Screen all children for potential heart-related issues

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Erickson does not report any relevant financial disclosures.

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In a new policy statement, the AAP said all children — especially those entering high school — should be screened for conditions that could lead to cardiac arrest or death, regardless of athletic status.

Christopher C. Erickson, MD, FAAP, professor of cardiology at the University of Nebraska Medical Center, and colleagues offered advice to help pediatricians identify children at risk for heart-related problems.

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The updated guidelines include a comprehensive overview of conditions that should require more attention and cardiac evaluation, the AAP said.

The recommendations include:

Physicians should assess whether a patient’s clinical history, family history, and physical examination indicate a risk of sudden cardiac arrest or sudden cardiac death. If there is concern, an electrocardiogram should be the first test administered and then interpreted by a physician trained to recognize heart disease. The physician should consider a patient’s clinical history and consider referral to a specialist. Physicians should work with the community to advocate for emergency action plans and CPR training. The use of automated external defibrillators is effective in sudden cardiac arrest. The screening consists of four questions that ask if a child or teen has ever fainted or had an unexplained seizure or had chest pain or shortness of breath, or if a family member has a history of heart disease or death before age 50.

“In the past, we tended to focus on athletes when parents brought their children and teens in for a physical sports or pre-participation exam,” Erickson said in a statement. “We know today that all children and teens benefit from simple screening to help identify any potential problem that warrants follow-up with a heart specialist.”

According to the AAP, about 2,000 people under the age of 25 die from sudden cardiac death each year in the United States. Although autopsy studies show that most patients have structural heart defects, the causes of 6% to 40% of deaths remain unexplained, AAP said.

References:

Erickson CC, et al. Pediatrics. 2021;doi:10.1542/peds.2021-052044.

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