Knowing the difference between faints, fits, convulsions and collapses

Every week 12 young people die from undiagnosed cardiac conditions (Cardiac Risk in the Young (CRY), 2008). However, most of these conditions could be detected in life by simple compulsory screening. Until that day, there are usually two ways that ambulance staff could discover these undetected conditions: when the young person collapses or fits, or tragically, and sometimes inevitably, through cardiac arrest.

Sudden cardiac death (SCD) is usually arrhythmic, with underlying (subtle) structural heart disease, abnormal conduction, or ‘channelopathies’. If a healthy child or young adult develops cardiac-sounding symptoms or excessive breathlessness during or shortly after exercise, this may be structural heart defect. If a syncopal exercise is atypical, or if it occurs on exertion, this may be arrhythmic.

A 12-lead electrocardiogram (ECG) is about 90% sensitive for these conditions, provided it is interpreted with the right expertise.

Subconsciously, we screen patients routinely on a daily basis, but we mainly concentrate on the elderly and historically tend to overlook the younger generation. The misconception is that they are too young to have any cardiac condition as these usually come with age, lifestyle abuse, or through long-term medication (changing this mindset is only a matter of education and more detailed investigations). Whatever you do for a 65-year-old’s chest pains you can do for a 15-year-old with the same.