Click any question to expand content…Who is at risk for sudden cardiac arrest (SCA)?
All children are at risk for SCA. In the future, as technology advances, screenings may be routine for all pediatric patients, but currently, no routine cardiac screening is in place for any of our children.
Heart for Athletes has chosen to focus on the most at-risk group. Athletes are up to 3 times more likely than their non-athletic counterparts to suffer from SCA. As the intensity of their training increases, so does their risk of SCA. An athlete with an undetected heart condition may have a 100-fold risk of suffering from SCA.
Sudden Cardiac Arrest (SCA) is the abrupt loss of the pumping action of the heart. Instead of the normal pumping function the heart preforms, heart movement becomes disorganized and the heart quivers. Blood is not pumped to the brain or body; the patient will lose consciousness quickly and without immediate and skilled intervention, death will occur within minutes.
SCA should be suspected in ANY collapsed and unresponsive athlete. The victim may appear to have seizure-like activity. The person may be gasping, gurgling, snorting, moaning or have labored breathing. For the best chance of survival, the Cardiac Chain of Survival must be started immediately.
Immediately after sudden cardiac arrest (SCA), bystanders will often witness seizure like activity followed by shallow attempts at breathing. What is happening to the SCA victim? Victims often have an hypoxic seizure (tonic phase). This is caused by oxygen deprivation due to ventricular tachycardia or ventricular fibrillation. This phase is often mistaken as an epileptic seizure. The seizure like activity is followed by agonal breathing. Agonal breathing is an attempt of the memory of the facial, neck and intercostal muscles making a failed attempt to breath without cerebral (brain) coordination and the diaphragm muscle. Agonal breathing is only gasps – the chest does not rise and fall. the patient’s body is not being oxygenated properly. Bystanders often do nothing because they think the person is breathing.
What should you do? The first thought when you see a young person fall unresponsive is to check for a pulse. After 911 has been called, CPR should be started immediately, and an AED should be obtained. For every minute that passes without the use of an AED/CPR, the victim’s chance of survival decreases by 10%. On average, out to hospital victims have less than a 8% chance of survival.
To view a simulation of a sudden cardiac arrest with agonal respirations, click here.Why does sudden cardiac arrest happen?
The majority of SCA cases occur due to structural/functional or electrical disorder of the heart. Some cases may be triggered by a sudden blow to the chest which leads to a condition known as commotio cordis.
A sudden blow to the chest can cause commotio cordis, which literally means “agitation of the heart.” The blunt trauma causes a disturbance of the electrical activity of the heart, resulting in ventricular fibrillation or other fatal arrhythmia. If an athlete collapses shortly after being struck in the chest by a firm projectile (like a baseball, hockey puck, football, etc), SCA caused by commotio cordis should by suspected. The only way to reverse this is prompt cardiopulmonary defibrillation by an AED. Approximately 20% of SCA cases in athletes are caused by commotio cordis.
The true incidence of SCA is unknown. Until late 2013, there was no national registry recording the number of sudden cardiac deaths and sudden cardiac arrests that occur. In the past, data has been collected through media reports, SCA advocacy groups, and insurance claims. These methods do not capture all of the cases, so the occurrence rate is underestimated. SCA take the live of thousands of students every year, and is the leading medical cause of death among student athletes.
In late 2013, the NIH and CDC announced the launching of a registry for sudden death in youth up to the age of 24 in the United States. This will be a huge step toward defining conclusively the true incidence of SCA/SCD in the United States. This will generate new research resulting in initiatives that will save more lives.
Studies have shown that standard PPEs do not pick up abnormalities that put our youth at risk for sudden cardiac death. Symptoms linking a potential risk factor to an actual SCA can be clinically silent or misinterpreted if a young athlete does not realize his “minor” symptoms are significant. If an EKG is added to the PPE, asymptomatic athletes can potentially be identified and effective management can be implemented, preventing sudden cardiac arrest and death.
The purpose of a heart screening event is to attempt to identify any pre-existing heart conditions that could potentially increase the student’s risk of sudden cardiac arrest (SCA) when participating in vigorous physical activity or athletic competition.
During the Heart for Athletes screening event, each athlete will take part in the following evaluation:
- Medical history – Each participant will fill out and return a medical history form, with the attached parental consent forms signed.
- Blood pressure check – Each participant will have their blood pressure checked.
- Electrocardiogram (ECG/EKG) – This test is performed while the athlete is at rest. Electrodes (small patches) are placed on the surface of the skin. The test maps the rate, rhythm and functions of the heart, and prints a tracing for physician review and interpretation.
- Physician review – A board certified pediatric cardiologist will be at the screening event and will review screening findings as described above. The physician may recommend a limited echocardiogram.
- Echocardiogram (echo) – An echo is an ultrasound image created by using a Doppler wand on the surface of the chest. This test will be performed at the direction of the evaluating physician, and will not be performed on each student.
Screening events are not intended for children under the care of, or who have previously seen a cardiologist, or for “second opinions” about other heart conditions. Heart screening events are specifically looking for the most common causes of SCA in young athletes.
CPR and AED training will also be available at the heart screening event.
If your child exhibits any of the warning signs (see FAQ question below for warning signs) that might put him/her at risk for SCA, make an appointment with your child’s primary care physician or pediatric cardiologist. If your child does not have symptoms (and many do not), you can still request that an EKG be done. The amount of money that you spend on the out of pocket expense for an EKG will be worth the peace of mind that you gain in knowing that your child is less at risk for SCA.
Primary prevention, through heart screenings, is a vital goal of Heart for Athletes. Currently, the standard approach of screening an athlete with an annual physical exam and review of medical history misses over 96% of those at risk for sudden cardiac arrest. A heart screening will detect approximately 60% of those at risk. Some conditions may not be detected and some causes cannot be prevented, but identifying as many at risk athletes as possible is the fundamental focus of the screening event.
Secondary prevention of SCD involves being ready to immediately treat someone who has a SCA. This is accomplished through community awareness and preparedness. The more people who recognize SCA when it occurs, and who are prepared to react appropriately with the proper CPR technique and AED equipment, the safer our young athletes and communities will be.
An emergency plan must be efficient and structured. 911 should be called immediately. Anticipated responders must be trained in CPR and AED use. There must be access to an AED for early defibrillation. This plan of early activation of EMS, early CPR, early defibrillation by AED and rapid transition to advanced care is outlined in the American Heart Association’s Cardiac Chain of Survial.
It is a common misconception that sudden cardiac arrest (SCA) and a heart attack are the same thing. They are not.
SCA is an electrical problem, whereby the arrhythmia prevents the heart from pumping blood to the brain and vital organs. There is an immediate cessation of the pumping function of heart. In many cases, there are no warning signs or symptoms.
A heart attack is a “plumbing” problem caused by one or more blockages in the heart’s blood vessels, preventing proper flow, and the heart muscle dies. Symptoms include chest pain, radiating pain in left arm, between shoulder blades, and/or jaw, difficulty breathing, dizziness, nausea and vomiting, and sweating. In some cases, a heart attack may lead to a sudden cardiac arrest event.
Warning signs prior to a SCA may include any of the following:
- Fainting or near fainting during or immediately after exercise
- Excessive and unexplained fatigue associated with exercise
- Shortness of breath with exercise
- Racing heart
- Unusual chest pain or discomfort
Many young SCA victims have no symptoms until the cardiac arrest. Ironically, although they lead active and healthy lifestyles, young athletes are almost 3 times more likely to suffer from sudden cardiac arrest when compared to non-athletes. Those with an underlying heart condition are up to 100 times more likely. Heart screenings are important because warning signs may be nonspecific and confusing in athletes who often train to physical exhaustion.
Often misinterpreted or disregarded, these warning symptoms can inadvertently misdirect the patient away from cardiac evaluation, resulting in a delay of correct diagnosis and treatment.
Primary prevention for an athlete should include an annual physical exam coupled with a heart screening every two years. Coaches, parents and athletes should be familiar with warning signs that could potentially indicate a cardiac problem, necessitating follow up care with a cardiologist (see previous FAQ for list of warning signs).
Secondary prevention is the avoidance of sudden cardiac death (SCD) after sudden cardiac arrest (SCA) has occurred. Schools, gyms and ballparks should be equipped with AEDs and trained staff to execute an emergency plan should a SCA occur. Parents, spectators, and fellow athletes should also learn how to perform CPR and know where the nearest AED is and how to use it.
When someone collapses from SCA, immediate cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) are essential for any chance of recovery. For patients in “VFib” (ventricular fibrillation), studies show that if early defibrillation is provided within the first minute, the odds are as high as 90% that the victim’s life can be saved. For each minute that care is delayed, the survival rate decreases by 10%.
Bystander CPR is initiated only 30% of the time when a SCA is witnessed, and, if initiated, more than 40% of chest compressions are of insufficient quality. There is an increasing awareness of a disparity in SCA outcomes among communities. You can make a difference in your community by ensuring that the links in the Cardiac Chain of Survival are strong.
As many as 30 to 50 percent of victims would likely survive if CPR and AEDs were used within five minutes of collapse. Less than 8% of people who suffer from a SCA outside a hospital survive. Training in CPR and on-site AED programs are the only means of achieving early defibrillation and improving survival from SCA and making our community HEARTSafe.