Although rare, sudden cardiac death in children does occur, increasing in prevalence with age through adolescence. The risk of sudden cardiac death in children may be increased in those participating in strenuous activity due to an increase in the dynamic and static demands made on the cardiovascular system. Thus, it is important for pediatricians to recognize those children at risk for sudden cardiac death and to restrict potentially their sports activities.

Sudden cardiac arrest is defined as “the sudden cessation of cardiac activity so that the victim becomes unresponsive with no normal breathing and no signs of circulation.” When it occurs in children, sudden cardiac arrest is usually caused by an inherited or congenital cardiac malformation (e.g., tetralogy of Fallot, transposition of the great arteries), an arrhythmia (e.g., Wolf-Parkinson-White [WPW] syndrome, long QT syndrome), an acute medical condition leading to inflammation of the heart (e.g., myocarditis), or to commotio cordis, a sudden impact to the chest that causes ventricular fibrillation or ventricular tachycardia. Regardless of the cause, sudden cardiac arrest should be treated with prompt cardiopulmonary resuscitation and activation of the emergency response system.

The initial determination of an athlete’s cardiovascular readiness for sports play should occur with the preparticipation exam. A detailed history, including family history of cardiac events and early cardiac death; a review of systems, including a history of dizziness, chest pain, or other symptoms with exertion; vital signs, which may show hypertension or tachycardia; and a cardiac exam, which may demonstrate a heart murmur, can alert pediatricians to the presence of a cardiac abnormality that needs further analysis and complete or partial restriction from sporting activities. Should any concerns for cardiac disease be found in the preparticipation physical, the athlete should be referred to a cardiologist for a more thorough analysis.

Athletes with structural heart disease may be at increased risk of sudden cardiac death, depending on their primary cardiac lesion and on the success
of their repair. Often these athletes, especially when unrepaired or with a suboptimal repair, are restricted to low-intensity activities that limit the dynamic and static stresses put on the cardiovascular system.