With more than 25 million adults in the United States suffering from heart disease, there are vast medical resources dedicated to its treatment and prevention.
But children’s heart disease is far more rare and often more complicated. Unlike adult heart disease, children’s heart disease rarely is caused by lifestyle choices and usually cannot be prevented. Furthermore, because of the delicate nature of pediatric care, treatment must address both the physical condition and the psychological consequences for children and their families.
“Successful treatment requires highly specialized care and a collaborative, interdisciplinary team approach,” said Dr. Nancy Lin, MD, a pediatric intensivist with MEDNAX National Medical Group at Sunrise Children’s Hospital.
There are three types of children’s heart disease
• Congenital heart defects (CHDs)
These involve structural problems within the heart. CHDs affect eight of every 1,000 babies born, making them the most common type of pediatric heart disease and the most common of all birth defects.
“CHDs usually occur when the child’s heart develops abnormally while in the womb,” Lin said. “Defects range in severity from simple problems, such as small holes between chambers in the heart, to very severe malformations, such as the complete absence of a chamber or one or more valves.”
At least 25 percent of infants with a CHD require surgery in childhood. The causes of these abnormalities generally are unknown, although genetics can be a factor. Someone who has had one child with a CHD has a higher risk of having another child with heart disease. In rare cases, the ingestion of certain medications or drugs, or contracting some viruses, during pregnancy can cause CHDs.
• Heart rhythm disturbances (arrhythmias)
Rhythm disturbances occur when there is a change in the normal sequence of electrical impulses in the heart.
“Some children are born with malformed heart conduction systems, while in other cases, rhythm problems can be caused by infections, drug exposures, or abnormal levels of chemicals in the blood. Rarely, they can be complications following complex congenital heart surgery,” said Lin.
Rhythm disturbances can manifest as fast heart rates, slow heart rates, or irregular palpitations.
• Acquired heart diseases
Acquired heart disease in children most often occurs as a result of infections causing damage to heart valves (endocarditis), heart muscle (myocarditis), or coronary arteries (Kawasaki Disease). In developing countries, rheumatic fever is the most common cause of acquired pediatric heart disease.
Rarely, acquired heart disease can result from long-standing high blood pressure, untreated CHD, or exposure to some toxins, like certain types of chemotherapy or radiation.
Treating pediatric heart disease
Though there are three main categories of pediatric heart disease, there are many individual conditions within these three categories and many ways to treat them.
“Typical treatments might include medication, surgery, cardiac catheterization, pacemakers and defibrillators, and potentially heart transplants,” Lin said. While both adults and children have the same basic treatment options available, there are many additional considerations when treating children.
Children and infants require specialized care and the concentrated effort of an interdisciplinary team because of their small anatomy and the complexity of their diseases. Feeding, growth and developmental difficulties must also be considered.
The interdisciplinary team can include pediatric critical-care physicians, cardiologists, cardiothoracic surgeons, nurses, respiratory specialists, pharmacists, dietitians, social workers, child-life specialists and psychologists.
Pediatric heart disease also can strain patients’ families, both emotionally and financially. Support groups, therapy and even financial counseling all are important for coping.
Lasting effects of pediatric heart disease
“Virtually all children with simple defects survive into adulthood,” Lin said. “Although exercise capacity can be limited, most people lead fairly normal or nearly normal lives.”
However, complex congenital heart defects may require multiple surgeries and medications throughout one’s lifetime and can increase a patient’s risk for certain chronic medical conditions or disabilities. All patients will require regular and lifelong medical care from a primary care doctor and a cardiologist.
Symptoms in children
Shortness of breath, decreased exercise tolerance, chest pain or palpitations and/or swelling in the face and limbs. In rare cases, fainting also could indicate heart rhythm disturbances.
Most congenital heart defects are diagnosed by ultrasound during pregnancy. Infants who have heart disease but were not diagnosed prenatally may exhibit the following symptoms: a light grey or blue skin color, heavy and quick breathing, poor weight gain and excessive sweating, fatigue and/or fussiness.
Did you know?
High cholesterol and atherosclerosis, the buildup of plaque and fatty deposits, can begin in childhood and adolescence. Be sure children eat well, exercise regularly and make other healthy lifestyle choices to help reduce their risk of heart disease later in life.