OPINIONS

Sudden death of a school child

Sunday, August 20, 2017

by Prof S Dwivedi

A young teenager and student of Central School, Gol Dak Khana, New Delhi collapsed in morning assembly on August 17 and died instantaneously. The general impression in lay public is that it was heart attack which killed this boy.

Question asked by one of the mothers was — do the young children also get heart attack and die like this?

Dr Shridhar Dwivedi

Dr Shridhar Dwivedi

Actually, there are three known cardiac causes of such deaths at such young age:

1. Hypertrophic obstructive cardiomyopathy — a well known childhood disease in which cardiac muscle of left ventricle get over grown and may lead ultimately to sudden cardiac death.

2. Long QT syndrome — This is electrocardiographic abnormality which also may result into sudden heart death because of irregularity of heartbeat.

3. Congenital abnormality of coronary arteries which have abnormal origin and course and get trapped in between two great vessels in the heart.

4. Sometimes rupture of Berry aneurysms in brain may also result in sudden death.

The big question is can these conditions be diagnosed in early childhood. Yes, provided there is a system of school health check-up once in a year in every school at least when they are in class 8th or so. A conscientious physician can detect these abnormalities on physical examination and ECG. In suspicious cases echocardiographic examination provides a definitive clue.

Keeping the above in view National Heart Institute, East of Kailash, New Delhi has taken a small initiative of creating health awareness among school going children particularly about heart ailment in the NCR region schools in a humble way.

Prof Shridhar Dwivedi
Senior Consultant Cardiologist, National Heart Institute, New Delhi
Founding Dean/Principal, HIMSR, Jamia Hamdard (Retired)
HOD Medicine, Delhi University College of Medical Sciences & GTB Hospital (Retired)

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1 Comment »

Comment by R N SEN
2017-08-28 12:37:18

Respected Prof. Dwivedi,

Pl accept my regards for such a timely beautiful article, but expecting a bit more details on these issues, like:::
Prevalence of HCM/HOCM percentage wise according to US database ( as in India we don’t have any such database), and making it a rare disease, its treatment cost, SCD possibility in elderly [ as it has already been indicated its mostly a disease of young adults( and as i know, also for participants for competitive sports/athletes)], gene screening contribution ( we dont have such available system in India), its deleterious effect of reducing preload and afterload ( as contrary to usual management of HF), as well as effect of nitrates/positive ionotropes and it’s effect due decreased venous return/ increased contractility etc. As it had been rightly pointed out , screening is most important. But , all clinicians may not be aware ( like experienced cardiologists) about mid systolic murmur and its augmentation due reasons as above and valsalva, reduction of murmur by increasing preload / afterload, handgrip exercise etc. and may miss symptoms during auscultation, thereby may not screen the patient by echo..
so may I request , to have more detailed presentation with your most valuable experience, as majority of readers are from medical fraternity and likely to be enlightened with your guidance.

Regards.

 
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