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In a Heartbeat

Life-threatening cardiac issues in young people

 They say life can turn on a dime. What started as a typical sports-day afternoon for the Greathouse family turned very quickly into a life-threatening situation for 13-year-old Kaine Greathouse.

Kaine’s mom, Amie, his two sisters and his grandfather sat on gym bleachers that afternoon, waiting for his wrestling match to begin. His dad was on his way to the gym.

“Kaine’s weight class was 105,” remembers Amie, “so it came pretty fast. I started to record the match, and 20 seconds into his match, he got pinned. It looked like he got the breath knocked out of him, and I was so focused on recording, I didn’t pay close attention. But then my dad asked why he was still lying there. I thought maybe his shoulder got dislocated.”

Amie’s dad went down to the mat to see what was going on, and then motioned for Amie to come. All of a sudden people were being evacuated from the area, recalls Amie, and complete panic set in. The next thing she knew, two women who turned out to be nurses came down to help, and started CPR.

Someone called 911 and handed the phone to Amie, who told the dispatcher her son was not breathing. “They said to get the AED [automated external defibrillator], so the vice principal ran to get it. I watched as my son got shocked.”

The AED restored Kaine’s heart rhythm. Paramedics arrived and transported him to the ER at Memorial Central, where the pediatric expertise is provided by Children’s Hospital Colorado. A doctor there told Amie and Kyle that their son had experienced cardiac arrest. 

The Greathouses were in shock. Kaine doesn’t remember what happened. “When I woke up,” he says, “I just felt completely normal.”

Fortunately for Kaine, one of the state’s three pediatric electric physiologists, Martin Runciman, MD, works for Children’s Hospital Colorado. Dr. Runciman, who is a pediatric cardiologist with Children’s Colorado’s Heart Institute, is a specialist in abnormal heart rhythms. He told the Greathouses he suspected Kaine had a rare and life-threatening heart rhythm condition called Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT).

As described by the National Institutes of Health (NIH), in CPVT the heart rate increases in response to physical activity or emotional stress, which can trigger an abnormally fast and irregular heartbeat called ventricular tachycardia. “Episodes of ventricular tachycardia can cause light-headedness, dizziness and fainting (syncope). In people with CPVT, these episodes typically begin in childhood.”

Genetic testing confirmed Dr. Runciman’s suspicion, and he discussed options with the Greathouses, which centered on the insertion of an ICD (implantable cardioverter defibrillator).

“On the rare occasions when a child has a cardiac arrest,” says Dr. Runciman, “it’s usually due to dangerous heart rhythms caused by diseases like Long QT syndrome or CPVT. Syndromes that result in life threatening rhythms need to be treated with medication and an implantable defibrillator, which will shock them out of it if those rhythms occur.”

Because of his training and specialty, Dr. Runciman sees a lot of children with abnormal heart rhythms. “The majority are tachycardias,” he says, “which are very fast heart rates. They can usually be treated with medication for awhile but almost all require a catheter ablation [making small scars in heart tissue to prevent abnormal electrical signals from moving through]. I go in and find a short circuit and eliminate that with a catheter ablation.”

Ventricular fibrillation in kids is extremely rare but extremely dangerous, says Dr. Runciman. “When you’re in V-fib, your heart is not pumping any blood and there’s no oxygen going to the brain. You will either die or suffer severe brain damage in less than two minutes unless someone can do CPR or get you back into a normal rhythm. The number of kids who die during sporting events in the U.S. is about 80 a year… Having someone there who knows CPR does save lives.”

Treatment for young people with cardiac issues is not the same as treatment for adults. “There are often size constraints and special equipment that need to be used with kids,” says Runciman. “They respond differently to treatment and medications, so we tailor that specifically to them. For example, when I put in defibrillators and pacemakers, I put them in through the armpit so they’re better protected, especially during sport activities.”

The advantages of being able to treat serious cardiac issues locally are many. In addition to having family and friends close by with a serious episode, says Runciman, “it also helps to be treated locally by the doctors who are then going to be looking after them for years to come. And it’s important to have that level of pediatric expertise locally, from your pediatric cardiologist and pediatric ICU to your pediatric intensivists, to take care of a child after an event when they can be critically ill and when minutes matter. Those minutes can change the outcome.”

Kaine went home after seven days in the Pediatric Intensive Care Unit, following three days of induced hypothermic coma, insertion of the ICD and a prescribed beta blocker. Now 15 years old, he says, “It changed my life, because I can’t really go out on all the types of sports I love, like football, mixed martial arts and wrestling. I also can’t get any jobs that have to do with any form of magnet. 

“I now look at life as a treasure to have, because I realized that you’re not invincible and something like this can happen to you… It makes me feel safe to know how much people are standing behind me.”