Can Children Have Heart Attacks

June 20, 2023

mom and kids hiking on park trail

What are the Potential Causes of a Child’s Chest Pain?

It’s a little unnerving when your child complains about chest pain. Maybe your child can’t sleep because their chest feels tight. Or your teenage ball player or gymnast complains about a sore chest after practice. Your mind races. Most heart attacks involve chest discomfort. But can children suffer heart attacks?

“Yes, heart attacks can happen in children, but they’re extremely rare,” explains John Dentel, MD, a congenital heart surgeon at Joe DiMaggio Children’s Hospital. “Children most at risk for heart attacks are those born with congenital heart disease. Most chest pain in children is due to other factors that don’t involve the heart, including musculoskeletal problems.”

Read on to learn about heart attacks, children’s heart issues and other possible reasons for your child’s sore chest.

Why a Heart Attack Happens?

A heart attack happens when something blocks the flow of blood carrying oxygen to your heart. Usually, the blockage is due to a buildup of plaque and cholesterol. When the heart muscle cannot get the oxygen it needs to function properly, it begins to die. This is the etiology for how heart attacks occur in adults.

“Heart attacks are rare in children because the risk factors that trigger a heart attack usually develop later in life when a person is an adult,” explains Dr. Dentel. “The risk factors for heart disease are high cholesterol, high blood pressure, diabetes, smoking, obesity and genetics.”

Risky Behaviors = Early Heart Trouble

While heart attacks in young people are rare, doctors now see more young adults with heart issues than in years past. Heart problems in young people can be caused by poor lifestyle choices, related to diet, lack of regular exercise, as well as smoking and drug use.

“For example, more kids are vaping today. And that can cause coronary artery vasospasms, a sudden narrowing of the arteries that supply blood and oxygen to the heart,” explains Dr. Dentel. “These spasms cause pain, pressure and tightness in the chest, and if they last long enough, they can cause a heart attack.”

Key to the pediatric patient population, the American Academy of Pediatrics reports that obesity rates are rising among children. Poor eating habits and obesity put young people at risk for higher cholesterol levels, early heart attacks and stroke.

If Heart Attacks are Rare in Young People, What Else Causes Chest Pain?

The most common causes of chest pain in children are sore bones and muscles in the chest. Problems that can cause chest pain include:

  • Muscle spasms or cramps in the muscles or nerves of the chest wall
  • A cold, infection or other illness
  • Repeated coughing
  • Costochondritis (swelling of the tissue connecting the ribs to the breast bone) caused by an injury or physical strain during exercise or lifting

Young people might also experience chest pain due to other conditions, such as:

  • Acid reflux
  • Asthma
  • Pneumonia
  • Stress and anxiety

If your child has chest pain, consult your child’s doctor for advice. Sometimes rest and over-the-counter pain relievers can help. Other times, your doctor might suggest testing to rule out heart issues.

What Rare Conditions Cause Heart Trouble in Children and Teens?

In rare cases when children do suffer heart attacks or other heart issues, it’s usually due a problem they were born with or a disease. Examples include:

The Left Coronary Artery Branches Out From the Wrong Blood Vessel

Early in pregnancy while the baby’s heart is still forming, something goes wrong. Both coronary arteries are supposed to branch out from the aorta, the large blood vessel that carries blood from the heart to the rest of the body. Instead, the left coronary artery branches out from the pulmonary artery. This condition, called anomalous left coronary artery from the pulmonary artery (ALCAPA), occurs in 1 of every 300,000 births. It’s the most common cause of heart attacks in children.

“The heart muscle does not get enough oxygenated blood, putting the baby at risk for a heart ischemia. At birth, these babies look healthy. Then in the first year of life, they become very sick with feeding issues, low energy and fatigue,” explains Dr. Dentel. “We can correct this condition with surgery and help these babies live healthy lives.”

One Coronary Artery (Or Both) Branch Out From the Wrong Place on the Aorta

This rare condition is called anomalous aortic origin of a coronary artery (AAOCA). It’s a significant cause of sudden cardiac death, often in teens or young adults engaged in heavy exercise. Most children don’t show symptoms so doctors don’t know they have it unless they check the heart for another reason. However, if doctors do diagnose it early, they can monitor children closely or treat them with surgery.

A Thick Heart Muscle

Due to an abnormal gene, the child’s heart muscle becomes very thick, forcing it to work hard to pump blood. Over time, an irregular heart rhythm develops. This condition, called hypertrophic cardiomyopathy, is the leading cause of sudden cardiac death in young athletes.

Body’s Immune System Damages the Heart Muscle

Some children develop myocarditis, a rare immune response to a viral infection, common cold, rhinovirus, enterovirus or coronavirus. This occurs in about one or two of every 100,000 children each year. While the immune system fights the infection, it damages the heart. Myocarditis can be life-threatening.

Know the Warning Signs of Heart Trouble in Children

Even though heart attacks in children and teens are rare, it’s smart to know the warning signs. These signs can include the following:

  • Chest pain during activity
  • Fainting during exercise
  • Fast breathing
  • Fatigue
  • Lack of appetite
  • Racing heart
  • Shortness of breath

In younger children who can’t communicate their symptoms, you might also notice:

  • Diarrhea
  • Feeding issues
  • Irritability
  • Lack of energy
  • Sweating
  • Vomiting

“To check for potential heart trouble, your pediatrician might order a chest X-ray, blood tests or other tests to check your child’s heart rhythm (such as an EKG) and the function and structures inside their heart (such as an echocardiogram),” says Dr. Dentel.

How to Reduce Your Child’s Risk for Future Heart Trouble

Since most risk factors develop later in life, now’s the time to help your child develop a lifetime of good health habits. As parents, you can:

  • Offer nutritious foods and a diet balanced with fruit and vegetables
  • Encourage 30 minutes of daily physical activity
  • Encourage a good night’s sleep
  • Take your child for annual physical exams
  • Find out if heart disease runs in your family and tell your pediatrician

“A healthy lifestyle reduces the risk for heart disease. Try to eat more meals at home so you can serve healthier foods. After dinner, go outdoors for a 30-minute walk together,” says Dr. Dentel. “You’ll ingrain good habits that will help your children grow into healthy adults.”

At Joe DiMaggio Children’s Hospital, our expert pediatricians will care for any heart issues and chest pain your child may experience. Learn more about our pediatric cardiology services.