Preventing Pediatric Sudden Cardiac Death: Where Do We Start?
As stated earlier, Sudden Cardiac Arrest (SCA) is an event not a disease, or a condition. Therefore, it can not be diagnosised in advance. However, for the heart disease related underlying causes, prevention is accomplished by early detection of symptoms and by education and good physical examinations. For non-disease related SCAs, such as in the case of Commotio Cordis, education and use of state of the art protective equipment and having an emergency response plan, can minimize the risk.
As stated earlier, many times there are no symptoms prior to the SCA. In other cases, symptoms that exist are not recognized. It would be difficult to list the symptoms of all the different types of heart diseases. For the symptoms associated with Hypertrophic Cardiomyopathy, please refer to the page "What is Hypertrophic Cardiomyopathy?. For symptoms of other heart diseases, please for refer to Useful Links page and scroll through the list of heart related diseases.
Family Health History
As stated by Dr. Stuart Berger and Dr. Robert Campbell (1): "First steps first. Good medical practice begins with good history. The details of a disciplined, comprehensive patient and family history may provide the first clues to a patient-specific medical diagnosis that directs a patient-specific medical treatment. Patient and family history is critical for diagnosing diseases that cause pediatric sudden cardiac death (SCD)."
(1) Preventing Pediatric Sudden Cardiac Death: Where Do We Start?, PEDIATRICS Vol. 118 No. 2 August 2006, pp. 802-804 (doi:10.1542/peds.2006-0564)
Two of the tools that should be used by physicians are: the American Academy of Pediatrics Preparticipation Physical Evaluation Form and the Pediatric Sudden Cardiac Death Assessment Form. Refer to the Delaware DIAA forms link for the version of the evaluation form.
The Matthew Krug Foundation advocates for heart screenings in youth for the early detection of risk factors and conditions associated with sudden cardiac arrest (SCA). Two of the primary tools used as part of a heart screening or used in diagnosing a patient with symptoms are; electrocardiogram and echocardiogram.
Electrocardiogram (ECG or EKG)
The electrocardiogram (ECG or EKG) is a diagnostic tool that measures and records the electrical activity of the heart in exquisite detail. Interpretation of these details allows diagnosis of a wide range of heart conditions. Interpretation by pediatric cardiologists or electrophysiologist may be required.
The term electrocardiogram was introduced by Willem Einthoven in 1893 at a meeting of the Dutch Medical Society. In 1924, Einthoven received the Nobel Prize for his life's work in developing the ECG.
During an ECG, the patient lies down quietly on a bed or stretcher. A technician (or sometimes a nurse, doctor, or other medical professional) will place 6 small adhesive electrode pads across your chest from your lower breast bone (sternum) to an area below your left armpit. Other pads will be placed on each of your arms and legs. Insulated wires will connect each of these 10 pads to the ECG machine. Once these wires, called "leads," are attached, the ECG records a few heartbeats on a single sheet of graph paper. Shown to the right is an example of a ECG being carried out on a youth, a typical ECG chart and a VFib chart.
An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen. Shown below is a sonographer (technician) taking a echocardiogram of a young man (left) and an example of an echocardiogram as seen on the monitor. As you can see by looking at the echocardiogram, special training is required to interpret the results. In the echocardiogram, LV, LA, RV, and RA are abbreviations for the four chambers of the heart: left ventricle, left atrium, right ventricle, and left atrium, respectively. To learn more about echocardiology, use the following link: Echocardiogram
Treatment of Youth identified with Heart Disease
Once a young person is diagnosed with a specific type of heart disease, the treatment will also be specific to that disease. Treaments can include medications, non-surgical procedures, surgery and devices. We suggest that the reader use our "useful links" page and click on the links to the disease specific organizations to learn more about the treatments for specific heart diseases. Discussed below are two types of devices used in treatment of heart diseases.
Implantable Cardioverter Defibrillator (ICD)
An implantable cardioverter-defibrillator (ICD) is a small battery-powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation and ventricular tachycardia. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity. To learn more about ICDs click on the title above. An example of an ICD is shown to the right.
A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.
Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that's too slow is called bradycardia (bray-de-KAR-de-ah).
To learn more about pacemakers, click on the title above.
Gene tests (also called DNA-based tests), the newest and most sophisticated of the techniques used to test for genetic disorders, involve direct examination of the DNA molecule itself. Other genetic tests include biochemical tests for such gene products as enzymes and other proteins and for microscopic examination of stained or fluorescent chromosomes. To learn more about genetic testing and how it can save lives use the following link: Advances in the Prevention of Sudden Cardiac Death in the Young: The Role of Genetic Testing in Prevention of SCD in the Young.
Protecting Children and Youth from Sudden Cardiac Arrest
PO Box 4860 Wilmington, DE 19808
Prevention - Diagnosis, Treatment