Transcript PACED Sudden Cardiac Arrest Prevention Powerpoint Seminar v2

Sudden Cardiac Arrest Prevention
* Audio Seminar
for Teachers and Coaches
RECOGNIZE AND RESPOND
TO THE WARNING SIGNS OF
P A E D I AT R I C A R R H Y T H M I A S
PREPARED BY PACED
PARENTS ADVOCATING FOR CARDIAC EDUCATION
* PLEASE CLICK ON THE AUDIO ICON FOR EACH NEW SLIDE
PACED is Parents Advocating for Cardiac Education
2
Mission
To create universal top of mind awareness and appropriate systemic response to the Warning Signs of
Inherited Heart Rhythm Disorders in Canadian communities
Vision
PACED envisions a day when Inherited Heart Rhythm Disorders (IHRD’s) are no longer a leading medical
cause of paediatric mortality in Canada, the number of young people dying each year is significantly
reduced and the majority of at-risk individuals are identified and receiving effective therapy or better still
a cure for their disease
Values
To advocate, with passion and integrity on behalf of all Canadians affected by IHRD’s. To respect the voice
of all stakeholders. To generate and disperse revenues ethically and wisely in pursuit of our stated goals
Copyright 2015 by PACED
www.paced.ca
Dr. Andrew Krahn
3
“Our research gives us an idea of the scope of the problem – there are
almost 200 young people who die suddenly every year in Ontario. A good
proportion of them have unrecognized heart disease. So the question is:
How can we catch this before it happens?” says Krahn.
He suggests that more attention be paid to possible warning signs such as
fainting. He believes that teachers, coaches and an aware public may be key
to detecting risk, ensuring prevention and formal medical evaluation and
therapy.
“I would advocate for careful screening of people who faint, using
questionnaires and education of healthcare professionals so that when
warning signs present themselves, they recognize them and this information
gets passed on to the right people,” he says.
From an article on Dr. Krahn’s presentation at the 2012 Canadian Cardiovascular Congress
http://news.bioscholar.com/2012/10/hidden-disease-sports-sudden-cardiac-arrest.html
Copyright 2015 by PACED
www.paced.ca
What are IHRD’s ?
4
 A group of genetic diseases that predispose people (children)
to sudden cardiac arrest
 Transmitted by an autosomal dominant gene: if one parent
has the gene on average half of the children will acquire the
gene
 The disease hides because there are usually no other
manifestations, in every other way the child is healthy
 Many deaths occur between the onset of puberty and the late
twenties
Copyright 2015 by PACED
www.paced.ca
Two Types of IHRD’s
5
Cardiomyopathies
Effect the development of
heart muscle making it weak
or thickened and less able to
conduct electricity
 HCM

Hypertrophic Cardiomyopathy - a thickening
of the muscle on the left side of the heart
Arrhythmogenic Right Ventricular
Cardiomyopathy – a weakening of the
muscle usually on the right side of the heart
Copyright 2015 by PACED
 Long QT Syndrome (1-14)
 Brugada Syndrome
 CPVT
 ARVC/D

Channelopathies
Effect the pathways that
conduct the heart’s electrical
signals
www.paced.ca
 Short QT
 WPW - Wolff Parkinson White - an accessory
electrical pathway not a true channelopathy.
IHRD’s by the Numbers
6
 700 young Canadians, under age 35, die each year


200 in Ontario
65 in BC
 1 in 500 would be conservative estimate of the disease
prevalence – Think 2 per High School !!!

About 1.5% of gene positive people die each year
 Nearly 50% of all patients have at least one fainting episode
prior to their death



5% (1 in 20) of all fainting episodes (syncope) are a warning sign
33% (1 in 3) or more of fainting during exercise is sinister
The good news is that 95% of all faints are benign
Copyright 2015 by PACED
www.paced.ca
The Warning Signs
7
 Fainting (syncope) or seizure during or shortly after
physical activity, especially if it happens repeatedly
 Fainting (syncope) or seizure resulting from emotional
excitement, emotional distress, or auditory startle
 Family history of unexpected sudden death during
physical activity or during a seizure, or any other
unexplained sudden death of an otherwise healthy
young person
Copyright 2015 by PACED
www.paced.ca
Additional Warning Signs
8
 Near fainting (syncope) or Brownouts
 Dizziness, lightheadedness
 (New) Extreme shortness of breath
 More so or different than other children
 Palpitations or Racing Heart
 Fatigue – more so than what a typical teen complains of
Copyright 2015 by PACED
www.paced.ca
Responding to the Warning Signs
9
 9-1-1 for all faints but especially those occurring during
or shortly after physical activity

An ECG acquired on scene by Paramedics may hold many
diagnostic answers
 Immediate visit to the Family Physician or walk-in clinic
for all other fainting episodes or secondary warning
signs.
 Provide parents/guardians with information about
IHRD’s, sudden cardiac arrest and the warning signs.
 No return to play until medical clearance has been
obtained
Copyright 2015 by PACED
www.paced.ca
Review #1
10
1.
Every year in Canada ______ young people, under age 35, die as a result of sudden cardiac arrest.
A.
B.
C.
D.
2.
What percentage of young cardiac arrest victims had at least one fainting episode in the weeks, months or
years prior to their death?
A.
B.
C.
3.
24 %
48 %
96 %
Faints associated with _______ are the most concerning as a risk factor for sudden cardiac arrest.
A.
B.
C.
D.
E.
4.
200
65
700
11
Flu symptoms
Auditory startle (unexpected loud noise)
Physical Activity
Lack of sleep
B and C
When a (young) person faints during or shortly after physical activity ______
A.
B.
C.
D.
E.
911 should be called
They should be given a 30 minute rest period before return to activity
Parents should be provided with information about fainting and heart arrhythmia
You should wait 15 minutes to see if they “seem fine” before calling 911
A and C
Copyright 2015 by PACED
www.paced.ca
Diagnosing an IHRD
11
Post syncope physicians will perform any or all of:
 An Event History

Gather eyewitness accounts
 A Patient History
 A Family History

Parents have homework
 An ECG


Stress ECG
Holter Monitor
 Echocardiogram (ultrasound)
 Cardiac MRI
 Tilt Table Testing
 Genetic Testing
Copyright 2015 by PACED
www.paced.ca
Treating IHRD’s
12
There are a number of effective treatment options for
patients diagnosed with IHRD’s:




Pharmacological Therapy – β Blockers
Surgical Options – Catheter Ablation
Implantable Devices – Pacemakers and ICD’s
Lifestyle Modification – No intense physical activity
Once identified patients living with an IHRD should enjoy
a long, healthy and productive life
Copyright 2015 by PACED
www.paced.ca
Testing First Degree Relatives
13
 Dr. Joel Kirsh (Sick Kids, Toronto)
estimates his clinic
identifies between 4 and 5
additional gene positive
First Degree Relatives for
every index patient
 Finding one patient must
begin a search for all
affected family members
 The policies being
recommended have a
significant multiplier effect
Copyright 2015 by PACED
www.paced.ca
Pre-Participation Screening Questionnaire
14
Patient History Questions
1.
2.
3.
4.
5.
6.
7.
8.
Has this child ever fainted during or shortly after physical activity?
Has this child ever experienced extreme shortness of breath, fatigue or “brown outs” during physical activity?
Has this child ever fainted as a result of emotional distress or excitement?
Has this child ever fainted from auditory startle: an alarm clock, a door slamming or unexpected noise?
Has this child ever fainted from any cause?
Has this child ever sustained an injury as a result of fainting?
Have any of this child’s faints involved seizure like activity?
Has this child ever been diagnosed with a seizure disorder such as epilepsy?
Family History Questions
1. Is there history of unexplained early death on either side (maternal/paternal) of this child’s family?
a.
More than one early death in the family?
b.
Unexplained death of family members under age 50?
c.
Unexplained death of family members under age 35?
d.
Any deaths occurring during or after intense physical activity? Running, swimming, cycling, soccer, hockey.
e.
Deaths of undetermined origin or “presumed” cardiac origin
f.
Are there any SIDS deaths (Sudden Infant Death Syndrome) in the family?
g.
Are there any deaths attributed to seizure disorder or epilepsy?
2. Is there any member of this child’s family that has a history of unexplained fainting or seizures?
Copyright 2015 by PACED
www.paced.ca
A Five Point Cardiac Arrest Prevention Strategy
15
30 Minute Arrhythmia Awareness Training
1.

mandatory for all Teachers, Coaches and CPR/AED trained staff
Pre-Participation Screening Questionnaire
2.

to be completed by parents/guardians at the time of enrollment in a new school or a
new sport
Mandatory 9-1-1 Calling for all Faints
3.

at least for all faints occurring during or shortly after physical activity
Mandatory Notification of Parents/Guardians of all Faints
4.

including providing them with information about IHRD’s
Mandatory Medical Clearance for Return to Play
5.

the most tragic deaths are those where fainting is ignored and the child is allowed to
continue to participate in physical activity
Copyright 2015 by PACED
www.paced.ca
Review #2
16
Event History is an important part of diagnosis. Eyewitnesses should be asked about:
1.
A.
B.
C.
D.
The presence of seizure like activity
The minutes leading up to the event
Whether the patient was able to use their hands and arms to break the fall
All of the above
Family History often holds the key to diagnosis. Parents should be asked about
2.
A.
B.
C.
D.
E.
The unexpected or sudden death of family members under age 35
Only those deaths that have occurred in the last 20 years
Any crib deaths or SIDS (Sudden Infant Death Syndrome) deaths in the family
Only deaths in the patients maternal family
A and C
Most children have a definitive diagnosis after two simple, non-invasive tests
3.
A.
B.
C.
D.
Genetic Blood Test and Cardiac MRI
Tilt Table Testing and Stress ECG
ECG and Echocardiogram
Holter Monitor and Cardiac MRI
Controlling heart rate and rhythm to prevent cardiac arrest often requires
4.
A.
B.
C.
D.
E.
Taking one Beta Blocker each day
Wearing a Pacemaker or ICD
Open Heart Surgery
Lifestyle modification
Any combination of A, B and D
Copyright 2015 by PACED
www.paced.ca
Laws and Regulations for SCA Prevention
http://www.simonsfund.org/sudden-cardiac-arrest-legislation-by-state/
State or
Organization
Awareness
Education
Pre Par Q
Remove from
Play / 911
Return to Play
Inform Parents
Pennsylvania
HB1610 - 2012
Mandatory for
Coaches. Annual
Yes. Signed by
parents annually
Yes. Mandatory
after any syncope
Yes. Cleared by
licenced HCP
Yes. Website and
handouts
New Jersey
S2367 (39-0)
Mandatory for
Coaches. Annual
Confirm receipt
of pamphlet
Yes. Mandatory
for any syncope
Yes. Cleared by
licenced HCP
Mandatory prior
to participation
Maryland
HB0427 (136-0)
Yes. Mandatory
for all Coaches
Confirm receipt
of information
Yes. Mandatory
after any syncope
Yes. Cleared by
licenced HCP
Mandatory prior
to participation
Indiana
HB1178 (
Yes. Mandatory
for all Coaches
Confirm receipt
of information
Yes. Mandatory
after any syncope
Yes. Cleared by
licenced HCP
Yes. Parents
receive info sheet
California Inter scholastic Fed.
Yes. Mandatory
for all Coaches
Yes. Signed by
parents annually
Yes. Mandatory
after any syncope
Yes. Cleared by
licenced HCP
Yes. Parents
receive info sheet
Ontario
Private Members
Bill
Yes. Mandatory
for all Coaches
and Teachers
annually
Strongly
recommended
Yes, Mandatory
after syncope
Yes, Cleared by
licenced HCP
Yes. Prior to
participation and
post syncope
Copyright 2015 by PACED
www.paced.ca
17
September 2014
Keeping Abreast of the Standard of Care: Automated External Defibrillators in Schools
Gillian Tuck Kutarna, Guelph
In April of 2009, grade 5 student Bezawit Chanyalew suffered a cardiac arrest during gym class at her
Vancouver school. Before emergency workers could arrive, she suffered brain damage due to a lack of
oxygen, leaving her with severe cognitive and physical disabilities. The School Board recently settled her claim
out of court for $1.7 million. The allegations of negligence levelled against the Board raised some interesting
questions about the standard of care to which school boards may be held.
Two days prior to the incident, the school Bezawit attended received a fax stating that she had a congenital
heart condition known as “Long QT Syndrome”, putting her at increased risk of seizures and cardiac arrest,
especially if she engaged in physical exertion. Bezawit was running in a 100 metre relay when she collapsed.
The Statement of Claim filed against the Board alleged that the Board’s school was negligent in two ways: first,
that after receiving the fax, the school should have immediately developed a protocol to minimize Bezawit’s risk
of injury; and second, that the school should have obtained all the information necessary to ensure Bezawit
was safely able to participate in physical education class.
http://www.millerthomson.com/en/publications/newsletters/education-law-newsletter/september-2014/keeping-abreast-ofthe-standard-of-care?utm_source=Mondaq&utm_medium=syndication&utm_campaign=View-Original
Copyright 2015 by PACED
www.paced.ca
18
Submit your Questions to Blake at [email protected]
19
Answers
Review #1
1.C, 2.B, 3.E, 4.E
Review #2
1.D, 2.E, 3.A, 4.E
Copyright 2015 by PACED
www.paced.ca
Thank you for Learning the Warning Signs
20
Parents Advocating for
Cardiac Education - PACED
Blake Hurst, Co-Founder
29 Mericourt Rd.
Hamilton ON
L8S 2N5
905 527-0462
[email protected]
www.paced.ca
@rhythmichearts
Copyright 2015 by PACED
www.paced.ca