Monday, May 16, 2011

Why Might a Child or a Teen Experience a Cardiac Arrest ?

Daniel is a finer person than I. I would be content to blog centered on my own survival, and the survival of my family following such a devastating loss of our youngest son from our family. Daniel and my Dad would expect better of us, and of me. They would expect me to convey as much as possible about what I knew about sudden cardiac death in children, in understandable form and what I know now, in the hope that someone's child somewhere gets a needed EKG and cardiac evaluation, and as a result, remains here on Earth. Daniel would want our loss, our de facto sacrifice of our time with him, to count for something. Someone's child somewhere should live.
Many people ask me, as a consequence of this blog, why a child would ever experience a cardiac arrest, in general ? A child or teen could experience a cardiac arrest, very quickly following a respiratory arrest, for any reason. For example, an influenza which causes airway swelling, the inhalation of even a small amount, a gulp of water, can cause a respiratory arrest later. (Sometimes called a "dry drowning".) Any drowning accident whatsoever can lead to a respiratory and then to a cardiac arrest. A severe allergy, sometimes to a food or a drug that a child was not known to be allergic to before, can also cause a respiratory arrest.(Called anaphylaxis or anaphylactic shock) There is also something called epiglottitis, an infection which causes inflammation over the windpipe, which can cause drooling in an child who has normally aged passed drooling, can progress to respiratory arrest. Something as simple as inhaling a gummy vitamin, a tiny piece of hotdog, other meat, popcorn, or a tiny toy, can lead to a respiratory arrest. Trauma, or an injury can as well. Sometimes a seizure (of any type, even of febrile variety) can stop respiration. Sometimes inhaling vomitus during a seizure will cause a respiratory arrest or cessation of breathing. Very soon after a child stops breathing, the heart also will not receive adequate oxygen, it too shall stop pumping,leading to a cardiac arrest.
Becoming CPR (cardiopulmonary resuscitation) certified is probably the best course anyone over about age 14 can take in preventing sudden deaths, especially in children. (Siblings, friends, and ultimately your own children) I have saved many lives with CPR, over the years, but I have been lucky. Still, with Daniel's cardiac arrest, he did not respond to well performed and rapidly delivered CPR. In retrospect, an AED would have been a good thing to have, had we known somehow this would ever be needed.
Sometimes a cardiac arrest in a child or teen begins as a cardiac arrest. A child with an undiagnosed structural problem within the heart, a child with an influenza or bacterial infection which has invaded the lining or the valves of the heart, or even the conduction system of the heart itself, can occur causing an arrest. A variety of influenza viruses can do this, and specifically a virus called "Coxsackie B" is known to potentially do this. (Coxsackie B can do other undesirable things to other organ systems also) Certain strains of Beta-hemolytic streptococcus, Group A (yes, following a strep throat, for example) can also invade and damage the heart muscle. Some illnesses can afflict the musculature of the heart on a cellular level.
Sometimes a child has, unbeknownst to parents, or their doctors, a cardiac conduction defect. Under certain conditions, stress, upset, playing sports, or being low on one or more electrolytes, the child may develop a heart rhythm disturbance or arrhythmia (also known as dysrrhythmia.) Sometimes these arrhythmias result in one which is incompatible with life. Those wishing to look these up can search "Long QT Syndrome", "Brugada Syndrome" or Wolff-Parkinson-White Syndrome".
Metabolic disorders due to undiagnosed chronic illness, or acute illness can also cause cardiac arrest. A diabetic child who has a sick day, and who uses insulin, may find a viral syndrome to increase insulin need. During a relative insulin deficit,the child may progress to diabetic ketoacidosis, the blood potassium may fall and heart rhythm disturbances may occur, and sometimes this can lead to cardiac arrest. A child who has an influenza or is quiet about how ill he really is, may not report a decrease in urine, diarrhea, or may cover a decreased fluid intake. His fluid and electrolytes may become unbalanced. If potassium, calcium, magnesium levels and others are significantly diminished, due to any organ failure, acute or chronic, then cardiac arrest can occur. Sometimes, a child is hit in the chest with a ball or a puck. If even a mild blow to the chest occurs during the t-wave of the EKG, a full arrest can ensue.(This is called Commotio Cordis.)
Metabolic disorders of endocrine or kidney origins can also also result in fluid and electrolyte imbalances. Sometimes, undiagnosed thyroid disorders can contribute to cardiac rhythm disturbances and electrolyte imbalances which can contribute to cardiac arrest. (Yes, even the normally controllable Hashimoto's thyroiditis has ended in cardiac arrest) There are many other potential causes of a cardiac arrest in children,and we must be attentive as we can be to alterations in their level of awareness and general condition, although I am afraid that sometimes, we may still not detect clear changes before an event of some kind.
In Daniel's case, doctor's theorize that he had a predisposition to an unknown, undiagnosed conduction disorder of the heart. (A rhythm disturbance proneness, or potential proneness to arrhythmia) They believe that a combination of excitement entering the holidays, a possible drop in his potassium levels as we spent the day somewhere drinking something other than soda. (Regular pepsi is actually a good source of potassium), and the advent of new puberty hormones, left him more prone than average to arrhythmia. Of course, this is a theory. This arrhythmia, the first time it was encountered, proved to be lethal.
We also need to pass along to parents, that sometimes, there was nothing that could be done to anticipate what happened. Sometimes a child dies suddenly, and the autopsy does not show a clear reason for the child's sudden passing. Sometimes, circumstances and events evolve that would have required supernatural information in order to prevent such a terrible loss.
All that we as parents and as health care providers and professors can do, is advocate CPR education and certification. We can take our children for pediatric evaluation when they are ill. Third, we can advocate for having AEDs (automatic emergency defibrillators) in all schools, government buildings, and sporting events. We can also advocate for baseline EKGs for all 12 year olds to help to diagnose or catch some of the conduction disorders which are often implicated in cases of sudden death, on the ballfields, and off. I am surprized as to how hard this particular entry has been for me to write. Stay well.

Rascal Flatts "I Won't Let Go"

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