Sudden Cardiac Arrest in Young Athletes: Questions and Answers
The country’s eyes were on Damar Hamlin on January 2nd when the Buffalo Bills safety collapsed on the football field after suffering cardiac arrest in front of a shocked stadium and live TV audience. Hamlin was immediately given CPR before being rushed to the hospital. After nine days, Hamlin was discharged and continues to recover at home. The incident naturally raised many questions for the families of the heart warriors we care for at Children’s Healthcare of Atlanta Cardiology. Children’s pediatric cardiologist and Medical Director of Project S.A.V.E. Robert Whitehill, MD, agreed to answer some of the most common questions he and his colleagues have received since Hamlin’s sudden cardiac arrest.
Q: What is sudden cardiac arrest? How does it differ from a heart attack?
A: SCA occurs when the heart suddenly and unexpectedly stops beating normally—usually a result of a heart electrical abnormality—stopping blood flow to the brain and other vital organs. SCA is different from a heart attack, which is caused by a blockage of blood flow to the heart through one of the coronary arteries. While SCA is very rare in children and adolescents, it does happen, and if not treated within minutes, can lead to death.
Q: What do we know about the risk and the frequency of sudden cardiac arrest in young athletes?
A: Without mandatory reporting, we don’t know the exact frequency of SCA, but we do know that it’s a very rare occurrence. Although they don’t happen often, they have a large and far-reaching impact, as we saw from Damar Hamlin’s event. However, because the risk is low, unless a young athlete is told by their cardiologist to refrain from playing sports, they should continue to be active and do what they love.
Q: What causes sudden cardiac arrest?
A: Typically, SCA in young people is due to underlying abnormalities of the heart, such as unrecognized congenital heart disease, heart rhythm abnormalities or heart muscle abnormalities such as hypertrophic cardiomyopathy, coronary artery abnormalities and long QT syndrome.
It can also happen in normal hearts due to commotio cordis, a rare, lethal disruption of the heart rhythm occurring because of a perfectly timed blow to a pinpoint location during the cycle of a heartbeat. Only 10 to 15 incidences pf commotio cordis—typically seen in baseball or lacrosse players—are reported worldwide per year. Commotio cordis occurs upon impact within a narrow window of about 40 milliseconds in the cardiac electrical cycle, which explains why it’s so uncommon.
Q: Are there early signs or symptoms of sudden cardiac arrest to watch for?
A: The warning signs of possible heart risk in children include:
- Fainting, nearly fainting or seizure-like activity during or immediately after exercise
- High emotions or being startled
- Unusual chest, shoulder, back or jaw pain during exercise
- Excessive, unexpected, and unexplained fatigue or shortness of breath with exercise
- Unexplained heart murmur or high blood pressure
- Premature, unexplained death in a close relative younger than 50; or close relatives with conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy, long QT syndrome, Marfan syndrome or clinically important arrhythmias.
Q: What is the chance of having a sudden cardiac arrest if a family member had one?
A: Depending on the condition of the family member, the risk may be very low or much more likely. It’s important to review the family history with a cardiologist and genetic counselor to accurately interpret the risk.
Q: If a child has had sudden cardiac arrest in the past, can steps be taken to prevent another one?
A: In many instances, a child can return to full activity if there is a problem with the heart that can be fixed. With an issue like commotio cordis, the person should be able to return to activity. However, sudden cardiac arrest can happen again, and it’s important to receive close follow-up care from your cardiologist. If medications are prescribed, the patient must strictly comply with taking them. In addition, families and patients should educate themselves, their coaches and teachers about warning signs and symptoms.
Q: What is important for physicians to know about sudden cardiac death?
A: General physicians should know how to properly screen patients for possible heart disease using guidelines published by the American Academy of Pediatrics. Physicians should refer the siblings and parents of patients who have experienced SCA for heart screening. They also have a role in advocating for action plans and defibrillators in schools and in sports facilities.
Q: What can parents do to help prevent sudden cardiac arrest?
A: The most important thing to do is have kids appropriately screened regardless of activity level and educate yourself on warning signs and symptoms as well as your family history.
Q: Why is it important to have a defibrillator available at all athletic events?
A: With a quick assessment, CPR and defibrillation as needed within five minutes of the SCA, there is a much higher likelihood—about 80 to 85 percent—of a positive outcome with neurological faculties still intact. Without an urgent assessment and action plan, positive outcomes plummet to around 10 percent or less. Although we do our best with screening, sudden cardiac arrests still happen, and there’s no way to predict an event like commotio cordis. Having a defibrillator available at sporting events has saved the lives not just of athletes, but spectators, school staff members and others in the community.
Q: How can coaches and parents tell the difference between sudden cardiac arrest and a player collapsing because of exhaustion or other causes?
A: You can tell the difference. People trained in CPR learn how to assess someone for cardiac arrest versus exhaustion, but the first several steps are the same in both cases, including calling for help immediately. Learning CPR empowers people to know what to do and possibly save a life.
Q: What is Project S.A.V.E.?
A: Project S.A.V.E.—which stands for Sudden cardiac arrest, Awareness, Vision for prevention, Education—was launched by Children’s Healthcare of Atlanta in 2004 with the mission of preventing sudden cardiac arrest in children, teens and young adults in Georgia communities. The program has brought AED and CPR training to every county in Georgia and has awarded more than 1,450 HeartSafe certificates to Georgia schools and colleges. Since its inception, Project S.A.V.E. has saved more than 125 lives, and there are many more “downstream” saves that occur after people receive Project S.A.V.E. training.
Q: What is Project ADAM?
A: Project ADAM is the national version of Georgia’s Project S.A.V.E.
Q: How can I get Project S.A.V.E. into my child’s school or athletic league?
A: Any community in Georgia can become a Project S.A.V.E. HeartSafe School or Community by requesting a consultation from our staff and completing a checklist demonstrating successful implementation of our program. We also provide resources for CPR and AED training and what to do in the event of life-threatening emergencies and non-life-threatening emergencies. Anyone who has questions about the program or the requirements to be a Project S.A.V.E. Heart-Safe School or Community can call 404-785-5204 or email ProjectSave@choa.org.
Q: Did this event have anything to do with COVID-19 vaccines?
A: There is no evidence that COVID-19 vaccines lead to cardiac arrest, and we continue to encourage all our patients to get their vaccines and discuss any concerns with their doctor.
Sudden Cardiac Arrest: What is It and How Can it be Prevented in Our Kids?
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Contributing Cardiologist: Robert Whitehill, MD
For more information about Children’s Healthcare of Atlanta Cardiology and our pediatric cardiology specialists, click here.