Not Missing a Beat: Child Athletes and Cardiovascular Issues

Kids and sports, sports and kids; in many homes, it’s the norm. While almost all kids can participate in sports or run and play with friends without the thought of any heart problems, a small percentage of young people may have a known or unknown heart condition. Because athletes are often regarded as very healthy, if a child experiences sudden cardiac arrest or even death, it can lead to fear and confusion about how safe it is to participate in sports.

Estimates vary, but some reports suggest that about 1 in 50,000 to 1 in 80,000 young athletes die of sudden cardiac death each year. In comparison, the occurrence of sudden cardiac arrest in the general population is about 1 in 1,000 yearly.

While it seems illogical, some of the strongest, fittest and youngest among us may be susceptible to a life-threatening heart event. The challenging part is that it’s often hard to know if children and teens have a severe heart issue. It can be something they were born with that wasn’t noticed, or something that was acquired more recently.

Regular, day-to-day activity may not necessarily cause symptoms, but problems may show up for young athletes during extreme exercise or sports, when the heart is under more stress. A heart condition can stay dormant until heavy exertion triggers it.

A genetic heart defect can trigger a cardiac event, including the most common, hypertrophic cardiomyopathy, in which gene mutations in the heart muscle cause the walls of the heart chambers to become thick. The heart becomes stiff, reducing the amount of blood pumped, taxing the body during strenuous exercise.

Of course, we all know physical activity is beneficial in many ways. Exercise reduces the risk of chronic disease, improves balance and coordination, helps with weight management and boosts self-esteem. Highly strenuous physical activities, however, can potentially put uncertain stress on the heart, especially for those with heart conditions. In addition to hypertrophic cardiomyopathy, other conditions can also lead to sudden cardiac arrest in young people.

Congenital Heart Defects
Some people are born with heart and blood vessel changes that can reduce blood flow and lead to sudden cardiac arrest. Defects can result from faulty embryo development, structures that don’t develop properly and misplaced structures.

Heart Rhythm Disorders
One example is Long QT syndrome, a condition that can cause fast, chaotic heartbeats linked to fainting and sudden death, especially in young people. Another is supraventricular tachycardia, or SVT, in which electrical signals in the heart’s upper chambers travel abnormally in the heart.

Blunt Chest Injury
A blow to the chest that causes sudden cardiac death is called commotio cordis, which can occur in athletes hit hard in the chest by sports equipment or another player. A recent example is NFL player Damar Hamlin, who received a hard blow to the left side of his chest during a tackle. A recent study noted 94 percent of victims of commotio cordis were male, and their average age was 19. A little less than two-thirds of the cases involved sports, and most of those involved a projectile of some sort, such as a baseball, softball or hockey puck.

Worried? Don’t Panic
Parents and coaches might be concerned about a young athlete’s possibility of cardiac arrest. Experts generally agree it’s good to be aware but not overly concerned, as very rare and unusual circumstances cause cardiac arrest. Prevention is possible. Young athletes should visit their pediatrician for a full physical and be screened for cardiac irregularities before participating in a competitive sport. Each athlete should have a yearly examination performed by a trained practitioner using currently recommended guidelines. Experts say this is an important first step in identifying at-risk individuals.

The American Heart Association and American College of Cardiology also recommend a 14-point screening questionnaire performed by a health care professional to evaluate a young athlete’s heart risks. Athletes with positive findings should be referred for further evaluation and testing. However, both the organizations do not endorse mandatory electrocardiograms for everyone, though, as mass testing of symptomless athletes can possibly hurt more than help. The tests are prone to false positives, which can stress parents needlessly and put young people at risk of being exposed to unwarranted testing and unnecessary procedures while preventing them from playing.

Sudden death in youth is rare, but any amount of prevention is worth it. Even though a youth’s heart issue could pose a risk during intense exertion, it doesn’t prevent them from playing sports altogether. Current medical knowledge now weighs risks to the individual patient versus the many benefits of participation, making every effort to keep kids playing their sports.

Cardiovascular exercise is beneficial and encouraged for a child’s overall health. Whether they can safely participate in exercise or sports depends on their specific condition and doctor’s advice.

Sources: mayoclinichealthsystem.org, heart.org, chla.org and acc.org.