1 in 300 youth has an undetected heart condition that puts them at risk for sudden cardiac arrest. Prevention of SCA is based on a combination of (i) ECG heart screenings, (ii) AED placement, (iii) CPR training, (iv) understanding the cardiac chain of survival, (v) developing a cardiac emergency response plan, and (vi) raising awareness and passing policy to address SCA (which is discussed on our Legislation webpage).
Parent Heart Watch provides an excellent overview on the importance of ECG heart screenings as a key SCA prevention tool: “While the prevailing perception is that heart disease is primarily an adult disease, there are thousands of seemingly healthy youth who suddenly and unexpectedly suffer fatal or severely debilitating consequences due to undetected heart conditions ever year. In fact, the standard approach to patient health history and physical examinations misses about 90% of youth at risk for SCA.
Youth are not adequately screened for heart conditions. Parent Heart Watch advocates for heart screenings in youth for the early detection of risk factors and conditions associated with SCA. Because most heart conditions that can lead to SCA are not detectable with a stethoscope, a simple, noninvasive, and painless test with an electrocardiogram (EKG or ECG) and echocardiogram, a comprehensive review of personal and family heart history, and the proper assessment and follow-up of warning signs and symptoms are the best tools for primary prevention. Approximately 2% of youth that are heart-screened are diagnosed with a heart abnormality or concern, while 1% are diagnosed with a life-threatening heart condition. As children grow their hearts change and repeat evaluations are recommended through age 25.
A thorough family history and physical examination that includes an electrocardiogram (ECG or EKG) as a baseline test can help detect approximately two-thirds of the heart conditions that can lead to SCA. Further screening with an echocardiogram can often detect the balance of conditions beyond the scope of an EKG.
Frequently, the warning signs and symptoms in youth go undetected or are misdiagnosed, with fainting being the #1 sign of a potential heart condition. Those who work and live with youth must be aware of these signs and symptoms. If any exist, they should be reported to the youth’s physician immediately, with community caregivers and coaches also advised of the condition.
Below are some of the most common heart screening tests:
An ECG is a simple, painless, noninvasive test that measures and records the electrical activity of the heart. With each heartbeat, the heart’s natural pacemaker sends an electrical impulse that travels along a nerve pathway and stimulates the heart muscles to contract, pumping blood through the heart’s chambers and into the blood vessels. When the heart muscles relax, the heart refills with blood and the process starts again. The ECG records this activity on graph paper via wires that are connected to electrode patches with slightly sticky backings and placed on the chest, arms, and legs. The heart’s activity is recorded in up and down patterns labeled consecutively as P waves, QRS complexes, T waves, and U waves. Irregularities in the patterns may indicate a problem with the heart.
An ECHO uses high frequency sound waves to display the structure, function and blood flow of the heart on a monitor screen without the use of x-ray. A colorless gel is applied to the skin on the area of the chest where the heart is located. A transducer, a small microphone-like device, is placed on top of the gel and moved across the chest to obtain images that the cardiologist wants to see. A computer transfers the information from the transducer to display an image of the heart on the monitor. The echocardiogram can detect structural abnormalities of the heart and show valve shape, motion, narrowing, or leaking.
A Holter Monitor is a portable, battery-operated ECG machine that is worn in a shoulder harness around the neck, in a pocket, or on a belt. A Holter Monitor can help detect problems that may not be observed on a resting ECG. As with an ECG, there are electrodes attached to the chest. The heartbeats are recorded over a 24 to 48 hour period. Patients are usually told to keep a journal of their activities during the day.
Automated external defibrillators (AEDs) are an important tool when SCA occurs. AEDs are devices that can be attached to the chest wall of an individual who is experiencing SCA. AEDs function by monitoring the person’s heart rhythm and determining if there are irregular heart rhythms occurring that can be shocked back to normal to save someone’s life. Unfortunately, not all sudden cardiac arrests can be helped by an AED, but many can, and an AED that is appropriately used can be the difference between life and death.
As explained by Simon’s Heart, “Cardiopulmonary resuscitation (CPR) is a skill that every adult should have. In addition to calling 911, and understanding how to use an AED properly, being able to perform CPR is one of the most important steps to take in order to save the life of someone who suffers a sudden cardiac arrest. The goal of CPR is to perform chest compressions that help the heart to resume pumping blood to the organs of the body. Being trained in the correct way to perform CPR dramatically increases your chance of saving someone’s life.”
As explained by Parent Heart Watch, “according to the American Heart Association, 7 in 10 cardiac arrests happen at home, with the balance occurring in public places. Immediate response to cardiac arrest with hands-only CPR and an AED, if available, can be the difference between life and death by tripling the chance of survival. Considering the national average of EMS arrival is 6 to 13 minutes, bystanders are a critical bridge to survival when every minute counts.
For every minute that a victim goes without defibrillation, their chance for survival decreases by 10%. Having easily accessible AEDs allows on-site individuals to deliver potentially life-saving defibrillation therapy quickly and effectively.
Rescuers must remember that an AED will not shock a victim if a fatal heart rhythm is not detected, so you cannot hurt a person by attempting to deploy an AED—the device is specifically designed for a non-medical person to use. What’s more important to understand is that if nothing is done for a cardiac arrest victim, they will most likely die. Equipping schools and other places where youth congregate with AEDs and training people how to use the technology properly can provide a youth struck by SCA another chance at life.
1. Recognize Sudden Cardiac Arrest
2. Call 9-1-1 and onsite first responders immediately
3. Start CPR immediately—Push hard and push fast on the center of the chest
4. Use the nearest AED to restore the heart to its normal rhythm
5. Direct EMS personnel to the victim
Cardiac emergency response plans are important for anywhere that people gather, including schools, workplaces, sports fields, etc. Parent Heart Watch provides an in-depth toolkit to create a cardiac emergency response plan at https://parentheartwatch.org/resources/sca-prevention/cardiac-emergency-response-plan/
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