Sudden cardiac arrest in children and young athletes: the importance of a detailed personal and family history in the pre-participation evaluation

Abstract

Healthcare providers have become more aware of and concerned about paediatric sudden cardiac arrest. The diseases predisposing a patient to sudden cardiac arrest are all infrequently encountered. However, a detailed and comprehensive patient and family history may reveal warning signs and symptoms that identify a patient at higher risk for sudden cardiac arrest. Since many of these diseases are genetic, extensive family evaluation may uncover a previously undetected cardiac disease process and as well direct the development of a complete family evaluation and treatment plan. Published data document that in many cases preceding warning symptoms and signs are present, but may be misinterpreted or disregarded by medical staff. Attention to the details of patient history, family history and physical exam is critical to the success of any detection strategy, which can and should be widely applied.

Something Old, Something New

“…Retrospective reviews performed following an athlete's sudden death found that between 10% and 53% of victims had a possibly related cardiovascular disease or early death in their family. 12 The autosomaldominant pattern of inheritance of most hereditary heart diseases may explain this observation, because these disorders are often inherited from a parent and may have been present in a family for generations. 13 However, even following the most comprehensive review of an athlete's family history, certain features of inherited cardiovascular diseases preclude a clinician from easily recognizing the risk of disease, even if it truly exists in the family (Box 1).…”

Pediatric Sudden Cardiac Arrest

“…The reader is directed to reference texts and previous publications for more detail about each of these individual conditions. 14,15 …”

Preventing sudden cardiac death in the young: Is electrocardiogram screening the most effective means?

“…The most efficient and effective venue is also unclear. Rather than creating specific screening clinics, it may be a consideration to first use a 'casefinding' approach that uses the expertise of the primary care physicians who ideally have access to longitudinal clinical follow-up data, a thorough family history and a relationship with the individual, which would facilitate information gathering and sharing, and the opportunity for diagnosis (2,35). • There will be a significant false-positive rate • There will be an important false-negative rate…”