Pediatric Heart Disease

Overview

Heart disease is a wide phrase that refers to a variety of conditions that can affect the heart in both adults and children. When the focus is narrowed to children, the word still contains a wide variety of disorders, from a disease with no symptoms and is never identified to a serious and possibly life-threatening illness that is evident from birth.

What is Pediatric Heart Disease?

Pediatric heart disease is a wide phrase that refers to a variety of cardiac diseases in children. It can be present from birth (Congenital) or developed later in infancy as a result of diseases, infections, or even therapy for a congenital heart abnormality.

What is Acquired Heart Disease?

While most people associate acquired heart disease with adults, it is also rather frequent in juvenile patients. Rheumatic heart disease and Kawasaki disease are two of the most frequent juvenile heart disorders.

Children who have been treated for congenital heart abnormalities may develop other acquired heart disorders. Endocarditis, a bacterial infection of the heart's lining or valves, and acquired cardiomyopathy, an abnormally enlarged or thickened heart, may be more common in these youngsters. In some situations, children and young people might develop arrhythmias, or abnormal heartbeats.

Treatments for acquired heart disease in children are similar to those used to treat congenital heart abnormalities.

Congenital Heart Disease (CHD) in Children

Congenital heart disease (meaning present at birth) refers to a variety of disorders that affect the heart. These cardiac anomalies occur during pregnancy, before the baby is born, when the infant's heart is growing. Heart abnormalities are the most prevalent birth defects, affecting one in every 120 newborns born in the United States.

Specific stages must be followed in order for the heart to develop properly. Congenital cardiac disease is frequently caused by one of these critical processes not occurring at the appropriate time.

Types of Congenital Heart Diseases

In order to better understand the complications that your kid may have, we can divide congenital heart disease into numerous groups. They are as follows:

1. Problems that cause too much blood to pass through the lungs

These flaws cause oxygen-rich blood that should be flowing to the body to recirculate through the lungs, producing increased pressure and tension. They are as follows:

Patent ductus arteriosus (PDA): This flaw disrupts the normal pulmonary vascular system, allowing blood to circulate between the pulmonary artery and the aorta. There is an open pathway between the two blood arteries before to birth. This opportunity closes shortly after delivery. Some blood returns to the lungs if it does not shut. Premature newborns frequently have patent ductus arteriosus.
Atrial septal defect (ASD): The abnormal opening between the two upper chambers of the heart — the right and left atria — causes aberrant blood flow through the heart in this disorder.
Ventricular septal defect (VSD): A hole in the ventricular septum (the separating wall between the two bottom chambers of the heart — the right and left ventricles) arises in this disorder. Due to increased pressure in the left ventricle, blood rushes back into the right ventricle through this hole. This causes the right ventricle to pump an excess amount of blood into the lungs, typically resulting in pulmonary congestion.
Atrioventricular canal (AVC or AV canal): AVC is a complicated cardiac condition characterized by many structural defects inside the heart, including an atrial septal defect, a ventricular septal defect, and incorrectly developed mitral and/or tricuspid valves.

2. Problems that cause too little blood to pass through the lungs

These circumstances allow blood that has not yet reached the lungs to pick up oxygen and go to the body. With these cardiac disorders, the body does not receive enough oxygen. Babies with certain types of CHD may be cyanotic, or seem blue. Among these conditions are:

Tricuspid atresia: In this condition, there is no tricuspid valve, which means no blood flows from the right atrium to the right ventricle.
Pulmonary atresia: This is a complicated CHD in which there is abnormal development of the pulmonary valve.
Transposition of the great arteries (TGA): With this condition, the positions of the pulmonary artery and the aorta are reversed.
Tetralogy of Fallot (TOF): This condition is distinguished by four defects: an abnormal opening, known as a ventricular septal defect; a narrowing (stenosis) at or just beneath the pulmonary valve, which partially blocks blood flow from the right side of the heart to the lungs; a right ventricle that is more muscular than normal and frequently enlarged; and an aorta that lies directly over the ventricular septal defect.
Double outlet right ventricle (DORV): In this condition, both the aorta and the pulmonary artery are connected to the right ventricle.
Truncus arteriosus: In this syndrome, the aorta and pulmonary artery begin as a single blood vessel before splitting into two distinct arteries. Truncus arteriosus develops when the one great vessel fails to completely split, resulting in a link between the aorta and pulmonary artery.

3. Problems that cause too little blood to travel to the body

These problems are caused by undeveloped heart chambers or blood artery obstructions, which prevent the necessary quantity of blood from reaching to the body to satisfy its demands. They are as follows:

Coarctation of the aorta (CoA): The aorta narrows or constrictes in this situation, restricting blood flow to the lower body and raising blood pressure above the constriction.
Aortic stenosis (AS): The aortic valve between the left ventricle and the aorta did not develop correctly in this disease and is constricted, making it difficult for the heart to pump blood to the body.
Hypoplastic left heart syndrome (HLHS): A combination of several abnormalities of the heart and the great blood vessels.

In certain circumstances, various cardiac abnormalities coexist, resulting in a more complicated condition that might fall into many of these categories.

Testing and diagnosis of congenital heart disease

During a normal ultrasound check during pregnancy, many significant congenital cardiac disorders are diagnosed. Others could be diagnosed soon after birth. Less serious heart abnormalities may go undetected until children reach a particular age and begin to exhibit signs or symptoms of congenital heart disease.

If your doctor suspects your baby has CHD during pregnancy, you will most likely be sent to a pediatric cardiologist for further testing. The type of diagnostic tests conducted will be determined by the type of CHD your kid has. Fetal echocardiography, electrocardiogram (EKG), cardiac magnetic resonance imaging (MRI), and cardiac catheterization are some of the tests utilized.

Treatments for Congenital Heart Disease

Congenital cardiac defects can be simple or complicated. Some heart issues can be monitored and controlled with medications by your child's cardiologist, while others will necessitate heart surgery or cardiac catheterization - sometimes as soon as a few hours after birth.

Some mild cardiac disorders, such as patent ductus arteriosus (PDA) or atrial septal defect, may even "grow out" in a kid (ASD). These issues may resolve on their own as the youngster develops. Other children will have more complex kinds of congenital cardiac disease, or a mix of several types, and will require many procedures or catheter interventions, as well as continued care for the rest of their lives.

Heart Failure in Children

The heart is a muscle that circulates oxygen-rich blood throughout the body. When you have heart failure, your heart cannot pump as efficiently as it should. Backflow of blood and fluid into the lungs is possible (congestive heart failure). Some bodily components do not receive enough oxygen-rich blood to function correctly. These issues result in heart failure symptoms.

What causes heart failure in a child?

The most prevalent cause of heart failure in children is a congenital cardiac abnormality (congenital). Other factors include:

Heart muscle disease or enlargement of the heart muscle (cardiomyopathy). This is often an inherited cause.
Decrease in the blood supply to the heart (ischemia). This is rare in children.
Heart valve disease
Irregular heartbeats (cardiac arrhythmias)
Low red blood cell count (anemia)
Infections
Medicine side effects, especially from medicines used to treat cancer

What are the symptoms of heart failure in a child?

Symptoms can occur a bit differently in each child. They can include:

Swelling (edema) of the feet, ankles, lower legs, belly (abdomen), liver, and neck veins
Trouble breathing, especially with activity including rapid breathing, wheezing, or excessive coughing
Poor feeding and weight gain (in infants)
Feeling tired
Excessive sweating while feeding, playing, or exercising
Irritability

Older children may also have:

Weight loss
Passing out
Chest pain

The severity of the symptoms is determined by how much of the heart's pumping function is compromised. Heart failure symptoms might mimic those of other medical diseases. Make an appointment for your child to visit a doctor for a diagnosis.

How is Heart Failure Diagnosed in A child?

Your child's symptoms and medical history will be discussed with the healthcare practitioner. He or she will examine your youngster physically. The provider will check for signs that might indicate heart failure. If your child's physician suspects heart failure, he or she may need to see a pediatric cardiologist. This is a doctor who has received specialized training in diagnosing and treating cardiac abnormalities in youngsters. Heart failure tests may include:

Blood and urine tests. Abnormal results may help find heart failure.
Chest X-ray. The X-ray may show heart and lung changes.
Electrocardiography (ECG). The ECG may show changes in the heart's rhythm.
Echocardiography (echo). The motion of the heart's chambers and valves is studied using ultrasound waves. The echo may reveal heart failure-related alterations such as enlarged chambers.
Cardiac catheterization. A short, flexible tube (catheter) is inserted into a blood artery and moved to the heart by the doctor. This monitors the pressure and oxygen levels within the heart.

How is heart failure treated in a child?

Digoxin

The treatment will be determined by your child's symptoms, age, and overall health. It will also depend on the severity of the problem. If a congenital cardiac defect causes heart failure, fixing the defect may cure the heart failure. Children's heart failure is frequently treated with medications. They might include:

Digoxin. This is a medicine that can help the heart beat stronger with a more regular rhythm.
Water pills (diuretics). These help the kidneys get rid of extra fluid that may build up in the body.
ACE (angiotensin-converting enzyme) inhibitors. These medicines help open the blood vessels and lower blood pressure. This makes it easier for your child's heart to pump blood to the body.
Beta blockers. These help lower the heart rate and blood pressure. This also makes it easier for the heart to pump blood to the body.

Other treatments include:

Pacemaker. Some children with heart failure require a pacemaker. When the heart is not pumping properly due to a sluggish beating, a pacemaker may be used to help.
Resynchronization treatment for the heart. A unique sort of pacemaker is used in this case. Some youngsters with chronic heart failure may benefit from this therapy.
Mechanical support devices. Special gadgets and tools may be used to assist children with severe heart failure. Your child might benefit from them while awaiting a heart transplant.
Heart transplant. A healthy donor heart replaces your child's diseased heart.

Children may also require the assistance of a dietitian, who may assist with eating and hydration management. An exercise rehabilitation program for older children may be beneficial.

Arrhythmias in Children

An arrhythmia is a cardiac rhythm disorder. An arrhythmia occurs when aberrant electrical signals go through the cardiac muscle, causing the heart to beat excessively quickly (tachycardia), too slowly (bradycardia), or irregularly. When the heart does not beat regularly, it is unable to pump blood throughout the body. This implies that the brain, lungs, and other organs may not receive adequate blood supply. Furthermore, the organs are unable to function properly and may become injured.

Arrhythmias in children include:

Long-Q-T syndrome (LQTS). This is a disorder that is handed down from parents to children (inherited). Children and young adults are most commonly affected. Many youngsters show no symptoms, but those who do frequently faint. It may potentially result in cardiac arrest.
Premature atrial contraction (PAC) and premature ventricular contraction (PVC). PACs or PVCs are aberrant heartbeats that begin in the upper chambers (atria) or lower chambers (ventricles) (ventricles). They are quite frequent among children and adolescents. They are frequently thought to be perfectly normal and harmless.
Sinus tachycardia. A fast heart rate that occurs with fever, excitement, and exercise. It is normal.
Supraventricular tachycardia (SVT), paroxysmal atrial tachycardia (PAT), or paroxysmal supraventricular tachycardia (PSVT). In youngsters, this is the most prevalent kind of tachycardia. Rapid heart rates can be caused by an aberrant electric circuit or focal point in the atria. If it occurs frequently or over an extended period of time, treatment may be required.
Wolff-Parkinson-White (WPW) syndrome. This is an unusual electrical signal that travels to the ventricle through an additional electrical conduit. It has been present from birth. A quick heartbeat is a common sign. A youngster may or may not exhibit symptoms. Sudden cardiac death is uncommon.
Ventricular tachycardia (VT). This arrhythmia has the potential to be fatal. It might be due to severe cardiac disease. A extremely quick electrical pulse from the ventricles causes it. A kid may get weak, weary, dizzy, or faint (syncope). He or she may also feel the beat of his or her own heart (palpitations).
Sick sinus syndrome. The heart's natural pacemaker (sinus node) is malfunctioning. This results in sluggish heart rates. It is possible that it will arise in children who have had open heart surgery. A youngster may not exhibit any symptoms. A youngster experiencing symptoms may feel weary, dizzy, or faint.
Complete heart block. The electrical transmission between the upper and lower chambers is obstructed. The heart normally beats much more slowly. This issue may arise following cardiac surgery or as a result of heart disease. It might cause a youngster to pass out.

What causes arrhythmias in a child?

The cause of an arrhythmia may be unknown. Some known causes in children include:

Heart problem that is present at birth (congenital)
Heart problem that is inherited
Infection
Abnormal levels of certain chemicals in the blood
Normal reaction to exercise, fever, or emotions
Changes in the structure of the heart
Electrical conduction abnormality

What are the symptoms of an arrhythmia in a child?

A child with an arrhythmia may not have any symptoms. For those who do, these are the most common symptoms:

Feeling weak
Feeling tired
Feeling like the heart is fluttering (heart palpitations)
Low blood pressure
Feeling dizzy
Fainting (syncope)
Not feeding or eating well

Arrhythmia symptoms might mimic those of other medical diseases or cardiac abnormalities. Make an appointment for your child to visit a doctor for a diagnosis.

How is an arrhythmia diagnosed in a child?

Your child's healthcare practitioner will inquire about his or her medical history as well as family history. He or she looks for arrhythmia indications and symptoms. The physician will do a cardiac checkup on your child. Your youngster may require the services of a pediatric cardiologist. This is a doctor who has received specialized training in treating youngsters with cardiac issues. Your youngster may require the following tests:

Electrocardiogram (ECG). This simple test measures the electrical activity of the heart. An ECG may show an arrhythmia. The test may be a:
- Resting ECG. Your youngster will be asked to lie down while electrodes are wired to the ECG equipment. For about a minute, the ECG monitors the electrical activity of the heart.

- Stress test (exercise ECG).As previously explained, your child is connected to the ECG machine. While the ECG is being recorded, he or she will walk on a treadmill or cycle a stationary bike. This test is used to monitor the heart during exercise.

Holter monitoring. Your child's cardiac rhythm will be monitored for 24 to 48 hours. A little portable monitor is worn by your youngster as he or she goes about his or her daily activities.

Electrophysiologic study (EPS). A tiny, thin tube (catheter) is inserted into a major blood artery in the leg or arm for this test. The catheter is advanced to your child's heart by the doctor. This test can determine the sort of electrical signal causing the problem as well as its location.

Tilt table test. If your kid often faints, this test may be performed. As your child changes positions, the test measures his or her heart rate and blood pressure.
Echocardiography (echo). This test uses sound waves to make detailed pictures of your child's heart structure and function.

Implanted loop recorder. This cardiac monitoring gadget may be used if your doctor believes your kid is at high risk for arrhythmia and previous tests have not shown a clear result. This test should only be used on high-risk children. The gadget is implanted beneath the skin. It is employed in long-term monitoring.

How is an Arrhythmia Treated in a Child?

The treatment will be determined by your child's symptoms, age, and overall health. It will also depend on the severity of the problem. Some youngsters might not require therapy. If your kid requires therapy, he or she will almost certainly be seen by a pediatric cardiologist. Treatment options include:

Medicines. Medicines can ease symptoms.
Radiofrequency ablation. This procedure uses a special catheter to destroy the tissue causing the abnormal electrical signals.
Surgery. Surgery can stop an abnormal heart rhythm.
Pacemaker. Some arrhythmias may necessitate the use of an artificial pacemaker. A pacemaker is a tiny device implanted in the abdomen or chest. It supplies a modest quantity of energy to the heart in order to keep it beating normally. If your child has a sluggish heart rate, he or she may require this.
Implantable cardioverter defibrillator (ICD). This device is inserted into the chest or abdomen. It sends an automatic shock to interrupt an irregular and harmful rhythm. Some ICDs also function as pacemakers.
Electrical cardioversion. An electric shock is administered. This temporarily halts the aberrant electrical activity in the heart. It "resets" the regular pacemaker in the heart. After then, the heart may resume its usual beat.

What Else Should I Know?

As children get older, it is critical to teach them how to manage their own medical care. A younger teen may be able to fill a prescription or make an appointment. Older teenagers should be aware of their cardiac diagnoses, as well as any surgeries or treatments they have had. They should comprehend their health insurance coverage and how to obtain their medical information as they become older.

Assist an older teen in transitioning from a pediatric cardiology to an adult cardiologist. The cardiologist should be involved in the selection of the new doctor. Encourage your child to schedule visits, ask questions, and take notes, as well as set aside time to meet with the doctor alone.

Conclusion

Pediatric heart disease refers to a variety of cardiac disorders that affect children. The most prevalent kind of pediatric cardiac disease is congenital, which means that it is present at birth. Adults can have congenital heart defects (CHD), although they are still called CHD if the adult was born with the disease.