You wrote a case study in 2020 looking at a connection between video games and cardiac events. What were the specific circumstances?
We looked at two young patients who had both had cardiac events that were triggered by playing video games. Both patients seemed to have some sort of predilection toward having a cardiac event related to an abnormal heart rhythm, and one of them had a genetic condition where they were sensitive to adrenaline rushes. With those adrenaline rushes, they could have fast abnormal heart rhythms that were make them symptomatic and could be life threatening. The other patient had had a prior event where they'd had an episode of cardiac arrest for unclear reasons.
How old were the patients?
One was preteen, 10, or 11. And the other one was a teenager. It’s important to note that these were extremely rare conditions. Most kids playing video games are not at risk for that happening. These same patients probably could have had a similar event if they were doing something else that was bringing on a lot of adrenaline or a lot of stress. If they were playing sports or watching something that caused some sort of strong emotional response, the same thing could have happened.
Generally speaking, are video games good or bad for your heart?
We may perceive video games as relaxing, or as a way to unwind. Those two cases are extreme examples of the fact that these patients weren't relaxed or unwinding; they were more stressed out than before they were playing. But unless you carry one of these rare conditions, you're probably not at risk for a life-threatening event in the short term. In the general population, it’s like everything else: moderation is key. Depending on the type of game you're playing. It could induce some stress, some adrenaline, raise your heart rate. But if that's balanced with time outside exercising or participating in sports or other physical activity, you're not likely to have an early heart attack just because you played video games. But if they're contributing to a sedentary lifestyle — if you're playing games all day long and doing that instead of other healthy activities — it's not going to help.
What does stress do to your heart?
The heart is a muscle, but we also think of it as a pump. There is only so much pumping that the heart can do over the course of your life, so chronically increasing your heart rate, chronically increasing your blood pressure over the course of your entire life, is going to increase the risk for earlier cardiovascular disease.
Why is it considered good when your heart rate increases when exercising, but not when you’re playing video game?
With exercise, there's a short-term elevation in heart rate, but in people who are physically fit, their average heart rate, over the course of the entire day, is in fact lower than someone who is sedentary. So while you briefly increase your heart rate during exercise, once you return to rest, your heart rate is going to be in effect slower. If you are playing video games for hours and your heart rate is elevated the whole time, that’s not healthy. All these risk factors for lifelong heart disease are going to be additive. If you're obese and you have high blood pressure and a poor diet, and then all you do is play video games, it's probably not going to help.
Do you have any recommendations in terms of how much time is healthy to play, or types of games to avoid or be more careful about?
I don’t know of any recommendations specific to video games, but the American Academy of Pediatrics has recommendations, according to age, about how much screen time is appropriate. Following those recommendations for video games makes sense to me. Then I think it's a matter of reflection between a child and his parents to step back and say, “As I'm consuming this media, as I'm playing this game, am I left feeling more stressed out, more wound up, than when I sat down to do this? Am I feeling positive and better about myself?” That goes not just for video games, but all sorts of experiences in life.
Are there any danger signs to look out for in terms of negative cardiac effects while your child is playing video games?
As pediatric cardiologists, things we would worry about most would be if they have severe chest pain, or their heart rate is stuck very high for a long period of time and is not coming back down to normal. Those are things you should check with your pediatrician about. If something odd happens, like your child passes out or has a seizure while playing video games, that's a reason to get checked out for one of these rare conditions. If you pass out or are losing consciousness, that's a reason to call an ambulance and to be checked out immediately.
Are there any positive effects of playing video games?
Playing video games can be something that can bring kids and families together if you're selecting the right games or playing in groups, but it also has the potential to isolate people if you're spending too much time doing it. I don't think it's inherently bad; I think it should be monitored and consumed in moderation.
