about,"he said, "not the faint that occurs five minutes past the finish line. Fainting that occurs duringexercise is a clear warning sign for SCD. Ignore it only at your patient's peril."