Sudden Heart Attacks in Teenagers Renew Concerns

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Two teenage deaths in Greece within days of each other have renewed attention on sudden cardiac death in young people and the heart conditions that can remain undiagnosed until a serious arrhythmia or cardiac arrest occurs.

In Karitsa, Larissa, a 15-year-old student died on September 20 after his family found him unconscious at home. Authorities continue to investigate the exact circumstances and cause of death, with an autopsy expected to provide further answers.

Two days earlier, on September 18, a 17-year-old student in Pefkochori, Halkidiki, suffered cardiac arrest outside his school.

According to available information, rescuers immediately used a defibrillator and performed cardiopulmonary resuscitation. The student initially regained a cardiac rhythm but suffered another cardiac arrest and was transferred to Ippokrateio Hospital in Thessaloniki.

Despite doctors’ efforts, he died on September 20.

The two cases do not, by themselves, establish an increase in sudden deaths among young people. Their close timing, however, highlights a longstanding public health issue: identifying heart conditions that can remain undiagnosed until they cause a serious arrhythmia or cardiac arrest.

A rare but real phenomenon

Sudden cardiac death during childhood and adolescence remains rare.

A population-based study of children aged one to 18 estimated the incidence at around 1.1 deaths per 100,000 person-years. Available figures vary, however, depending on the population studied, the definition of sudden death and the methods used to record cases.

Greek data from Epirus, based on forensic examinations, recorded an annual rate of sudden cardiac death of 1.78 per 100,000 people among those aged one to 35.

In the same study, a significant proportion of cases among younger people showed no clear anatomical cause after autopsy. This highlights how difficult it can be to identify certain primary electrical disorders of the heart.

The available epidemiological evidence therefore does not support describing sudden deaths among young people as an “epidemic”.

Every case remains extremely serious, but the rarity of the phenomenon also needs to remain part of the public discussion so that concern does not turn into unjustified panic.

What can cause sudden cardiac death?

The causes vary.

Doctors have identified cardiomyopathies, congenital abnormalities of the coronary arteries and electrical heart disorders — known as channelopathies — among potential causes in young people. These include long QT syndrome and Brugada syndrome, as well as other conditions that can trigger dangerous arrhythmias.

In some cases, the heart may show no obvious structural abnormality even after death.

Hypertrophic cardiomyopathy is one of the important inherited heart conditions associated with sudden death among younger people, particularly during athletic activity.

The overall picture, however, is more complex than simply equating sudden death with hypertrophic cardiomyopathy. Causes vary according to age, population and whether the person is an athlete.

The challenge of “silent” heart disease

One of the greatest difficulties is that some of these conditions may cause no obvious symptoms before a first serious event.

That does not mean every sudden death could have been predicted through a simple preventive check.

This represents one of the major challenges for preventive cardiology: no available test can rule out every possible cause of sudden cardiac arrest.

European recommendations for children who take part in organised sporting activities emphasise an individual and family medical history, clinical examination and a 12-lead electrocardiogram, with systematic screening beginning no later than around the age of 12.

An echocardiogram can provide additional information about certain structural heart conditions that an ECG may not detect, when appropriate medical indications and facilities exist.

The potential value of screening also emerged from a large Italian study involving more than 22,000 children aged seven to 18.

In an organised programme of repeated pre-participation cardiovascular screening, doctors identified cardiovascular conditions associated with a risk of sudden cardiac death in around 0.3% of the children.

Most diagnoses occurred among children aged 12 and older, while a significant proportion emerged during follow-up examinations.

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