Child Nearly Dies After Taking Big Bite of Hot Dog

Taking a big bite of a hot dog nearly killed a 9-year-old boy in Turkey, but it was a rare heart disorder, not choking, that triggered the close call, a new case report reveals.

The boy suffered sudden cardiac arrest after the mouthful, was revived by emergency services and was later diagnosed with Brugada syndrome, a heart rhythm disorder that usually has no symptoms, according to a report of the case, published online Sept. 6 in the journal Pediatrics.

Brugada syndrome is a rare condition that is usually inherited; it disrupts the electrical impulses between the ventricles, or lower chambers of the heart, which causes them to beat abnormally, according to the National Organization for Rare Diseases. [27 Oddest Medical Case Reports]

People with Brugada syndrome may develop a fast and dangerous heart rhythm known as ventricular fibrillation that prevents the heart from pumping enough blood to the rest of the body. Sometimes, the first signs of Brugada syndrome are passing out, a sudden fast heart beat or even sudden death, according to the Mayo Clinic.

The boy in the recent case fainted and experienced a sudden heart attack during lunch at his school.

Choking risk?

It's not uncommon for kids to choke on a hot dog or even on popcorn if they are running around and eating these foods at a ball game, for example, and some children may even die as a result of choking on these foods, said Dr. Elizabeth Saarel, chair of pediatric cardiology at Cleveland Clinic Children's in Ohio.

Pediatricians have typically assumed that these deaths were due to an airways issue, meaning the food blocked the child's ability to breathe, Saarel said.

In this child's case, there may have been a cardiac reason to explain the way his body reacted after he took a large bite of food, Saarel said.

A big bite irritated his vagal nerve, which runs behind the throat, Saarel told Live Science. When the vagal nerve is stimulated by a large bite of food sliding down a person's throat, the heart rate slows down and blood pressure drops, she said.

But in a person who has Brugada syndrome, like this 9-year-old, a slower heart rate can trigger a life-threatening and abnormally fast heart rhythm, Saarel explained. This may lead to fainting, sudden cardiac arrest or sudden death, she added.

Brugada pattern

After paramedics successfully resuscitated the boy, he was sent to the children's intensive care unit of the hospital for evaluation. He had normal results on an electrocardiograph (ECG) and exercise stress test. But his doctors noticed a suspicious elevation in one of his heart-rhythm patterns, and the boy was sent to a specialist, according to the case report. 

Heart specialists detected a type 1 Brugada pattern on the boy's ECG, the telltale abnormality used to diagnose Brugada syndrome.

Named for the Spanish cardiologists who first described the condition, in 1992, Brugada syndrome tends to be more common in men and may occur more frequently in people of Asian descent. Sometimes, this abnormal heart rhythm is first seen in children after they have experienced a high fever, which can irritate the heart, according to the case report.

This dangerous heart rhythm may also occur after consuming too much alcohol, when taking certain medications or, more frequently, while people are sleeping, according to the case report.

To prevent future heart attacks, the 9-year-old boy was treated with an implantable cardioverter defibrillator placed under his skin. This small device monitors the rhythm of the heart and delivers a small electrical shock to control an abnormal heartbeat, according to the Mayo Clinic.  

Because Brugada syndrome can be inherited, the boy's parents and brother were also screened for the condition. Only his brother was diagnosed with this abnormal heart rhythm, according to the case report, but that boy did not receive an implantable defibrillator, because he had no symptoms.

It's rare to diagnose Brugada syndrome in children, and usually kids are first diagnosed after the condition is seen in one of their parents, Saarel said. And though the disorder runs in families, it's very rare for Brugada syndrome to not be seen in parents, but to be found in two of their children, as occurred in this case, she said.

Currently, no medication has been shown to be completely protective for people with Brugada syndrome, but the implantable defibrillators generally work well for people with the condition, Saarel said. The devices are not typically put in kids unless the measure is really needed, she explained. 

Original article on Live Science.