By Bobby V. Khan, MD, PhD, Chairman, Board of Directors Sudden Cardiac Arrest Foundation, and Assistant Professor Medicine/Cardiology, Emory University School of Medicine, Atlanta, GA
Jill was a healthy teenager who was very active in her school and church activities. She had been selected to her cheerleading squad at high school and was very excited about it. One day during cheerleading practice, she collapsed and died suddenly. The autopsy revealed that she had a heart abnormality that had never been detected. Needless to say, this was a tremendous shock to her family and friends, and they will always wonder if something could have been done to prevent her sudden and unexpected death.
Though it’s true that sudden cardiac arrest (SCA) is a primary cause of death in adults (there are about 300,000 sudden cardiac deaths each year in the United States alone), it’s quite rare in the young. Around the world, there are millions of children and young adults who are able to live a healthy life and do whatever they want without incident.
What can cause SCA in young people?
The causes of SCA and death in young people vary. In most cases, a coroner discovers during an autopsy that SCA and the ultimate demise was due to a cardiac abnormality. Other causes of deaths are not determined because the cause could never be found. Sometimes, there may be a genetic disorder, and we may need to do further genetic testing to confirm that it’s heart-related. However, what all SCA episodes have in common is the final common pathway that leads to death. For a variety of reasons, something causes the heart to degenerate into a chaotic and abnormal electrical rhythm and the heart beats out of control. This abnormal heart rhythm is known as ventricular fibrillation.
Can sudden death in young people be prevented?
Yes, it often can. Many times these deaths occur with no advance warning. However, there are a couple of signs that can indicate trouble. The first is sudden and unexplained fainting that occurs during physical exertion. This is known as syncope. In addition to syncope, seizures can also occur. So if someone passes out while running in a race, that’s a warning sign. The other major warning sign is a family history of unexplained deaths before the age of 50. If there are deaths like this in your family, it should prompt you to pay close attention and perhaps talk with your doctor about screening options.
Who should be screened for sudden death risk factors?
This is a controversial topic. In Italy and Japan, authorities screen young people with the use of an electrocardiogram that records the electrical signals present in the heart. However, the problem with screening is that these tests can lead to false-positive results — tests that look suspicious, but turn out normal. But if someone has risk factors, it’s important to get checked. For example, if someone in your family has died young from causes related to SCA, it’s essential that an autopsy be done on that person to determine the cause of death. In addition, all first-degree relatives of the deceased must be evaluated carefully — that means parents, siblings and children.
What is the bottom line?
SCA and sudden death is rare in the young. But SCA can happen, and it’s important to determine how we can find these people who are at risk for SCA. It’s estimated that 6-8,000 deaths result from SCA in the young on an annual basis. That is something to be concerned about.