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Pediatric Cardiology

Pediatric Cardiology

Pediatric Cardiology

Overview

Children are not simply little adults. Children's cardiac issues are substantially different from those of adults. Youngsters, for example, are more likely to be diagnosed with a congenital heart defect, yet heart attacks in children are extremely rare. Pediatric cardiologists are specially educated to search for cardiac issues in youngsters.

Medical health statistics show that approximately 1% of the children born annually suffer from congenital heart defects. On the other hand, some develop different heart conditions after birth or as they grow older. Regardless of the type of disease, the child can experience both growth and development difficulties. 

To manage these conditions, pediatric cardiology is designed to help the infants and children battling with heart conditions. The primary goal of this field is not only to treat the children's conditions but also to ensure that they live everyday healthy life. 

 

How the Heart Works?

Heart

Understanding congenital heart abnormalities requires understanding how a normal heart operates. Your child's heart is a little muscle the size of a hand. It functions similarly to a pump and beats 100,000 times each day.

The heart has two sides that are divided by an inner wall known as the septum. The right side of the heart circulates blood to the lungs, where it picks up oxygen. The oxygen-rich blood then returns from the lungs to the left side of the heart, where it is pumped to the rest of the body.

The heart is made up of four chambers and four valves and is linked to numerous blood arteries. Veins are blood veins that transport oxygenated blood from the body to the heart. Arteries are blood arteries that transport blood from the heart to the rest of the body.

Heart Chambers

The heart has four chambers or rooms.

  • The atria are the two upper chambers of the heart that gather blood as it enters.
  • The ventricles are the two bottom chambers of the heart that send blood to the lungs or other regions of the body.

 

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

  • The tricuspid valve is located between the right atrium and the right ventricle on the right side of the heart.
  • The pulmonary valve is located on the right side of the heart, between the right ventricle and the pulmonary artery, which transports blood to the lungs.
  • The mitral valve is located between the left atrium and the left ventricle on the left side of the heart.
  • The aortic valve is located on the left side of the heart, between the left ventricle and the aorta, the artery that transports blood to the body.

Valves function similarly to doors that open and close. They open to enable blood to pass through to the next chamber or an artery, then close to prevent blood from going backward.

The heart's valves generate a "lub-DUB" sound when they open and close, which a doctor can hear using a stethoscope.

  • The tricuspid and mitral valves close at the start of systole, producing the first sound, the "lub." When the ventricles contract, or squeeze, and pump blood out of the heart, this is referred to as systole.
  • The second sound, the "DUB," is produced when the pulmonary and aortic valves close at the start of diastole. Diastole occurs when the ventricles relax and fill with blood from the atria.

 

Arteries

The arteries are major blood vessels connected to your heart.

  • The pulmonary artery transports blood pumped from the right side of the heart to the lungs to replenish oxygen levels.
  • The aorta is the primary artery that transports oxygen-rich blood from the left side of the heart to the rest of the body.
  • The coronary arteries are the other major arteries that connect to the heart. They provide oxygen-rich blood from the aorta to the heart muscle, which requires its own blood supply in order to operate.

 

What is Pediatric Cardiology?

pediatric cardiologists

Pediatric cardiology is a medical practice that focuses on studying the structure, functions, and health conditions of the heart and the blood vessels. It’s also concerned with treating, managing, and preventing a range of heart or related conditions affecting infants, children, and adolescents. 

On the other hand, pediatric cardiologists are medical experts who diagnose and treat cardiology disorders in children. They are also responsible for conducting a number of tests and procedures and administering medication based on the heart condition. 

 

What is a Pediatric Cardiologist?

healthy heart

If your kid's physician has a concern about his or her heart, he or she may send your child to a pediatric cardiologist. Pediatric cardiologists are experts in the diagnosis and treatment of cardiac abnormalities in children. Pediatric cardiologists collaborate closely with pediatric cardiac surgeons to establish the best therapies and strategies for children who may require heart surgery.

To offer coordinated and complete treatment, pediatric cardiologists collaborate closely with primary care doctors. Because cardiac disorders in children can be complex and cause other problems, pediatric cardiologists frequently collaborate with other health care specialists.

Pediatric heart surgeons, cardiac anesthesiologists, neonatologists, cardiac pediatric intensivists, pediatric radiologists, pediatric nurses, dietitians, and speech, occupational, and physical therapists are among those who work with children. These teams have significant training and knowledge in the unique needs of children with cardiac disorders and are especially sensitive to their requirements.

Pediatric cardiologists have significant training and experience working with children and treating children with cardiac conditions. You may be confident that if your physician recommends that your kid see a pediatric cardiologist, your child will receive the highest possible treatment. 

 

Pediatric Cardiological Conditions 

There are many categories of heart conditions affecting children of all ages. Some are congenital disorders, while others are acquired. In addition, certain types of heart diseases are minor, while others are chronic and come with severe complications.  

Overall, these are the common types of childhood heart conditions; 

Congenital heart conditions

Congenital heart conditions

Congenital Heart Defects (CHDs) are present at birth and can damage the structure and function of a baby's heart. They have the potential to influence how blood flows through the heart and out to the rest of the body. CHDs range in severity from modest (a tiny hole in the heart) to severe (such as missing or poorly formed parts of the heart).

The causes of CHDs in the majority of newborns remain unknown. Some kids are born with cardiac abnormalities as a result of mutations in their unique genes or chromosomes. CHDs are also likely to be caused by a mix of heredity and environmental factors, such as the mother's nutrition, her health problems, or her medication usage during pregnancy. Certain illnesses, such as pre-existing diabetes or obesity in the mother, have been related to cardiac abnormalities in the infant. Heart abnormalities have also been related to smoking during pregnancy and using certain drugs.

This is a kind of cardiac condition present at the time of birth. It may have a long-term impact on the child’s overall health if not corrected on time. The types of congenital heart disorders affecting the infants include; 

  • Heart valve condition: Involves narrowing down of the aortic valve and altering blood flow. 
  • Hypoplastic left heart syndrome: Occurs when the left part of the heart is not fully developed. 
  • Atrial septal defects:  Normally, oxygen-rich blood from the lungs travels from the left atrium to the left ventricle, then through the aorta and into the body. Some blood from the left atrium leaks back into the right atrium due to an irregular opening between the right and left atria (the upper chambers of the heart). To carry the additional blood to the lungs, your heart has to work extra hard. The severity of the condition is determined by the size of the aperture.

 

  • Ventricular septal defects: If a hole exists between your right and left ventricles, oxygen-rich blood returning from your lungs leaks from the left ventricle into the right ventricle rather of being pushed into the aorta and out to the rest of your body. Depending on the extent of the opening, surgery may be required to close it.

 

  • Patent ductus arteriosus: The ductus arteriosus is a passageway for blood between the aorta and pulmonary artery that normally closes a few days after birth. If it fails to close properly, too much blood flows to the lungs. The condition is common in premature babies, but rare in full-term babies. How serious it is depending on how large the opening is and how premature the baby is.

 

  • Tetralogy of Fallot: Consists of four different defects: the narrowed path between the pulmonary artery and right ventricle, a hole in the ventricular septum, thickened right section of the cardiac, and displaced aorta. 

 

Signs and Symptoms

CHD signs and symptoms vary depending on the kind and severity of the problem. Some abnormalities may have little or no visible indications or symptoms. Others may produce the following symptoms in a baby:

  • Blue-tinted nails or lips
  • Fast or troubled breathing
  • Tiredness when feeding
  • Sleepiness

 

Acquired heart conditions

Acquired heart conditions

The common types of acquired heart conditions include;

  • Arrhythmia: This is an abnormal heart rhythm that makes the heart to beat irregularly. The categories of arrhythmias that affect children are tachycardia (rapid heart pulse), bradycardia (slow heart pulse), and long Q-T syndrome. 
  • Atherosclerosis: This involves the buildup and accumulation of fat or cholesterol filled plaques within the arteries. It makes the arteries narrow and stiff, hence increasing the risks of heart attacks and blood clots. 
  • Kawasaki disease: This heart condition inflames the vessels located in the throat, hands, feet, lips, and mouth. It causes fever and swollen lymph nodes. 
  • Rheumatic heart disease: This is a severe condition that can cause permanent damages to the heart muscles and the heart valves.
  • Pericarditis: This disorder is caused by inflammation or infection on the membrane or the thin sac surrounding the heart. 
  • Heart murmur: This is a sound created when the blood circulates the heart chambers, valves, and through the vessels located near the heart. 
  • Viral infections: A virus can sometimes impact normal heart health. It mainly causes myocarditis, which can alter the heart's ability to pump blood to all body parts.  

 

Signs and Symptoms of Childhood Cardiological Disorders 

inability to exercise

Certain types of heart conditions portray varying signs and symptoms, while others do not have any symptoms. However, you should see a pediatric cardiologist if your child shows symptoms such as; 

  • Dizziness 
  • Shortness of breath 
  • High blood pressure 
  • Changes in the heart rhythm 
  • Chest pain 
  • Fainting 
  • Problems with exercise or inability to exercise 
  • Poor feeding 
  • Fast breathing 
  • Lung infection
  • Low or abnormal weight gain

 

Diagnostic Tests and Procedures of Heart Conditions 

Diagnostic tests of Heart Conditions

Before the child is born, the pediatric cardiology surgeons and specialists can conduct specific tests to check congenital heart abnormalities. These tests include; 

  • Fetal echocardiogram: This test involves the use of images captured through ultrasound to check the heart in motion. It enables the pediatrician to view the structure of the heart and check if there is any abnormality. 

Other tests that can be conducted after birth to diagnose heart disorders include; 

  • Physical examination: This is the first diagnostic procedure that involves assessing heart conditions by looking at the physical symptoms. It also involves looking at the medical history of the child as well as family history. 
  • Electrocardiogram (EKG): A pediatrician can perform this procedure to check and measure the child’s heart's electric activity. It can also be used to diagnose heart rate disorders or arrhythmias and identify the heart sections that are either large or overworking. 
  • Echocardiogram: This is a painless type of ultrasound used to check the child’s heart's inner part and detect any defect. The entire procedure typically takes an hour or even less. 
  • Magnetic resonance imaging (MRI) and computed tomography (CT) scans: These are the common types of imaging tests that cardiologists use to acquire detailed information and images of the child’s heart.
  • X-ray: Pediatric cardiologists can opt for an x-ray to check the signs of the enlarged and abnormal shape of the child’s heart. It also enables them to determine if the lungs contain fluid, as this can cause heart failure. 
  • Pulse oximetry: This is used to measure the amount of oxygen in the child’s blood. It’s performed by placing a sensor at the tip of the finger. Low levels of oxygen can indicate that the child has heart problems. 
  • Cardiac Catheterization: A tiny, flexible tube called a catheter is inserted into a vein in the arm, groin (upper thigh), or neck and threaded to the heart during cardiac catheterization. A special dye is injected into a blood artery or a chamber of the heart through the catheter. On an x-ray picture, the dye allows the doctor to view the flow of blood through the heart and blood arteries. Cardiac catheterization can also be used by the doctor to assess the pressure and oxygen levels inside the heart chambers and blood arteries. This can assist the doctor in determining whether or not blood is mingling between the two sides of the heart. Some heart abnormalities can also be repaired by cardiac catheterization.

 

Treatment of Cardiological Conditions

 Treatment of Cardiological Conditions

While some heart conditions are minor, others are severe and usually require immediate medical care. Basically, there are various forms of treatment that the pediatric cardiologist can opt for. This, however, depends on factors such as the type of heart condition and the child’s age. But generally, these are the standard treatment options;

  • Medications

Certain types of congenital and acquired heart defects are minor; hence can be treated and corrected using medications. These medications enable the heart to work and function more efficiently. 

A pediatric cardiologist can thus administer drugs such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and beta-blockers. Other medications that trigger fluid loss can as well be administered. This helps relieve heart stress by minimizing heart rate, blood pressure, and the level of fluid in the chest. 

 

A surgical procedure may be performed to treat and repair defects based on the child's heart condition. Open heart surgery is a method that involves opening the chest area. In other instances, the cardiologist can opt for the minimally invasive heart surgery alternative. This is another type of surgery that involves creating small incisions on the chest. Certain special equipment is then inserted and used to correct the defect.

 Open-heart surgery may be done to:

  • Repair any holes in the heart with stitches or a patch.
  • Heart valves can be repaired or replaced.
  • enlarge arteries or heart valve apertures
  • Repair complicated flaws, such as issues with the location of blood veins around the heart or how they formed. 

Babies are occasionally born with several problems that are too difficult to fix. These children may require cardiac transplants. In this treatment, the youngster's heart is replaced with a healthy heart donated by the family of a deceased child.

 

  • Catheterization procedure 

This procedure is used to treat heart conditions without necessarily opening the heart or the chest. It’s mainly used to correct cardiac or blood vessel holes as well as the narrowed regions. 

During the procedure, the cardiologist inserts a tiny tube known as a catheter into the vein located in the leg. The catheter is then guided towards the heart with the help of x-ray equipment. Once it reaches the affected area, small pieces of equipment are threaded via the catheter towards the heart to correct the defect. 

 

Heart transplant

In case the child’s condition is more severe and beyond repair, then a heart transplant might be the best alternative to consider. 

Adults and children who have become dangerously sick, frequently as a result of an injury, are eligible to donate organs. They will die as a result of their disease or injuries. If the donor is over the age of 18, he or she may have decided to be an organ donor before getting unwell.

Many tests are performed prior to the heart transplant. These include blood testing to increase the chances that the donor heart will not be rejected. Other tests are performed to ensure that your kid and family are emotionally prepared for the transplant. During this time, your youngster will require your assistance.

Sometimes youngsters just have to wait a few days or weeks before receiving a donated organ. It may potentially take months or years to find a suitable donor organ. During this period, your child's healthcare physician and the transplant team will be monitoring him or her closely. During this tough waiting period, you can also seek assistance from support groups.

Each transplant team has its own set of rules for informing you when a donor organ is available. When an organ becomes available, you will usually be contacted. You will be advised to come to the hospital as soon as possible so that your kid can prepare for the transplant. Because this call might occur at any time, you should always be prepared to travel to the hospital.

 

  • Regular monitoring and treatment

Regular monitoring is suitable for a child who has had heart surgery or is suffering from a certain condition. For severe cases, the child might require frequent monitoring and treatment for the rest of their life. This helps prevent further complications and enable the child to live a normal healthy life. 

 

  • Prevention of infections

Sometimes, the child may be required to take the necessary measures to prevent infections. However, this is based on the types of heart condition and treatment opted for. 

Some heart defects can influence infection risks, particularly on the heart valves or the heart lining. In such cases, the child may be required to take antibiotics to keep off infections before surgery. 

 

  • Restricting exercises 

Exercise restriction mainly depends on the types of heart conditions and the treatment option used to correct the defect. While children may be required to minimize the type and amount of exercise, others can freely participate in the usual activities. However, the doctor will always inform you of the safe activities that your child could engage in. 

 

Conclusion 

Pediatric cardiology is mainly concerned about the children’s wellbeing and the conditions that affect the heart. Some of these conditions are present at birth, while others develop over time. These conditions can also alter the blood vessels, heart valves, or the heart lining. Due to this, pediatric cardiology is a vital field that helps diagnose, treat, and prevent such defects.