By Bhavana Sachdev, MS

Heart is a muscular organ that pumps blood to all parts of our body. It consists of a network of blood vessels, such as arteries, veins, and capillaries which carry blood to and from all areas of the body. Any abnormality in the structure and function of heart and blood vessels can lead to various heart diseases in adults as well as children.

Heart conditions in children are described by term “Pediatric heart disease “and it is present in around 1 in 100 babies, making these the most common birth abnormality. For a child to grow and develop, the heart needs to function properly, to provide optimal blood flow throughout the body. There are different types of heart problems that can affect children, from congenital heart defects to viral infections and heart disease acquired later in childhood due to illnesses or genetic syndromes.

Types of heart diseases in children:

Congenital heart diseases

It is a type of heart disease that children are born with, usually caused by heart defects that develop before birth. In fact, it is the most common type of heart disease in children and associated with structural defect, or abnormality of the heart or blood vessels near the heart. Some congenital heart defects in children are simple and don’t need treatment but other types are severe and are diagnosed soon after birth which needs immediate treatment like surgeries performed over a period of several years.

The different causes of congenital pediatric heart disease include:

Holes in the heart:

occur due to congenital heart defects i.e. abnormalities in the structure of the heart at the time of birth. These defects cause ineffective flow of blood in the heart. As the heart is made is made up of four chambers two upper chambers called atrium and two bottom chambers called ventricles. The wall which separates the two upper chambers is called atrial septum and which separates the lower chambers is called ventricular septum. Septum prevents the in intermixing of oxygen rich and oxygen poor blood and thus helps in proper functioning of the heart. Presence of a hole in the septum allows oxygen rich blood to mix with oxygen poor blood resulting in circulation of blood not carrying as much oxygen as normal in the child’s body. This result in fatigue, irritability, swelling in legs, ankles and feet, pale color of skin and fingernails. Many holes do not need any treatment but some require immediate treatment depending upon the size and location of the hole. Treatment usually includes cardiac catheterization and surgery.

Blood vessels Abnormality:

These are defects which happen by incorrect formation and position of blood vessels in the heart. Examples of this kind of defects include Transposition of the great arteries is a condition in which the arteries which carry blood away from the heart are placed reversibly. Pulmonary artery which carries blood away from the heart’s right ventricle is placed in the aorta’s place which carries blood from left ventricle and vice versa. This results in cyanosis and treatment includes balloon septostomy. Co arctation of the aorta includes narrowing of the aorta, which causes high blood pressure and difficulty in breathing. Treatment usually includes surgery.

Abnormalities in Heart valves:

If the heart valves which allows blood to flow in one direction are damaged i.e. can’t open or close properly, then either it will obstruct blood flow or will allow the blood to leak. Example includes Ebstein’s anomaly and Pulmonary Atresia. In Ebstein’s anomaly there is a malformation and leakage of tricuspid valve located between right atrium and ventricle. In Pulmonary Atresia pulmonary valve is missing which causes abnormal blood flow to the lungs.

Obstructed blood flow:

It is caused by the narrowing of blood vessels or heart valves which results in obstruction in blood flow because narrowed valves force the heart muscle to work harder leading to thickening and enlarging of the heart. The most common of this type of defects are Pulmonary Stenosis and Aortic Stenosis. In Pulmonary stenosis valve that allows blood to pass from the right ventricle to the lungs via the pulmonary artery becomes too narrow to function properly and in aortic stenosis, the aortic valve, which allows blood to pass from the left ventricle out to the body via the aorta, becomes too narrow.

An underdeveloped heart:

It is a condition in which heart or major portion of it is not developed properly For example Hypoplastic left heart syndrome, in which left portion of the heart has not developed properly causing ineffective pumping of blood to the body.

A combination of defects:

Some infants or children are born with several heart defects. For example Tetra logy of Fallot which is a congenital heart defect involving four abnormalities occurring together which includes ventricular septal defect (hole between the wall of the ventricles), Right ventricular hypertrophy (thickening of the muscle walls of the right ventricle), Pulmonary steno sis (narrowing of the passage between right ventricle and pulmonary artery) and shifting of the connection of the aorta.

Eisenmenger syndrome:

It is an untreated congenital cardiac defect which affects the blood flow from the heart to the lungs leading to pulmonary hypertension, reversal of blood flow and cyanosis. In this the left -to-right shunt is converted into right- to- left shunt leading to elevated pulmonary artery pressure and vascular disease. Symptoms include chest pain, dizziness, shortness of breath, stroke, swelling in joints, kidney failure and bluish lips, fingers toes and skin. It is diagnosed by abnormal heart rhythm, clubbed fingers and heart murmurs. Treatment includes medicines to decrease pulmonary hypertension, heart-lung transplantation and phlebotomy.

Symptoms of congenital heart disease:

• Rapid heartbeat
• Rapid breathing
• Shortening of breath
• Pale gray or blue skin color (cyanosis)
• Poor feeding
• Extreme tiredness and fatigue
• Chest pain
• Clubbed fingernails
• Poor blood circulation
• Swelling in the legs, abdomen or areas around the eyes

Complications:

Children with congenital heart disease can develop a range of complications which include:

• Slower growth and development
• Congestive heart failure.
• Heart rhythm problems.
• Cyanosis.
• Stroke.
• Repeated respiratory tract infections (RTIs)
• Pulmonary Hypertension
• Heart infection (endocarditic)
• Emotional issues.
• A need for lifelong follow-up.

Treatment:

Not all children who have Cogenital heart defects need treatment and may only need to be observed and visit their cardiologist. But some may require surgery or a cardiac catheterization to reduce the effects of and repair the defect. Many medical treatments are also available to help the heart perform at its best.

Common treatment includes:

• Surgery
• Cardiac catheterization
• Heart Transplants
• Recommending Physical activity and healthy feeding tips.

Acquired heart diseases

These are heart diseases which are acquired by children after an illness in the childhood. There are four main types of acquired heart defects seen in children:

1) Kawasaki disease
2) Rheumatic heart disease
3) Myocarditis
4) Cardiomyopathy

Kawasaki Disease

It primarily occurs in the children under the age of 5 and causes inflammation of the blood vessels that result in damage of heart muscles or coronary arteries. It produces persistent fever, swollen lymph nodes, rash in the groin region, swollen hands, feet’s and tongue, red swollen cracked lips. Treatment depends on the extent of the disease, but prompt treatment with intravenous gamma globulin (immunoglobulin) made from donated blood transfusions is helpful to stop the fever and another signs of this disease, treatment with aspirin, and sometimes corticosteroids can reduce future.

Rheumatic heart disease:

It is caused by acute rheumatic fever which is a delayed complication of streptococcal disease, a throat infection caused by streptococcal bacteria. Rheumatic fever occurs in children aged 5 to 15, but usually the symptoms of rheumatic heart disease don’t show up for 10 to 20 years after the original illness. This disease can seriously and permanently damage the heart muscle (myocarditis) and the heart valves. Early diagnosis and treatment of acute rheumatic fever can prevent rheumatic heart disease. Symptoms of acute rheumatic fever include fever, joint pain, swelling and inflammation of the heart (Carditis). Acute rheumatic fever is treated with medication, usually antibiotics including penicillin and children are usually hospitalized. If the disease has damaged heart valves (rheumatic heart disease), surgery may be needed to repair or replace damaged valves.

Myocarditis

It is a viral infection which causes heart muscle inflammation (myocarditis), which can damage the heart cells and affect the heart’s ability to pump blood throughout the body. It is a rare disease and caused by viral infections like Influenza, Glandular fever, Rubella, HIV and Rheumatic fever. Symptoms include Fever, chest pain and palpitations, swelling in the face, feet or legs, poor blood circulation resulting in cold hands and feet, skin discoloration in blue or grey tones. Treatment includes Intravenous immunoglobulin or purified antibodies, to reduce inflammation, Medicines to control blood pressure and body fluids and also immunization against the viral diseases that can trigger myocarditis.

Cardiomyopathy

It is a disease of the heart muscles which is caused in children by heart valve problems, viral infections, genetic disorders and family history of cardiomyopathy. Symptoms include swelling of hands, feet and abdomen, fatigue, dizziness, breathlessness and irregular heart rhythm. It is mainly diagnosed by ECG, blood tests, chest X-Ray, electrocardiogram. Treatment includes surgery, transplantation and medicines.

Other heart diseases

Atherosclerosis

Atherosclerosis is the hardening and narrowing of the arteries due to building up of fat, cholesterol, cells and debris filled plaques inside the walls of the arteries, which increases the risk of blood clots, heart attacks and many other kinds of heart problems. It begins in early age and progresses slowly into adulthood. Atherosclerosis increases the risk of developing cardiovascular diseases, such as heart attack, stroke and peripheral vascular disease as it affects and blocks arteries that supply blood to the heart and brain. Doctors recommend screening for high cholesterol and high blood pressure in children who have risk factors like family history of heart disease or diabetes and are overweight or obese. Treatment typically involves lifestyle changes like increased exercise and dietary modifications.

Arrhythmias

An arrhythmia is an abnormal or irregular rhythm of the heart or heartbeat, which can cause the heart to pump less efficiently. It may be too fast or too slow or have extra beats or even less beats from normal. The heart rate is defined as the number of times the heart beats each minute and it is said to be normal if beats 70 to 110 times/minute in a kid whose age is between 1 – 3yrs , 55 to 85 times/minute in a teenager and 100 to 150 times/minute in a newborn baby. Heart rhythm is usually regular but it changes easily like it becomes fast while exercising or when we feel excited or scared and slows down during rest or sleep.

Different types of arrhythmias that occur in children, include:

According to the rate of the heart beat

i) Tachycardia: Fast heart rate
ii) Bradycardia: Slow heart rate

According to the origin

i) Atrial arrhythmias

a) Premature Atrial contractions
b) Atrial Fibrillation
c) Sinus arrhythmia
d) Sinus tachycardia
e) Atrial flutter
f) Supraventricular tachycardia

ii) Ventricularl arrhythmias

a) Premature ventricular contractions
b) Ventricular fibrillation
c) Wolff-Parkinson-White Syndrome
d) Ventricular tachycardia

Symptoms may include:

a) Weakness
b) Fatigue
c) Dizziness
d) Fainting
e) Chest Pain
f) Palpitations
g) Difficulty feeding

Treatment:

It depends on the type of arrhythmia and how it’s affecting the child’s health. Common treatments include Radiofrequency and catheter ablation, medications, lifestyle changes, surgical procedures and with the help of implantable devices like pacemakers and cardioverter defibrillator.

Heart Murmurs

A heart murmur is a abnormal sound made by blood circulating through the heart’s chambers or valves, or through blood vessels near the heart. It may be caused by congenital heart defects, fever, or anemia. Heart murmurs can be divided into two categories “innocent murmurs” or “functional murmurs.” not due to structural problems in the heart and Murmurs which are due to a structural problem of the heart (such as a hole in the heart, a narrowed heart valve or a leaky heart valved. If a doctor hears a heart murmur in a child through a stethoscope some additional tests will be performed to be sure the heart is healthy. Not all murmers are pathological and resolve by themselves, but others may require additional treatment.

Pediatric Pericarditis

It is an inflammation or infection of the pericardium, the thin sac (membrane) that surrounds the heart. There is usually a small amount of fluid between the inner and outer layers of the pericardium but when the pericardium becomes inflamed, the amount of fluid between its two layers increases, compressing the heart and interfering with the heart’s ability to function properly. It usually occurs following surgery to repair congenital (present at birth) heart defects or acquired heart disease in children. Symptoms include fatigue, chest pain, irregular heartbeat, low grade fever, irritability and loss of appetite.

It may not be possible to prevent these conditions but some things we do might reduce child’s risk of developing birth and heart defects. Like avoiding harmful substances during pregnancy, getting rubella vaccine when you try to conceive as rubella infection during pregnancy may affect baby’s heart development, taking multivitamins with folic acids etc.

One leading cause of heart disease in children is childhood obesity/overweight.
This if not controlled on time can lead to several heat diseases such as type-2 diabetes, hypertension, dyslipidemia and the metabolic syndrome. This can be controlled by developing healthy eating habits and getting engaged into physical activities that is important not only for heart health but for growing bodies as well.

References:

1. http://www.nhs.uk/conditions/Congenital-heart-disease/Pages/Introduction.aspx
2. http://www.world-heart-federation.org/press/fact-sheets/cvd-in-children-and-youth/
3. http://www.nhlbi.nih.gov/health/health-topics/topics/holes/signs
4. http://www.nhlbi.nih.gov/health/health-topics/topics/holes/signs
5. http://www.patient.co.uk/doctor/congenital-heart-disease-in-children
6. http://www.cincinnatichildrens.org/patients/child/encyclopedia/defects/default/
7. http://www.heartfoundation.org.au/your-heart/Pages/Children-and-heart-disease.aspx