A heart attack, medically termed a myocardial infarction, can occur in a 13-year-old, though it is extremely rare. It happens when blood flow to a section of the heart muscle is severely reduced or blocked, causing tissue death from lack of oxygen. While the event is the same as in an adult, the mechanisms are vastly different from the typical plaque buildup seen in older patients. The estimated incidence in adolescents (ages 13 to 18) is approximately 6.6 events per 1 million patient-years. Causes in teenagers generally involve structural or inflammatory issues rather than the progressive fatty blockages common in adults.
Why Heart Attacks Occur in Adolescents
Heart attacks in adolescents are seldom caused by the long-term, cholesterol-driven atherosclerosis that affects older adults. Causes are related to congenital defects, inflammatory diseases, or acute triggers affecting the coronary arteries. A common structural cause is a congenital coronary artery anomaly, such as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). This condition supplies the heart muscle with deoxygenated blood under low pressure, leading to ischemia (lack of blood flow).
Inflammatory conditions are another cause. Kawasaki disease causes inflammation in blood vessel walls and can lead to coronary artery aneurysms in children. These weakened arteries risk developing blood clots or rupturing, resulting in a heart attack. Systemic inflammatory diseases, such as lupus or rheumatoid arthritis, can also accelerate coronary artery disease through chronic inflammation.
Genetic disorders can predispose a young person to a heart attack by causing elevated cholesterol levels, known as familial hypercholesterolemia. The most severe form, homozygous familial hypercholesterolemia (HoFH), can lead to significant coronary artery disease in the teenage years. Other connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, can weaken the aorta and coronary arteries, making them prone to dissection or rupture.
Acquired risk factors often involve acute coronary artery spasm. The use of stimulants, such as cocaine, can cause sudden constriction of the coronary arteries, restricting blood flow and inducing an infarction. Less common factors include severe obesity, undiagnosed hypertension, and uncontrolled diabetes, which contribute to premature cardiovascular damage. Substance abuse and tobacco use, including vaping, are associated with a higher incidence of myocardial infarction in adolescents.
Recognizing Warning Signs in Teens
The presentation of a cardiac event in teenagers is often vague or atypical, making identification challenging. Unlike the classic crushing chest pressure described by adults, a teenager’s pain may be sharp, localized, or a heavy sensation. It is concerning if the chest pain, pressure, or tightness occurs during physical exertion, suggesting inadequate blood flow when heart demand is highest.
Syncope (fainting) and near-syncope are warning signs, especially if they happen during or immediately following exercise. This loss of consciousness may signal a life-threatening heart rhythm disturbance caused by an underlying heart condition. Unexplained shortness of breath (dyspnea) that is out of proportion to the activity level or does not resolve quickly should not be dismissed as simple fatigue.
Teens may experience symptoms that mimic other common illnesses, which can delay diagnosis. These include gastrointestinal complaints such as nausea, vomiting, or abdominal pain, often mistakenly attributed to a stomach bug or indigestion. Lightheadedness, dizziness, or unusual fatigue that persists after rest should raise suspicion, especially when accompanied by cold sweats or paleness. While a panic attack can share symptoms with a heart attack, any severe or persistent symptoms require immediate medical evaluation.
Immediate Action and Medical Management
If a teenager exhibits sudden, concerning symptoms like severe chest pain, fainting, or difficulty breathing, immediate action is necessary. Call emergency services (911 or the local equivalent) immediately, as medical personnel provide rapid, life-saving care. It is safer to wait for an ambulance than to drive the child to the hospital, as the teen’s condition could worsen quickly.
If the teenager collapses and is unresponsive, the bystander should initiate cardiopulmonary resuscitation (CPR) right away. CPR, focusing on chest compressions, helps to circulate oxygenated blood to the brain and other organs until professional help arrives. An automated external defibrillator (AED) should be used if one is available nearby, as it can deliver an electrical shock to correct certain life-threatening heart rhythms.
Once in the hospital, the medical team performs diagnostic tests to confirm a heart attack. These include an electrocardiogram (ECG or EKG) to check electrical activity and blood tests to measure cardiac enzymes, such as troponin, released when heart muscle is damaged. An echocardiogram (ultrasound of the heart) visualizes the heart’s structure and function to look for the underlying cause, like a congenital anomaly. Initial treatment focuses on restoring blood flow, managing pain, and stabilizing the patient. Long-term follow-up with a pediatric cardiologist is necessary to identify the specific cause and develop a plan to prevent future events.