In Chamarajanagar, Karnataka, approximately 175 km from Bengaluru, an 8-year-old Class 3 student died of cardiac arrest on 6 January. The child collapsed in her classroom while presenting her notebook to a teacher.

She was rushed to JSS Hospital, where doctors confirmed she was brought in dead.

A similar tragedy unfolded on 10 January at Zebar School for Children in Ahmedabad, Gujarat. Gargi Ranpara, also eight years old, collapsed in the school lobby shortly after arriving in good health. Despite receiving CPR and emergency hospital care, she was pronounced dead due to cardiac arrest.

In Aligarh, Uttar Pradesh, two children, aged 8 and 14, were among five fatalities attributed to cardiac arrest over 25 days. The 14-year-old collapsed during training for a sports event, while the 8-year-old fell unconscious while playing with friends. Local cardiologists have noted an increase in heart attack cases among young individuals post-COVID-19, citing stress and lifestyle changes as potential contributing factors.

These incidents have underscored concerns and misconceptions about heart-related conditions in children. Questions persist regarding the difference between cardiac arrest and heart attacks and the underlying causes of such sudden deaths in prepubescent children.

Heart attack vs cardiac arrest: Understanding the difference

Heart attack and cardiac arrest are different conditions but often confused with one another.

A heart attack happens when a blocked artery stops the flow of oxygen-rich blood to a part of the heart muscle. If the blockage isn't removed quickly, the affected area of the heart begins to die due to lack of oxygen.

Think of your heart like a house with pipes that carry water. Sometimes, one of these pipes can get clogged. When this happens, the clogged pipe becomes damaged, and over time, it can affect the rest of the house. Similarly, during a heart attack, one of the blood vessels supplying blood to the heart becomes blocked. This can feel like chest pain, often described as a heavy weight, and it can sometimes hurt a lot.

In contrast, a cardiac arrest is an abrupt and unexpected event. It occurs when the heart has an electrical malfunction, leading to an irregular heartbeat, or arrhythmia. This disrupts the heart's ability to pump blood to vital organs like the brain and lungs.

To simplify, imagine your heart is like a machine powered by electricity. If the electrical system goes haywire, the machine stops working. During a cardiac arrest, the person loses consciousness and has no pulse. Without immediate treatment, death occurs within minutes.

"A heart attack is like a plumbing issue, where one of the blood vessels to the heart becomes completely blocked, damaging part of the heart muscle. Cardiac arrest, on the other hand, is an electrical problem that causes the heart to suddenly stop beating," explains Dr Mukharjee Madivada, Senior Interventional Cardiologist and Managing Director of the Pulse Heart Center in Hyderabad.

Dr Madivada adds that someone having a heart attack may often express severe pain, while a person suffering from cardiac arrest usually collapses without warning, unable to communicate their distress.

However, it's important to note that one of the primary causes of cardiac arrest is a heart attack.

"When the heart's pumping ability weakens, the risk of cardiac arrest increases, and one of the main culprits behind this weakened function is indeed a heart attack," explains Dr Madivada.

"Nevertheless, a cardiac arrest is the more critical situation because, without immediate intervention, it can prove fatal within minutes. Unlike a heart attack, which is primarily related to blood flow, a cardiac arrest can be triggered by various factors such as high potassium levels or dangerously low oxygen levels in the body," says Madivada.

He adds, "Hence, there exist numerous causes for cardiac arrest, while a heart attack typically results from the blockage of a blood vessel."

Can cardiac arrest or heart attack occur in kids?

Cardiac arrest, although rare in children compared to adults, can and does occur. Sudden Cardiac Arrest in children is a serious condition where the heart unexpectedly stops pumping blood, leading to a rapid loss of consciousness and potentially death if not treated immediately.

Research estimates that cardiac arrest affects about 1 to 3 children per 100,000 annually. It often strikes children who appear otherwise healthy and have no prior diagnosis of heart conditions.

In many cases, children who suffer cardiac arrest show no warning signs before the event. However, the condition can be linked to several factors, such as a family history of heart disease or sudden cardiac death.

Previous episodes of unexplained fainting or seizures may also indicate an underlying risk. Furthermore, participating in competitive sports without undergoing proper cardiac screening can sometimes lead to cardiac events.

What's are the leading causes of cardiac arrest in children?

Congenital heart defects, structural abnormalities in the heart or blood vessels near the heart present from birth, are a leading cause of sudden cardiac arrest in children. These defects can affect the heart's ability to pump blood efficiently, disrupt normal blood flow, or cause irregular heart rhythms, increasing the risk of dangerous arrhythmias.

Hypertrophic cardiomyopathy (HCM), a genetic condition marked by thickened heart muscle, can obstruct blood flow and lead to life-threatening arrhythmias, particularly during physical activity. Often undiagnosed, HCM is a significant contributor to sudden cardiac arrest in young athletes. Similarly, genetic disorders like Long QT syndrome, which affects about one in 7,000 young people, can trigger cardiac arrest during physical exertion or emotional stress.

Arrhythmias caused by abnormal electrical activity in the heart can lead to irregular heartbeats and cardiac arrest, even in structurally normal hearts. Examples include ventricular fibrillation and Wolff-Parkinson-White syndrome. Myocarditis, often resulting from viral infections, can inflame the heart muscle, impair its function, and increase the likelihood of cardiac arrest. Respiratory conditions, such as severe asthma attacks, pneumonia, or airway blockages, may cause oxygen deprivation (hypoxia) and trigger cardiac events if untreated.

Physical trauma, such as blunt chest impact (commotio cordis) or severe head injuries, can disrupt the heart's rhythm and lead to cardiac arrest. Exposure to toxins, severe allergic reactions (anaphylaxis), or metabolic disorders like electrolyte imbalances or hypoglycemia can also interfere with normal heart activity and increase the risk of cardiac arrest in children.