Batra AS, Hohn AR: Palpitations, syncope and sudden cardiac death in children: who's at risk? Pediatr Rev 2003; 24(8):266-271.

Sudden cardiac death is relatively rare in children, and many are asymptomatic until death. This article reviews palpitations and syncope as two symptoms requiring evaluation to determine the benign from the deadly forms. Palpitations are subjective sensations of strong, rapid, and irregular heartbeats, and syncope is temporary loss of consciousness following palpitations, lightheadedness, dizziness, weakness, pallor, nausea, cold sweat, blurred vision, or hearing loss. Usually, the child recovers quickly with no more help than stopping the activity and lying down. A child presenting with these symptoms needs careful evaluation to rule out significant cardiac problems such as atrial fibrillation, ventricular tachycardia, prolonged Q-T syndrome, and cardiac structural defects.

Unfortunately, a cost-effective broad-based screening technique does not exist. These children need a complete history, physical examination, and ECG as a basis for any abnormal findings and then referral to a cardiologist. If cardiac problems are found, the American Academy of Pediatrics offers guidelines for participation in competitive sports. The table in the article lists a dozen cardiac defects and athletic limitations for each condition. Restrictions vary from none to no competitive sports.