I do physicals on teenage kids all the time. Usually, I’m clearing them to play sports at their school. I’m often temped do a fairly perfunctory exam because…really, how unhealthy can someone be at 13?
Statistically, there isn’t much to worry about. Most kids are just fine. Pretty much almost every kid is perfectly healthy and there’s nothing to find on physical exam because there’s nothing there to find. But, like everything in life, this isn’t 100%. There will always be a small percentage of kids who are, literally, living on borrowed time because of a congenital heart defect that nobody detected when they were born. Some defects don’t show up until the child is in h/er late teens and usually only cause problems during a strenuous workout or just afterward (probably because their heart was already starting to fail but they couldn’t tell).
Every time I do a sports physical on a child or young adult, I’m reminded of the Russian pairs figure skating couple Sergei Grinkov and Ekaterina Gordeeva. If you have heard of them, it isn’t likely you’ve forgotten them. They were arguably the best pairs figure skaters in the history of the sport – certainly they were the undisputed champions from the mid-1980’s through until the mid 1990’s. I was pretty young kid when I saw them win their first gold medals at the 1988 Calgary Olympics, and I still remember their performance. This was one of the greatest years in figure skating history. It was the year of Katerina Witt (meeeow to this 14 year old), and the stratospheric leaps of Brian Boitano.
In all, the pair skated in 31 senior and professional competitions, winning 24 of them, including gold again at the 1994 Lillehammer Olympics. Woven throughout their skating careers is an inspiring romantic tale as well. The pair fell in love in the late ’80’s and were married in 1991. By the time they won their second gold medal, much of the world was in love with them, too. They skated with impeccable skills, but unlike many of the technical wizards of today, they were pure art in fluid motion. To prepare for some of their greatest performances, the pair traveled throughout Europe and studied sculpture masterpieces of the Renaissance – then mimicking on ice the poses they saw captured in marble. Their love story was touching, their success inspiring, their artistry was eternal.
Then suddenly, after a ho-hum practice in Lake Placid, New York in November 1995, Sergei collapsed while still on the ice. He’d had a massive heart attack, and died later that day. He was 28.
Aside from the tragedy of the event, the question remains: What happened? Why would someone simply drop dead at such a young age and in such excellent physical condition? It’s a scary thought and happens with a reasonable amount of regularity. Sergi was a very young man, but it can happen to teenagers. It can be boys or girls. It happened to a pretty good soccer player while I was in medical school.
What happened to Sergi Grinkov was different than the cardiac condition that more commonly afflicts young adults and kids. He had clogged arteries. Although his heart muscle itself was young and very strong, the coronaries that supply blood to that muscle were clogged so much that one pathologist said they looked like the coronaries of a 70 year old man. So, he had a heart attack normally reserved for septuagenarians. Could his neighborhood family doctor have prevented the condition? Then, no. Today…maybe. The only indication that there was a problem with Sergi’s coronaries was based on a family history of men in his family dying in their early 50’s of heart attacks. Today we have better cholesterol measures and might even have considered angiography for him. So, he might have lived…if his childhood screening physicals were done well.
The more common condition to affect kids and young adults – and it often leads to them dropping dead during physical activity, is called hypertrophic cardiomyopathy (HCM). HCM is the leading cause of sudden cardiac death in adolescent children. There are lots of variants of the disease, but the most worrisome is when the heart muscle is so large that it can’t push blood out of the left ventricle – usually because the septum between the left and right side of the heart is too big.
Things to watch out for are similar to the things any mother would worry about in their kids. Shortness of breath “is the most common symptom”. So? The kid’s been running. But you can also look for dizziness, feinting and be attuned to the description of “feeling my heart beating in my chest.”
HCM is rare in general. Something around .5% to .2% of the U.S. population are estimated to have it. In people with a strong family history of the diesease and thus get echocardiographs, around 25% of them will turn out to have the disease. However, mortality in those who have the disease is about 2-4%, which is a bit dicey.
HCM, and Sergi’s condition, both can be treated if they can be detected. The best way to catch both is to be suspicious about the possibility in their first place. A primary care doc can start with an EKG, and then get the patient in for an echo if there is any concern. One thing to be happy about – it is VERY rare for either of these diseases to show up in someone without any sort of family history. Knowing history, then, is the secret.
Below is a YouTube video of Grinkov and Gordeeva at the Lillehammer Olympics. It’s grainy, but still amazing to watch.
secretwave101 
Thank you for that article. My typically healthy 6 year old daughter has been complaining of chest pain, burning on the left side of the neck and feeling her heart “in her throat” as she says. She says it goes too fast and she gets dizzy and has actually passed out several times while doing minimal activity. I have taken her to several Dr’s, only to be told “kids don’t have heart attacks” I’m at my wit’s end with this and worry over it constantly.
She had bloodwork to check her cholesterol about 14 months ago and it was high. She recently had it checked again and it was 259. Her sister (age 10) had a cholesterol level of 126. They eat virtually the same thing and my 6 year old is only 40 lbs, so she isn’t overweight. This is now starting to affect her normal playing routine because she says running/playing make it hurt worse. I’ve been told it’s constipation, reflux, heartburn, pulled sternum….but so far no Doctor feels it is anything to worry about. She had a EKG and it showed she was tachycardia and a few arrythmias, however her pediatrician feels that could be normal for her age. Her teacher at school tells me she complains 5-10 times a day and says ‘my heart hearts’. We live in a very small town and have to travel 120 miles to a ped. cardiologist…however they won’t see her without a referral and her pediatrician doesn’t feel it is necessary. If you have any suggestions for me I would love to hear them. I’m worried that even though diet has been modified and the rest of the family has no cholesterol issues (grandparents do) that this high level is affecting her. Do you know of any other tests that I could suggest her Doctor perform? He has also shrugged off any suggestions of a heart echo.
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This letter concerns me enough that I’m making it into a blog. Look for it in the next few days. Bottom line: You’re not stupid for being worried.
SW101
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I’m so sorry about your child. I am 14 and have intense and frequent chest pressure. I’m also not sure what to do and everyone says not to worry?! HELP!
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Naughty, naughty! Shame shame for coming to SW101 for medical advice. I’ll give you some ideas about medicine, but really this site is more of an entertainment thing. Sorry. Just gotta be that way. I can’t be telling you what to do medically when I haven’t seen you or your labs, etc.
That said, if you’re having chest pressure, it’s always worth it to see an actual doctor. Long odds that there really is anything wrong with you, but don’t take it from me. Pu-leeze don’t take that from me.
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Pingback: Reader Comment: A Child’s Chest Pain «
Wow I’m 14 and have a LOT of cest pressure… My mom says nothing to worry about… Help?
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Well, if you have alot of chest pain, i suggest you worry!
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this page is really worrying me 😦 im 16 and i have been having chest pains too. Sry Alexandra for urs.
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I have gone to doctors and they have been worried too. I have a family history of high colesteral but i love cheese!
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in 12 and i am very overwieght (120lbs) i constantly have horrid cramps on my right side today i had one so bad i couldnt get up fos water my parents dont know because im afraid theyll make fun of me what should i do. it started about a month ago. i take health and i know hwy cramps happens and i know to drink water and it stops the cramp but i want to stop them before it happens… please help.
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im 15 and play football…..i get chest pains after running hard…and somtimes just when im idol….wat does it indicate?
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Inane a slight pain right under my heart is that a sign of heart disease?
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Okay so I have had chest pains since I was about six and right now I am thirteen. Today I had a feeling in my right arm’s muscle, it was kind of a numbing feeling. My mom told me I was having a heart attack and so did my sister (I guess they were just playing). So I began looking up the symptoms of a female heart attack and it had numbness in right arm and neck, anxiety and shortness of breath (in which all I have) . So I told my mother she told me I was exaggerating and she may schedule a doctors appointment friday of this week. And since I’ve read this article I can’t get my mind off of it. Though I’m like 158 lbs. I run track and play volleyball and basketball and I’m so scared… Help!
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I just read this cause I’ve alerrigies and my family(me and mom) are sick. I was just laying in bed and I felt my heart beating REALLY fast. I asked my mom if kids can have heart attacks, but she said no. But then I told her the whole story and she said to braeth big and drink water. I’m also 10 and about 95 pounds. But after readin this, I think I don’t have anything to worry bout.:)
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Whenever I run, i get a cramp of some sort in my chest….
And it HURTS!
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Take your symptoms very very seriously. Just last Sunday while attending a birthday party at a roller rink I watched a six year old girl complain of a pain in her stomach after exerting her self on the rink. Then less than 30 seconds later she was passed out on the floor and pronounced dead 2 hours latter from a heart attack. As a parent I can’t express just how scared this make me. I do not understand how a young child can have this happen to them or how people just assume that a child is to young for this to happen. With the technology and access to medical care we have today don’t take your child’s complaints lightly demand more from your Dr., and if they won’t do anything go to someone who will. Just like any profession there are good Docs and bad Docs. Demand nothing but the best for your children and of your Dr. Trust me after attending the service for a six year old child no one should have to go through this if it can be prevented.
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THATS REALLY TOO BAD NO CHILD DESERVES TO SUFFER LIKE THAT RIP 😦
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In all, No one in young age can suffer from a Myocardio Infarction, There would have to be 20-50 years of cholesterol blockage in either the jugular vein (stroke) or the Aortic Valve or Coronary Heart Disease, and Doctors know this, if there is any TFA involved that, might indeed cause higher risk at lower ages, TFA is found in many fast food resturants, in Ritz Crackers, Hamburger Pattys, and every other fatty food. TFA is short term for Trans Fatty Acids or Trans Fat, unlike saturated fat, it has been hydrogenated in the chemical properties adding hydrogen to the compound of the Atom, this is also known as Hydrogenated Oil, while only 2 grams of Trans Fat a day can seriously deplete their health on someone, many food labeling’s don’t list it if it has less then .5 grams or less, however the ingrediants list it, When you see Partially Hydrogenated _______________ Oil or Hydrogenated ________ Oil. It means there’s trans fat in it. Since, it has caused more than 30,000 heart attacks nationwide in ages 6-13 & more heart attacks (2-3 more) in ages 30-89.
-Mike
-Pediatrician (4 years)
Sources: Knowledge.
Ending Thread due to long reply span
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