It can be alarming when a child complains of chest pain. Whether they wake up feeling tightness in their chest or experience discomfort after an intense practice session, the concern is natural. Chest pain is often associated with heart attacks in adults, but can children suffer from heart attacks too?
“Yes, heart attacks can happen in children, but they are extremely rare,” says Dr. John Dentel, a congenital heart surgeon at Joe DiMaggio Children’s Hospital. “Children most at risk for heart attacks are those born with congenital heart disease. However, most chest pain in children is caused by non-cardiac issues such as musculoskeletal problems.”
Understanding why heart attacks occur in children requires exploring congenital heart conditions, genetic factors, and certain lifestyle risks. Here’s a closer look at what causes heart attacks in children and other possible reasons for paediatric chest pain.
Why Do Heart Attacks Happen?
A heart attack occurs when the heart does not receive enough oxygen-rich blood due to a blockage in the arteries. In adults, this blockage is typically caused by plaque and cholesterol buildup, leading to heart muscle damage. However, the traditional risk factors for heart disease—high cholesterol, high blood pressure, diabetes, smoking, obesity, and genetics—usually develop later in life.
Children, on the other hand, can suffer heart attacks due to congenital heart defects, rare conditions, or, in some cases, early exposure to unhealthy lifestyle habits.
Sudden Cardiac Death in Young People
Sudden cardiac death is the unexpected and rapid cessation of all heart activity, leading to immediate loss of consciousness and death. It differs from sudden cardiac arrest (SCA), which is the abrupt loss of heart function due to an irregular heart rhythm. Survival from SCA is possible with rapid medical intervention.
Although rare, sudden cardiac death is a leading cause of death among young athletes. Estimates suggest that approximately 1 in 50,000 to 1 in 100,000 young athletes die from sudden cardiac death each year.
Causes of Heart Attacks and Sudden Cardiac Death in Children
Several conditions can lead to heart attacks or sudden cardiac death in young people:
1. Congenital Heart Defects
Some babies are born with structural heart abnormalities that can increase the risk of heart failure or heart attack. Examples include:
- Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA): This occurs in 1 in every 300,000 births and results in inadequate oxygen supply to the heart muscle, leading to heart ischemia.
- Anomalous Aortic Origin of a Coronary Artery (AAOCA): A condition where one or both coronary arteries branch from an incorrect location, increasing the risk of sudden cardiac arrest in young athletes.
2. Hypertrophic Cardiomyopathy
This genetic disorder causes an abnormal thickening of the heart muscle, making it harder for the heart to pump blood efficiently. It is a leading cause of sudden cardiac death in young athletes.
3. Myocarditis
A rare immune response to viral infections, such as the common cold, rhinovirus, enterovirus, or coronavirus, can cause inflammation of the heart muscle. This can be life-threatening in severe cases.
4. Long QT Syndrome
A heart rhythm disorder that can cause fast and chaotic heartbeats, increasing the risk of sudden death, especially in young people.
5. Brugada Syndrome and Wolff-Parkinson-White Syndrome
These are other irregular heart rhythm conditions that can lead to sudden cardiac death.
6. Commotio Cordis
A forceful hit to the chest, such as from sports equipment or another player, can disrupt the heart’s electrical signalling and cause sudden cardiac death.
Risky Behaviours Leading to Early Heart Issues
While congenital defects are the primary causes of heart attacks in children, lifestyle choices can contribute to early heart trouble.
“With rising obesity rates, poor diets, and sedentary lifestyles, we are seeing more young people with early signs of heart disease,” says Dr. Dentel. “Additionally, smoking and vaping can cause coronary artery vasospasms—temporary narrowing of the arteries—which may lead to chest pain or even a heart attack.”
Recognizing Warning Signs of Heart Trouble
Though heart attacks are rare in children, it’s crucial to be aware of symptoms that may indicate heart trouble:
- Chest pain during activity
- Fast breathing or shortness of breath
- Fatigue or lack of energy
In younger children who cannot describe their symptoms, watch for:
How Can Parents, Coaches, and Others Assess Risk?
Sudden cardiac death often occurs without warning, but certain signs can indicate a higher risk:
- Unexplained fainting during activity
- Shortness of breath or chest pain
- Family history of sudden cardiac death
If any of these signs are present, consult a healthcare professional for a heart screening.
Can Sudden Death in Young People Be Prevented?
Sometimes. High-risk individuals may be advised to avoid competitive sports. Treatments like medications, surgery, or implantable cardioverter-defibrillators (ICDs) may be recommended to manage heart conditions.
Many athletic facilities have automated external defibrillators (AEDs) to deliver life-saving shocks during cardiac arrest. These devices are user-friendly and can significantly improve survival rates.
Should Young Athletes Be Screened for Heart Risk?
There is ongoing debate about routine ECG screening for young athletes. Some studies, such as one from Italy, suggest that mandatory ECG screening reduces sudden cardiac death rates. However, concerns about false positives and overdiagnosis exist.
The American Heart Association does not recommend routine screening for non-athletes or those without symptoms.
Should Young Adults with a Heart Condition Avoid Physical Activity?
It depends on the condition. Some individuals may need to avoid high-intensity sports, especially if they have an ICD. However, many can safely participate in lower-impact activities. Always consult a healthcare professional to determine what level of activity is appropriate.
How to Reduce Your Child’s Risk for Future Heart Trouble
While some heart conditions are unavoidable due to genetics, parents can take proactive steps to reduce their child’s risk of heart disease later in life:
- Encourage a balanced diet rich in fruits and vegetables
- Promote daily physical activity (at least 30 minutes per day)
- Limit screen time and encourage outdoor play
- Schedule annual physical checkups
- Discuss family history of heart disease with a paediatricians
Final Thoughts
Although heart attacks and sudden cardiac death in young people are rare, understanding the causes and risk factors can help parents stay informed. Most childhood chest pain cases are not heart-related, but recognizing the warning signs and encouraging a heart-healthy lifestyle can reduce risks as children grow. If you have concerns about your child’s heart health, consult a paediatrician for evaluation and guidance.
