Two 8-Year-Olds Die of Cardiac Arrest in One Week: Understand Why Sudden Cardiac Arrests Happen In Children

Grim coincidence or a warning sign? Two 8-year-old girls lose their lives to cardiac arrest in a single week in India, causing an alarming concern. Read this blog to learn what causes cardiac arrest in children, what are the early signs and symptoms, and how it can be prevented. 

In a shocking turn of events, just a couple of days after the sudden death of 8-year-old Tejaswini in Karnataka, another young life has been reportedly lost to cardiac arrest. The latter, 8-year-old Gargi Ranpara, collapsed in her school in Ahmedabad, Gujarat on 10th January. 

Sudden Cardiac Arrest In Children

Gargi Ranpara 

The principal of the school, Sharmishtha Sinha, told PTI that Gargi arrived at the school feeling completely fine, however, on the way to her classroom, she felt a little uneasy. The class 3 student sat on a chair, and soon after, lost consciousness. She was rushed to the hospital where the doctors confirmed that she had suffered a cardiac arrest. The CCTV footage shared by the school captures the exact sequence of events.

Tejaswini 

Tejaswini’s case is somewhat similar to Gargi's. The 8-year-old from Chamarajanagar, Karnataka also collapsed on her school premises after feeling dizzy and losing her balance in the corridors, while she was with her classmates. She was rushed to the hospital immediately, however, the doctors were not able to revive the little girl. It was later declared that she died due to cardiac arrest. 

What Is Sudden Cardiac Arrest (SCA)? 

Sudden cardiac arrest is said to occur when a person's heart ceases to function unexpectedly, without a prior warning sign. This is caused by the sudden and abrupt disruption of the heart's electrical conduction which can be due to various underlying factors. This is most commonly seen in adults, especially males, and children lying in the age group of 10 to 19 years. However, it is pertinent to understand that SCA can affect children of any age group, even infants. 

What Happens During A Sudden Cardiac Arrest?

The human heart is like a pump that beats 24x7 to ensure continuous flow of oxygenated blood throughout the body. The heart has a special conduction system made up of a complex network of nodes and cells (conducting cells and muscle cells) that generate and transmit electrical signals to different parts of the heart, to regulate its contraction and expansion, or in other words, its pumping action. 

When the conduction system of the heart is not functioning optimally, it negatively impacts the pumping capacity of the heart and eventually the heart, being unable to meet the requirement of the body, ceases to function. This is what we commonly know as sudden cardiac arrest. 

Difference Between Sudden Cardiac Arrest & Heart Attack

Cardiac arrest and heart attacks are two different terms, often used interchangeably owing to their nature and occurrence, however, both are quite different from each other. Sudden cardiac arrest is solely linked to an abnormality in the electrical conduction system of the heart which affects its ability to pump blood, whereas heart attack is caused by a blockage which prevents optimal blood circulation in the body. 

How Common Is Sudden Cardiac Arrest In Children?

“Sudden cardiac arrest (SCA) is rare in children with estimates between 1 and 3 cases/100,000 children.” [1] 

Most of the cases are seen in kids who did not present with any major symptoms previously. It is pertinent to note that despite thorough structural evaluation, whenever a fatal or potentially life-threatening paediatric cardiac arrest event occurs, the underlying explanation remains unidentified in nearly 50 percent of the cases.[2]  

What Causes Sudden Cardiac Arrest In Children?

The disruption of the heart’s electrical conduction that can ultimately lead to a sudden cardiac arrest may be caused by several factors that include, but are not limited to:

• Allergic reaction 

• Electrocution 

• Rigorous physical activity 

• Severe viral infection 

• Chest injury

• Reaction to prescription medication 

• Underlying heart disease 

Risk Factors Of Sudden Cardiac Arrest In Children

There are several factors that are known to increase the risks of sudden cardiac arrests in children. These include:

• Arrhythmias

• Marfan Syndrome 

• Congenital heart diseases

• Arrhythmogenic cardiomyopathy

• Hypertrophic cardiomyopathy

• Myocarditis 

Link Between Family History & Sudden Cardiac Arrest

Sudden cardiac arrest has been linked with a family history of known heart abnormalities and certain heart diseases like:

• Long QT syndrome

• Brugada syndrome

• Catecholaminergic polymorphic ventricular tachycardia (CPVT)

• Hypertrophic cardiomyopathy (HCM)

• Arrhythmogenic right ventricular cardiomyopathy (ARVC) 

• Familial cardiomyopathies

Signs/Symptoms Of Sudden Cardiac Arrest In A Child

In the majority of cases of sudden cardiac arrest, there are no early warning signs and it happens very abruptly. In 30 to 50 percent of the cases, there may be some signs but these are often misinterpreted. These are:

• Chest pain and discomfort following rigorous physical activity 

• Syncope or unexplained fainting

• Recurrent episodes of fainting

• Dizziness

• Palpitations 

• Fatigue 

• Breathlessness 

CPR For Sudden Cardiac Arrest In Children 

If you suspect that a child has a cardiac arrest, perform CPR (Cardiopulmonary resuscitation) if you are able to and rush to the hospital. This can help to bring back a stooped heart into rhythm if done in the right way and at the right time. If the child is 1 year old or above, here’s what you need to do.

Compressions:

• Lay the child on their back and sit down on your knees beside them.

• Place the heel of one hand in the center of the child's chest, on the lower half of the breastbone. You can use both hands for an older child.

• Position yourself directly over the child’s chest and press down firmly with your arms straight, covering at least one-third of the depth. Release pressure. This counts as 1 complete compression. 

• Try to aim for 100 to 120 compression in a minute while maintaining proper rhythm. 

Mouth-To-Mouth

• Open the child’s airway by performing a head tilt. Place one hand on the child’s forehead and gently lift their chin by placing your other hand under the chin to tilt the head back.

• Block the nasal pathway by pinching the soft part of the nose. 

• Open the child’s mouth using your fingers, take a deep breath, open your mouth, and create a firm seal over the child’s mouth with your lips.

• Blow steadily into the child’s mouth for about 1 second, ensuring that enough air enters to make the chest rise.

• After you do so, check if the child’s chest falls, and listen or feel for air being expelled. Maintain the head tilt and chin lift position.

• If the chest doesn’t rise, check the mouth for any obstructions and remove them. Repeat the breath if necessary.

Give 30 compressions followed by 2 breaths. This is often termed as 30:2. Try to do 5 sets of 30 compressions and 2 breaths for around 2 minutes. If you are only doing the compressions, aim for 100 to 120 in a minute.

Preventing Sudden Cardiac Arrest In Children

Sudden cardiac arrest happens without a warning sign and even in children who are otherwise healthy. The best possible ways to protect your little ones are:

• Take your child for regular heart assessments, especially if you have a family history of heart disease. 

• Provide proper sports gear if your little one loves to play rigorous sports like baseball, cricket, basketball, lacrosse, and football.

• Identify any unusual symptoms and bring them to the notice of a pediatrician. 

Source:

1. Couper K., Putt O., Field R., et al. Incidence of sudden cardiac death in the young: a systematic review. 

2. Unexplained sudden cardiac arrest and sudden cardiac death in the young: What is killing these young people when nothing is found?