Preventing Sudden Cardiac Arrest in the Young

In July 2004, EMS Magazine published my article titled My Child Just Fainted: No Big Deal, or Sudden Death Warning? which focused on my family's story with Long QT Syndrome.

I am a mother of two boys living in Beulah, ND, and have been an EMT-I and an American Heart Association instructor trainer for more than 20 years. In the past four years, I have listened to hundreds of stories similar to mine, but with a different diagnosis or no diagnosis at all. This article is intended to share information on ways sudden cardiac arrest can happen to a young healthy person, and to provide information on ways the EMS community can help prevent these tragedies.

WHY SCA IN CHILDREN?

How many children and young adults die annually due to sudden cardiac arrest? Should schools have AED programs? The answers to these questions are not readily available. There are statistics gathered from death certificates, but many SUDS (sudden unexplained death syndrome) cases do not list a cause. Many families who have lost a child to SCA (sudden cardiac arrest) have not received any answers about their child's death. There are statistics gathered on 15- to 25-year-old athletes who collapse on the court or field, but what if they collapsed somewhere else and they were 12 years old?

I believe the numbers of SCA in the young have been dropping. I have read and visited with many who survived SCA due to AED programs in schools and athletic functions and cardiac screening for athletes. Many organizations have been working diligently to provide awareness and prevent SCA in youth. Their efforts will continue to reduce the number of SCA incidents in the young, but why do we need so many deaths to protect them?

EMS may be the first to let families know that their child may need further testing after a syncopal spell or other suspicious incident and can help bring awareness and education to the community. Do your local schools have AEDs? Are there AEDs at baseball games, Little League, soccer etc.? Does your police/sheriffs/state highway patrol carry AEDs? Does the school staff know CPR? Does the school have an emergency action plan or conduct annual drills that include cardiac arrest emergencies? Does the school offer CPR/AED training to its staff and/or students?

KEEPING CHILDREN SAFE

Imagine going to your son's basketball game to cheer him and his team on. He plays the first half, goes into the locker room and dies of cardiac arrest. Or, a hockey team's goalie blocks a shot with his chest and dies of cardiac arrest. As parents we spend our lives trying to protect our children from harm. My life was no different.

On March 25, 1999, we found my 17-year-old son Shannon dead in his bedroom. His death was ruled as unexplained sudden cardiac arrest. This perfectly healthy 6'1", 190-lb. teenager went to sleep Wednesday night and did not wake up on Thursday morning. Three months after his death, I found a copy of his sports physical that had been conducted 13 months prior to his death. He had checked "yes" to chest pain, trouble breathing and dizziness during and after activity. Eleven months after his death, the Mayo Clinic in Rochester, MN, diagnosed my youngest son and me with Long QT Syndrome--an electrical glitch in the heart. It can be an inherited or acquired prolongation of the "QT" interval. When the time between beats is too long, it renders a person vulnerable to cardiac arrest.

LONG QT SYNDROME

LQTS is a disorder of the heart's electrical system that can cause lethal arrhythmias. It particularly involves a process called repolarization, or recharging of the electrical system after each heartbeat. The QT interval is the duration of "electrical recharging" measured on the electrocardiogram (ECG or EKG). In the patient with LQTS, the QT interval is often longer than normal. This abnormally prolonged recharging process renders patients vulnerable for an abnormal arrhythmia known as torsade de pointes (TdP). When TdP occurs, the heart cannot effectively pump blood, resulting in the typical symptoms of LQTS: fainting, seizing and sudden death. It is possible to go from a normal heartbeat to cardiac arrest in less than one minute. With LQTS, the only difference between fainting and waking up versus fainting and dying is whether or not the LQTS heart returns spontaneously to normal rhythm or whether first responders get to the heart in time to defibrillate. Fortunately, most LQTS patients do not die suddenly. Tragically, mine did.