Four warning signs of heart disease in children during sports activity

By Ahmet Taş | Wise News Press
ANKARA, TURKEY — Chest pain, fainting, unusual fatigue and palpitations during sports may be early warning signs of heart disease in children and should not be dismissed.

Sports play a major role in children’s physical, mental and emotional development. Experts encourage families to help children discover sports they enjoy at an early age. However, Associate Professor Erman Çilsal, a pediatric cardiology specialist at Acıbadem University Atakent Hospital, warned that some congenital or acquired heart diseases may show their first signs during intense physical activity.

Sports should be encouraged, but symptoms matter

Regular physical activity supports muscle and bone development, weight control, self-confidence, social skills and psychological well-being in children. Football, basketball, swimming, athletics and other sports can help children build discipline and healthy habits.

However, symptoms that appear during exercise should be taken seriously. Çilsal said some complaints are often interpreted as “normal tiredness,” “lack of fitness” or “part of growing up,” although they may sometimes be early signs of an important heart condition.

This does not mean that every child with a complaint must stop doing sports. The goal is not to create fear around exercise, but to make sure children can participate safely after proper medical evaluation.

Symptoms are especially important in sports that require intense effort, such as football, basketball, swimming and athletics. During exercise, the heart must work harder to meet the body’s increased oxygen demand. Conditions affecting the heart muscle, rhythm or coronary vessels may become noticeable during this period.

Chest pain during exercise should be evaluated

Not every chest pain in a child is caused by the heart. In childhood, chest pain may be related to muscles, bones, breathing problems, reflux, stress or chest wall sensitivity.

But chest pain that appears during exercise, repeats over time or forces a child to stop playing should be evaluated by a pediatric cardiology specialist.

According to Çilsal, chest pain that occurs while running, climbing stairs, playing a match or during intense training may be linked in some cases to heart muscle diseases, congenital coronary artery anomalies or rhythm disorders.

Families should pay attention to when the pain starts, how long it lasts and whether it appears with exertion. A brief, mild pain at rest is not the same as pain that develops every time a child runs or plays.

If a child says, “My chest hurts when I run,” “I feel pressure during a match” or “I cannot continue because of chest discomfort,” these complaints should be noted and shared with a doctor in detail.

Fainting during sports is a red flag

Fainting in children is often caused by benign factors such as hunger, dehydration, standing for a long time, heat, fear, excitement or a drop in blood pressure.

However, loss of consciousness during sports or exercise should be considered differently. Fainting while running, racing, swimming or during sudden intense effort requires careful investigation.

Çilsal said exercise-related fainting may be associated with serious rhythm disorders, heart muscle diseases or certain congenital heart problems.

Families and coaches should not automatically explain such episodes as “the child was hungry,” “too tired” or “overexcited.” These may be possible explanations, but fainting during physical activity deserves further evaluation.

It is also important to know whether the child had warning symptoms before fainting. Palpitations, chest pain, dizziness, blurred vision or shortness of breath before the episode may help doctors understand the cause.

Early fatigue may not be just poor fitness

It is normal for children to feel tired during sports. But if a child becomes tired much faster than peers, wants to leave the game early, stops frequently during training or becomes breathless quickly, the situation should be observed carefully.

Early fatigue does not always mean heart disease. Lack of fitness, anemia, respiratory problems, poor sleep, inadequate nutrition or recovery after infection can also affect performance.

Still, a clear decline in performance in a child who regularly plays sports should not be ignored. If a child can no longer complete activities that were previously easy, or consistently falls behind peers, further evaluation may be needed.

Çilsal said some congenital heart problems or diseases affecting the heart’s working capacity may appear as early fatigue and reduced exercise tolerance.

Parents’ observations are valuable in this process. Changes in training performance, difficulty climbing stairs, frequent breaks during play, shortness of breath, weakness or bluish discoloration around the lips should be reported to the physician.

Palpitations during exercise need attention

An increased heart rate during exercise is normal. When a child runs, swims or plays a match, the heart naturally beats faster to supply more oxygen to the body.

But not every palpitation should be considered normal. Palpitations that start suddenly, feel extremely fast, seem irregular, cause discomfort or force the child to stop should be evaluated.

Çilsal said palpitations accompanied by dizziness, blurred vision, weakness, chest discomfort, near-fainting or shortness of breath require further investigation for possible rhythm disorders.

This is especially important if the palpitations begin during exercise. Families should ask the child to describe the sensation clearly: Did it start suddenly? Did it stop suddenly? Was it regular or irregular? Did it happen more than once? Did it occur during rest or only during effort?

These details can help the pediatric cardiology specialist decide whether tests such as electrocardiography, echocardiography, rhythm monitoring or exercise testing are needed.

Family history can be as important as symptoms

Family history is an important part of heart evaluation in children. Çilsal said family history can sometimes be more valuable than symptoms because some inherited heart diseases may progress silently during childhood.

Children should receive detailed cardiology evaluation if there is a family history of unexplained sudden death at a young age, serious rhythm disorder, cardiomyopathy or genetic heart disease.

Such histories may point to inherited conditions that affect heart rhythm or heart muscle. In some children, the first sign may appear during intense exercise unless appropriate screening is performed.

For this reason, parents should inform doctors about sudden deaths, fainting episodes, pacemaker use, known rhythm disorders or diagnosed genetic heart conditions in close relatives.

Safe sports are possible with proper screening

The presence of symptoms does not always mean a child must permanently stop sports. The important step is to identify whether there is an underlying risk and define safe limits.

With proper screening, many children can continue sports safely. Depending on the findings, the doctor may recommend further tests, temporary rest, treatment, follow-up or specific restrictions for high-intensity activity.

Families, coaches and schools should work together when a child reports warning symptoms. A child who has chest pain during exercise, faints during sports, becomes unusually tired compared with peers or experiences troubling palpitations should not be pushed to continue before medical evaluation.

Early diagnosis can protect the child’s health while also allowing safe participation in physical activity when possible.

This article is for informational purposes only and does not replace medical diagnosis or treatment. Children with chest pain during exercise, fainting during sports, unusual fatigue, palpitations or a family history of sudden cardiac death should be evaluated by a pediatric cardiology specialist.

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