Signs of Heart Issues in Adolescents and Teenagers

February is American Heart Month. On this On Call for All Kids, Ashish Shah, M.D., who specializes in pediatric cardiology in the Johns Hopkins All Children’s Heart Institute, gives parents some insight about what to look for if they suspect their child might have heart issues.

What kind of chest pain should be concerning to parents?

Most chest pain in children and adolescents is benign. The type of chest pain that raises a red flag is the one that occurs with vigorous physical exertion. Chest pain that occurs with vigorous exercise and is associated with other symptoms such as dizziness or palpitations.

Fainting — how to know if it may be heart related?

Fainting is very common and occurs more frequently than people think. When we stand up quickly or stand for a long period of time (lunch line, cashier in the store, etc.) and experience dizziness with visual changes (blurry vision, tunnel vision, stars/spots/colors), nausea (a sick feeling in the stomach), fast heart rate and then faint — this is considered a usual cause for fainting and not for alarm. The medical term for this is vasovagal syncope. This is very often related to how much clear liquids a person drinks in a day. The more you drink, the less likely you are to faint.

When one faints in the context of competitive sports or vigorous exercise, it is very unusual. There may be a cardiac cause and further evaluation with the primary care physician and most likely with a cardiologist is necessary to rule out a cardiac cause. While your child is waiting for the appointment to see the cardiologist, he or she should not be allowed to participate in any sports until the evaluation has been completed.

What causes palpitations and when should parents be concerned?

Palpitations has a very broad definition. Many people describe this symptom very differently. Most palpitations are benign and not a cause for concern. If your child describes his or her “heart racing fast” when not participating in vigorous exercise, that is very unusual. Usually, the child will report a sudden onset and a sudden relief of their sensation of a fast heart rate. It usually lasts at least five minutes, perhaps longer. The episodes of fast heart rate are often associated with chest pain, dizziness. Your child may also appear pale. Some parents report that when they put their hand over their child’s heart, they feel the heart beating so fast that “it’s like a rabbit thumping in the child’s chest.” Episodes of very fast heart rates should be evaluated by the primary care physician and probably also by a cardiologist.

If your child plays sports — what heart issues should you ask your pediatrician about?

All children playing sports need to get clearance from their primary care physician. When going for that physical exam and evaluation, it’s important to notify your pediatrician of any chronic medical conditions that your child may have. There are some key points in your own family history that are important to communicate to the pediatrician as well. The family members affected are first degree relatives. The important diseases in your family history that could play a role in your child are: congenital heart disease, sudden cardiac death under 50 years of age, individuals needing a heart transplant or who have undergone a heart transplant, connective tissue disorders such as Marfan syndrome and arrhythmias related to long QT syndrome.

There are symptoms to pay attention to as well. Symptoms such as chest pain, fainting and palpitations while participating in vigorous physical activity are concerning and might indicate the possibility of a heart problem. If you notice any of these symptoms, stop playing sports and discuss it with your child’s primary care clinician. These symptoms are even more worrisome if your child had COVID-19.