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Identifying Potential Heart Issues in Kids

February is American Heart Month, a time to advocate for and educate families on heart health and learn about the signs of a potential heart problems. Ashish Shah, M.D. pediatric cardiologist with the Johns Hopkins All Children’s Heart Institute, answers some common questions parents have and shares valuable information about telltale signs that might suggest their child has heart issues.

Is chest pain concerning?

Most chest pain in children and adolescents is benign, but what raises a red flag is the one that occurs with vigorous physical exertion. Chest pain that occurs with vigorous exercise is usually associated with other symptoms such as dizziness or palpitations.

When is fainting related to a cardiac concern?

Fainting (Vasovagal Syncope) is very common and occurs more frequently than people think.

Typical reasons include:

  • Standing up quickly
  • Standing for a long period of time (lunch line, cashier in the store, etc.)
  • Not drinking enough fluids

Symptoms before fainting often include:

  • Dizziness with visual changes (blurry vision, tunnel vision, stars/spots/colors)
  • Nausea (a sick feeling in the stomach)
  • Fast heart rate

It is unusual for a child to faint during competitive sports or vigorous exercise. This might indicate a cardiac cause and further evaluation with the primary care physician and most likely with a cardiologist is necessary. Your child should not participate in any sports until he or she has been evaluated.

Are palpitations problematic?

Most palpitations are benign and not a cause for concern. What is concerning, is when a child describes their “heart racing fast” when they are not participating in vigorous exercise. Usually the child will report a sudden onset and a sudden relief of their sensation of a fast heart rate and it typically lasts at least 5 minutes, perhaps longer. Other warning signs during episodes of fast heart rate are often associated with chest pain and dizziness, and the child may also appear pale. Some parents report that when they put their hand over their child’s heart, they feel the heart beating so fast that “it’s like a rabbit thumping in the child’s chest.” This warrants an evaluation by their primary care physician and likely a cardiologist.

If my child plays sports – what heart issues should we ask the pediatrician about?

All children playing sports need to get clearance from their primary care physician. During the physical exam and evaluation, it’s important to notify your pediatrician of any chronic medical conditions that your child may have. There are some key points in your own family history that is important to communicate to the pediatrician, such as first degree family members who affected.  The important diseases in your family history that could play a role in your child are:

  • Congenital heart disease
  • Sudden cardiac death under 50 years of age
  • Individuals needing a heart transplant or who have undergone a heart transplant
  • Connective tissue disorders such as Marfans and arrhythmias related to Long QT Syndrome

Lastly, physicians are now learning that both kids and adults infected with COVID-19 could have suffered heart damage, so it’s important to share if your child was ever diagnosed with COVID-19 with your doctor.

For more information about heart health, visit the Johns Hopkins All Children’s Hospital Heart Institute page.

*Photos provided by Johns Hopkins All Children’s Hospital

About the Author: Ashish Shah, M.D., M.B.A. specializes in pediatric cardiology in the Johns Hopkins All Children’s Heart Institute. His areas of focus include noninvasive imaging, general pediatric cardiology and quality improvement. He is Tri-Chair of the Heart Institute Patient Safety & Quality committee. 

Previously he was a pediatric cardiologist with Phoenix Children’s Heart Center, where he was co-director for the Cardiac High Acuity Monitoring Program for Infants and Newborns (CHAMPION) and site leader for the National Pediatric Cardiology Quality Improvement Collaborative. Dr. Shah worked to develop and implement newborn pulse oximetry screening for critical congenital heart disease in newborns across the state and served on the Arizona Department of Health’s Newborn Screening Committee. He was also the physician volunteer for the Nick and Kelly Heart Camp. 

Dr. Shah completed his pediatric cardiology fellowship at Baylor College of Medicine/Texas Children’s Hospital in Houston. He is a graduate of the University of Connecticut Schools of Medicine & Business Administration. He completed his pediatric residency at Connecticut Children’s Medical Center / University of Connecticut.


Ashish Shah, M.D., M.B.A.
Ashish Shah, M.D., M.B.A.
Ashish Shah, M.D., M.B.A. is pediatric cardiologist at Johns Hopkins All Children’s Heart Institute.

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