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About sudden cardiac death in the young. Risk Assessment for your child sudden cardiac death
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Sudden Cardiac Death Risk Assessment for Youngers Print this page Mail to friend(s)
Parents, answer these questions (or have your child’s doctor help complete them) every few years at these times: preschool, before/during middle school, before/during high school and before participating in organized sports.
Patient History Questionnaire:
Unanswered Questions will be Highlighted in Red.
1. Has your child fainted or passed out during exercise, emotion or startle?
2. Has your child fainted or passed out AFTER exercise?
3. Has your child had extreme fatigue associated with exercise (different from other children)?
4. Has your child ever had unusual or extreme shortness of breath during exercise?
5. Has your child ever had discomfort, pain or pressure in his chest during exercise?
6. Has your child ever been diagnosed with an unexplained seizure disorder?
Family History Questionnaire:
7. Are there any family members who had an unexpected, unexplained death before age 50? (include SIDS, car accident, drowning, others)
8. Are there any family members who died of heart problems before age 50?
9. Are there any family members who have had unexplained fainting or seizures?

Is Your Child At Risk? for sudden cardiac death

Your child or a young person you know may be at risk for sudden cardiac death due to an inherited condition. He/she will appear healthy and, in most cases, you will have absolutely no idea that something might be wrong. Once diagnosed, these conditions are treatable!

About sudden cardiac death in the young

  • Each year in the United States, hundreds of young people die suddenly and unexpectedly due to cardiac arrhythmias.
  • These conditions include Long QT Syndrome (LQTS), Hypertrophic Cardiomyopathy (HCM), and others.
  • LQTS is now known to be 3 times more common in the US than childhood leukemia.
  • HCM is the most common cause of sudden cardiac death in people less than 35 years old.

what you can do

  • You or your child’s doctor should fill out the questionnaire on the back of this form. If you answer yes to any of the questions, your doctor should check your child’s heart.
  • If your child has any of the following signs see your doctor Warning Signs
  1. Family history of unexpected, unexplained sudden death in a young person
  2. Fainting (syncope) or seizure during exercise, excitement or startle
  3. Consistent or unusual chest pain and/or shortness of breath during exercise


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