On the morning of March 26, 2008, Rebecca Knowles heard her husband cry for help from their son's bedroom. There, they found 7-year-old Cameron blue in the face and without a pulse after he tried to wake him up for school.
Knowles, a registered nurse in Rochester, N.Y., immediately began CPR, and the paramedics arrived soon after. Firefighters shocked Cameron's heart three times before it started to beat again.
Doctors later said that Cameron had been dead for more than 12 minutes before his parents found him. After several tests, doctors diagnosed Cameron with long Q-T syndrome, a heart rhythm disorder that can cause fast and chaotic heartbeats.
The rapid beats can cause seizures or fainting spells, and in some cases, the heart may beat so erratically that it can bring on sudden death.
"We didn't know he had underlying heart condition, and most people don't until something like this happens," said Knowles. "They almost always find this problem after someone has already arrested."
Knowles said that their home security alarm, which had accidentally gone off that morning, likely triggered Cameron's cardiac arrest.
An 8-year-old boy from Lincoln County, N.C., did not have the same fate as Cameron. After local emergency services received a call at 8 a.m. Thursday morning about a boy at Pumpkin Center Intermediate School who had difficulty breathing, the boy was rushed to Carolinas Medical Center in Charlotte. He died later that evening, according to local news station WBTV.
The boy's parents wish to keep his identity and the details of his case private.
While lethal heart problems in otherwise healthy children are rare, there are a number of conditions that could explain a sudden cardiac death or life-threatening heart attack in young patients.
The first important distinction to make is between a heart attack and cardiac arrest, says Dr. Amy Peterson, a pediatric cardiologist from American Family Children's Hospital in Madison, Wisc.
Heart attack occurs when there is an insufficient amount of blood delivering oxygen to the heart and part or all of the heart muscle begins to die. This could be due to blockages in the arteries, heart disease, or structural abnormalities of the heart muscle or the arteries. Cardiac arrest on the other hand refers simply to a heart that has lost its rhythm and stops beating, which could occur for a number of different reasons, she says.
"In general, heart attack in children is extraordinarily rare and when kids present with chest pain it is at the bottom of the list of things we suspect," Peterson says. Cardiac arrest is less rare but still very uncommon, she says, but there are a number of ways that parents can be on the lookout for undiagnosed heart conditions that may cause a problem
Pediatric Heart Problems
True heart attack in children can occur in rare circumstances where there is a genetic predisposition to exceptionally high cholesterol. In this case, a child who may or may not be overweight, can suffer from arterial blockages similar to those which cause heart attack in adults with hypercholesterolemia, Peterson says. In these cases, a family history of severe high cholesterol is the best indicator that a child might be at risk for this kind of problem.
Other reasons for heart attack would include a structural abnormality of the heart or arteries that a child would be born with. Unfortunately, for these issues, the first symptom that presents can often be a heart attack or sudden cardiac death.
Another reason that children might suffer from a heart attack is as a complication from Kawosaki Syndrome, a relatively common illness in infants and children that results in an inflammation of the arteries, says Dr. Rene Herlong, a pediatric cardiologist with Singer Heart & Vascular Institute, where the boy from North Carolina was treated. Fortunately, this syndrome is very treatable these days, once diagnosed, will usually not escalate to the point of heart attack, he adds.
Cardiac arrest due to arrhythmias and other inherited heart conditions are much more likely to afflict children than heart attack itself, however.
Hypertrophic cardiomyopathy, where the structure of the heart muscle is abnormal, and myocarditis, where the heart muscle itself becomes inflamed, are more likely heart problems for children and will often result in an arrhythmia that prevents the heart from beating normally, says Dr. Harry Kaplovitz, a pediatric cardiologist at Maimonides Hospital in Brooklyn. Cardiomyopathy is often inherited, he adds, but for myocarditis, there often isn't a clear answer for why it occurs.
An inherited predisposition to an arrhythmic beat is another culprit for cardiac arrest that can be difficult to diagnose, Peterson says. Because the child will not always have an erratic heartbeat, a medical exam would have to specifically catch a period of arrhythmia in order to catch the problem.
Warning Signs and Quelling Fears
So what can a parent do to protect their child against sudden cardiac death?
In some cases, diagnosis can be incredibly difficult as the first symptom of a problem will be cardiac arrest or sudden death. Examples of this have been widely publicized in cases of teen athletes who drop dead seemingly out of no where on the field or court. While these instances are devastating, Herlong urge parents to not become overly worried that this might happen to their child as it "as rare as walking outside and getting hit by lightning."
"I would try to take away fear from parents," he says. "I would want to reassure parents of children that have been receiving routine health care and who are not known to have any kind of heart condition that the chances here are vanishingly small."
But if your child suffers from chest pain, especially during exercise, or faints during exercise, this is something that should be checked out by a medical professional as it could be a sign of a heart condition, he says.
Knowing the family history and being away of any genetic predispositions towards heart conditions is one of the best things a parent can do, Peterson says. And when a heart attack or cardiac arrest occurs, it is essential to give the child basic life support in the form of CPR or defibrillation, if a defibrillator is available, as soon as possible until advanced life support from medical professionals arrives.