Heart disease in children
Published:Wednesday | February 2, 2022 | 12:11 AM
FOR A child to grow and develop, the heart needs to maintain normal pump function, to provide optimal blood flow throughout the body. However, sometimes the heart of a child may not function normally. The term ‘heart failure’ describes a heart that is not functioning properly. It does not mean that the heart has stopped working, but instead that it is not working as well as it should.
There are two major types of heart problems in children, congenital and acquired. Congenital heart defects develop before birth when the baby’s heart is forming. The cause and prevention of most of these problems is unknown. On the average, for every 1,000 births, six to eight babies have congenital heart defects. Many mild defects require no treatment. Other defects, described as moderate to severe, must be treated.
The second type of heart problem that occurs in children is acquired heart disease. This problem appears after birth. Usually, it is the result of damage done to the heart by a disease, virus or bacteria. The most common acquired heart problem is caused by rheumatic fever. In some children with acquired heart disease, a cause cannot be found.
Dr Ernest Madu, founder and chairman of the Heart Institute of the Caribbean and the HIC Heart Hospital, said most congenital heart diseases result from a genetic abnormality or exposure to a toxic stimulus during the developmental stage, resulting in congenital malformations.
KAWASAKI DISEASE
“This could be from infections, heavy metals, drugs or medications. Kawasaki disease (KD), also known as Kawasaki syndrome, for example, is an acute febrile illness of unknown cause that primarily affects children younger than five years of age. The disease was first described in Japan by Tomisaku Kawasaki in 1967, and the first cases outside of Japan were reported in Hawaii in 1976,” Madu said.
Kawasaki disease causes swelling (inflammation) in children in the walls of small to medium-sized blood vessels that carry blood throughout the body. Kawasaki disease commonly leads to inflammation of the coronary arteries, which supply oxygen-rich blood to the heart.
“Some congenital heart defects may be diagnosed before birth. Signs of certain heart defects may be observed during a foetal ultrasound examination or routine prenatal test,” Dr Madu said.
Diagnosis of a congenital heart defect, he said, may be made after birth if the child appears blue, demonstrates abnormal growth or a heart murmur is heard on auscultation prompting further investigations, which may reveal a congenital heart malformation.
There is a significant difference between heart disease (congenital or acquired) that affects children and the type of heart disease that affects adults. Adults have coronary artery disease that may cause heart attacks. Heart disease that affects children is different from coronary artery disease and usually does not cause heart attacks.
CONGENIAL MALFORMATIONS
“Unlike in adults where most heart disease is acquired, most heart disease in children are from congenital malformations. Because of advances in medicine and technology, many children with congenital heart disease are now living well into adulthood often post-surgical correction, and so pre-existing congenital heart diseases can be encountered in both children and adults,” Dr Madu said.
“Some patients with congenital heart diseases acquire other forms of heart disease from lifestyle risk factors as they get older and, in such patients, congenital and acquired heart disease will coexist in adulthood,” he added.
Symptoms for children vary, depending on which condition is present, severity of the condition and the age at presentation. Children with anomalous aortic origin of a coronary artery, for example, may not have symptoms at all.
According to Dr Madu, there are also multiple genetic mutations that may precipitate heart rhythm disorders or sudden death and may be unrecognised and asymptomatic until a fainting or sudden death episode.
Some key symptoms to watch out for in infants and that should prompt cardiologist evaluation include rapid breathing or gasping for breath, difficulty gaining weight, pale or grey colour, blue colouration and swelling.
In older children, chest pain at rest or during exercise, dizziness or fainting during exercise, unexplained fainting episode, decreased activity tolerance or profound fatigue, shortness of breath at rest or with exertion, palpitations or irregular heart-beats, swelling or edema.
There have been major advances in both the diagnosis and treatment of heart diseases over the past 25 years. Treatments depend on the type of heart disease present. They include percutaneous procedures that can be safely performed to close certain holes in the heart in children.
Electrophysiologic procedures can be safely performed with radio-frequency ablation to treat certain arrhythmias in children and cardiac surgery can be performed to reposition great vessels, resolve valvular or vascular malformations or disorders of coronary arteries to improve blood flow and heart function.
Other treatments include IIV immunoglobulin, infusions of antibodies (proteins), to help children with Kawasaki disease fight infections. A child may also get aspirin and steroids and various other medications.