Ensuring Children's Cardiac Health: The Role of Screening and Awareness

Title: Ensuring Children's Cardiac Health: The Role of Screening and Awareness

Introduction: As the director of the Student Heart Check Program at my previous hospital for several years, I had the privilege of detecting numerous cardiac conditions that, if left undiagnosed, could have led to sudden cardiac events during exercise or at rest. In this article, we will discuss various cardiac conditions that are associated with such events and the importance of cardiac screening for children, particularly those engaged in competitive sports.

Cardiac Conditions and Screening:

Hypertrophic Cardiomyopathy: Hypertrophic cardiomyopathy is a condition in which a portion of the heart muscle thickens excessively, potentially obstructing blood flow and increasing the risk of malignant arrhythmias, especially during physical activity. This condition is often hereditary and it is usually asymptomatic in children during the first 10 years of life. Early diagnosis through cardiac ultrasound and ECG is critical. If detected, medications can help alleviate the obstruction and delay the disease's progression. In advanced cases, surgical intervention or implantable cardioverter defibrillator placement may be necessary. Screening first-degree relatives is also imperative. Competitive strenuous sports are generally not recommended.

Dilated Cardiomyopathy: Dilated cardiomyopathy can result from genetic mutations or other factors such as viral infections, medications, or metabolic conditions. Children may remain asymptomatic or show mild cardiac dysfunction, during the first years of life. Early detection using cardiac ultrasound and ECG is crucial. Medications can aid in recovery and remodeling of the heart muscle, delaying disease progression. In later stages, implantable cardioverter defibrillators or cardiac transplants may be the only options. Competitive strenuous sports are generally not recommended for affected children. Screening of first-degree relatives is essential.

Myocarditis: Myocarditis is often triggered by viral infections but can also result from medications or drugs. There has been an increase in myocarditis cases associated with COVID-19 and mRNA vaccines. Symptoms may include chest pain, fatigue, and shortness of breath. Diagnosis involves echocardiograms and ECGs, with cardiac MRI being the gold standard. Children diagnosed with myocarditis require close monitoring by cardiologists and should refrain from exercise for 4-6 months. The initial treatment is usually symptomatic with Motrin, but in more severe cases it requires intravenous medication to help the poor ventricular function. Children are usually admitted to the hospital for a couple of days. 

Wolf Parkinson White: Wolf Parkinson White is characterized by an accessory pathway in the heart that can lead to supra-ventricular tachycardia (SVT). Treatment options include medications (beta-blockers) or cardiac ablation, performed by electrophysiologists. After the procedure, most children can resume exercise. Screening first-degree relatives is essential. Children are usually asymptomatic by the time they are diagnosed with WPW. 

Prolonged QT: Prolonged QT syndrome delays cardiac repolarization, increasing the risk of malignant arrhythmias. Most affected children are asymptomatic, but some may experience fainting, which must be distinguished from benign vasovagal syncope. Beta-blockers and, in some cases, implantable cardioverter defibrillators are used for management. Screening first-degree relatives is crucial.

Screening Programs and Awareness: These cardiac conditions most of the time can be present with a normal cardiac exam. Therefore, conducting cardiac screening, including echocardiograms and ECGs, is crucial. While such screenings are not widely recommended in the United States, countries like Italy have successfully implemented them, at least requiring an ECG in each child before they start competitive sports; the ECG interpretation has shown to have a low false-positive or false-negative results when interpreted by experienced readers.

In the United States, some adult and pediatric cardiologists, hospitals, and states offer these services, although they may require substantial resources. Some programs focus on secondary prevention, teaching CPR and AED use, which is also very important and it has been proven to save lives when done properly. Some states are mandating for schools to have an AED on the premises and for teachers and students to be familiar with the location and how to operate an AED and how to perform CPR. 

I will explain below what are the two more important tests to diagnose these conditions: echocardiogram and electrocardiogram (ECG).

An ECG records the electrical signals that control each heartbeat. These signals trigger the heart's muscles to contract and pump blood throughout the body. By capturing this electrical activity, an ECG can detect irregularities or abnormalities in the heart's rhythm, helping healthcare professionals diagnose heart conditions. During an ECG, small electrodes (usually 10) are attached to the skin on the chest, arms, and legs. These electrodes are connected to a machine that amplifies and records the heart's electrical signals as a series of waves on graph paper or a digital display. The entire process is painless and typically takes just a few minutes.

An echocardiogram is a painless and safe imaging technique that uses high-frequency sound waves, also known as ultrasound, to create real-time images of the heart. These images, known as echocardiograms, provide detailed information about the heart's size, shape, and how effectively it is pumping blood. During an echocardiogram, a specially trained technician (sonographer) or a cardiologist applies a gel to the patient's chest and uses a small, hand-held device called a transducer. This transducer emits sound waves that bounce off the heart's structures, creating a visual representation on a screen. The resulting images are dynamic and provide a comprehensive view of the heart's chambers, valves, and blood flow patterns.

Below, is a quick explanation of how to do CPR and how to use an AED. 

First, call 911 and ask someone to bring the AED. if the child is unresponsive, open the Airway: place the child on their back on a firm surface. Tilt their head backward slightly to open the airway. then check for Breathing; if there's No Breathing: close the child's nose and give two rescue breaths. Then check for a Pulse: find the carotid artery (on the side of the neck) and check for a pulse. Do this for no more than 10 seconds. If there is no pulse, or you're unsure, begin chest compressions. Keep your elbows straight and use your upper body weight to push down hard and fast. Compress the chest at least 2 inches deep at a rate of 100-120 compressions per minute. Allow the chest to fully recoil (come back up) between compressions. For child CPR, use a ratio of 30 compressions to 2 rescue breaths. If there are no signs of a pulse and the AED arrives, then use it. Apply the AED to the chest, follow the instructions in the manual, turn on the AED, and follow the instructions. the AED will tell you what the cardiac rhythm is and if a shock is advisable. Make sure nobody is touching the child before shocking the child.

Conclusion: In conclusion, raising awareness about the importance of cardiac screening for children is paramount. Early detection of cardiac conditions through proper screening can lead to medical or surgical treatment, allowing many children to resume physical activities. Parents and schools should take advantage of cardiac screening programs, especially for children engaged in competitive sports. Be proactive in discussing any cardiac symptoms your child may have with a pediatrician and inquire about any family history of cardiac disease in young people. By promoting both primary and secondary prevention, we can help ensure the cardiac health and safety of our children.