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Sudden cardiac death in Children participating in organised sport There has been concern in the media about sudden cardiac death in children during sport, particularly following the collapse of Fabrice Muamba. There are calls being made that all children should be screened prior to taking part in sport. Whilst every child dying is a tragedy, it is often not preventable. The main causes of sudden cardiac death in school age children are congenital heart disease such as Valvular or anomalous coronary arteries, or due to one of the inherited cardiac myopathies. Asthma and other non-cardiac disease can also lead to sudden death. Sudden cardiac death in children is rare, affecting 1 in 200,000 young athletes. It is 2 to 4 times more common in children taking part in sport, than in children who don’t. As many children do not take part in organised sport, more sudden deaths may occur in children who don’t take part in sport. The main suggested screening tool is an ECG. It is unable to identify premature coronary artery disease and congenital coronary anomalies, which account for a major proportion of sudden cardiac death in young athletes. It will detect cardiomyopathy, but not necessarily in younger children. There are also a relatively high number of false positives, 10 to 20%, which will generate anxiety, and unnecessary investigation. It is also not clear that telling children not to participate in sport will prevent a cardiac event and there may be other psychological impacts from the screening. There is no support from the National Screening committee for screening of children before exercise. There has been a recent review 1 which found the benefit of screening children prior to exercise was equivocal, due to it being a rare condition and no very sensitive or specific screening tool. If a parent and child present asking for cardiac screening due to the publicity in the media, a suggested approach is to take a family history about any sudden deaths, and do physical examination (see guide line below). The evidence shows this has limited sensitivity. American Heart Association guidelines for preparticipation cardiovascular screening of young, competitive athletes Medical history* Chest pain or discomfort on exertion Unexplained syncope or near syncope † Excessive exertional dyspnoea or fatigue Prior recognition of a heart murmur Raised systemic blood pressure Family history Premature death (<50 years) from heart disease, in one or more relatives Disability from heart disease in a close relative aged less than 50 Specific knowledge of certain cardiac conditions in family members: hypertrophic and dilated cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan’s syndrome, or clinically important arrhythmias 1 Preparticipation screening for cardiovascular abnormalities in young competitive athletes (BMJ 2008;337:a1596 doi:10.1136/bmj.a1596) Physical examination Heart murmur‡ Femoral pulses to exclude aortic coarctation Physical stigmata of Marfan’s syndrome Brachial artery blood pressure (sitting position, taken in both arms) *Parental verification is recommended for high school and middle school athletes †Judged not to be vasovagal; of particular concern when related to exertion ‡Auscultation should be done both while supine and while standing or with Valsalva manoeuvre, specifically to identify murmurs of dynamic left ventricular outflow tract obstruction A 12 lead ECG should not normally be required, but would be the first investigation if any further investigation is thought to be necessary. It would be helpful to discuss the comparative risks with the parents. We don’t have figures for Liverpool immediately available, but it is likely to be 1 to 2 children dying from sudden cardiac death per year at the most. More children die from traffic accidents and alcohol misuse is likely to have a much greater impact on the health of young people. Dr Ewan Wilkinson Public Health Liverpool PCT April 2012