Tuesday, June 7, 2011

Let's Review

We know that many children who experience a sudden cardiac death secondary to a heart rhythm disturbance (also known as an arrhythmia), are without symptoms. Many times, their first symptoms are their last. However, Daniel would want us to review symptoms that may allow some families to detect these issues and to have their children with them longer, or even through adulthood and old age.

Remember that some children and teens who die of sudden cardiac death, have inconclusive or "clean" autopsies. No conclusive structural issues are found, and a sudden arrhythmic disorder becomes a diagnosis of exclusion, or of family history. Some children who die of sudden cardiac death had a viral infection a few weeks prior to their sudden death. Some children have an enlarged heart detected only following sudden death. Sometimes they are found to have cardiomyopathy, (an enlargement or thickening of the heart) or other times dilated cardiomyopathy, although Daniel did not have either.

The children who should be evaluated for potential arrhythmic disorders by a cardiologist  are:

1. Any child with unexplained fainting or "seizures" with a normal or inconclusive EEG.
(Sometimes these are not seizures, but short cardiac arrests which appear to cause seizures when the brain receives insufficient oxygen.)

2. A child with exercise induced asthma is at higher risk for sudden cardiac death than those without. (Daniel had some degree of exercise induced asthma, and saw an allergist)

3. Some physicians think that the siblings of children with SIDS or Near Miss SIDSs should
have EKGs as a precaution. (Daniel had one brother, with Near Miss SIDS at age six weeks)

4. A child with other relatives with arrhythmic disorders or who experienced sudden death before age 60 may also be at risk. (Much older people in our family have had arrhythmias,on both maternal and paternal sides.)

Remember that many children who die of sudden cardiac death were indeed athletic, and not sedentary. The patients who have Long QT syndrome, Wolff-Parkinson-White Syndrome, and Brugada Syndrome may not be those you might expect.

Remember that a heart rhythm disorder can occur in someone with "squeaky clean" coronary arteries. Daniel's were squeaky clean. Coronary artery disease does not cause all arrhythmias.

Lastly, make sure that everyone you love knows it. There are plenty of ways to teach your children, without cross words. Remember that every time that someone you love leaves the room, that you might never see them alive again. Treat everyone well.


This is a simulation, but this is almost identical to many cardiac arrests. Daniel's probable arrhythmia,his arrest and his passing, may have been just this rapid. In Daniel's case, people with Long QT syndrome may experience an "R on T phenomenon (shown in the clip) then centricular tachycardia, (also shown) and progress to "Torsade des Pointes", (a twisting of the points). Torsade is almost impossible to convert to a life sustaining rhythm especially out of a hospital.
Even though we heard Daniel collapse in the bathroom, by the time we got through the locked door, and moved him away from it, and turned him over, and assessed for breath sounds, valuable time had elapsed. Even though he got CPR quickly, and then epinephrine, what we did may all have been just too late for the rapid progression of his presumed arrhythmia.


Today's post is dedicated to Andrew Gold. Rest in Peace

Karla Bonoff, below, worked with Andrew Gold, in a group called Bryndle. Now, both Kenny Edwards and Andrew Gold, both of Bryndle and also of individual artist fame, are gone from Earth.

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