Pediatric Diseases: Healing Little Hearts
Introduction
Although the prospect of a heart defect in a child is frightening, most
children with abnormalities of the heart lead normal or near normal lives, can
safely undergo corrective procedures, and have an excellent outlook for
long-term survival and quality of life.
What types of heart problems affect children?
Most heart problems in children are congenital, which means they are
present or existing at birth. Congenital heart diseases are abnormalities or
defects of the heart and its major blood vessels. These heart defects occur in
1 percent of the population and range in severity from simple defects — for example, a
ventricular or atrial septal defect (a small hole in the wall between two
chambers of the heart) — to complex abnormalities — for example hypoplastic left
heart syndrome (an underdeveloped left atrium and ventricle, narrowed valves
connecting these chambers, and an abnormally formed aorta).
What is a heart murmur?
Most children have heart murmurs at some time in their lives. A heart
murmur is a sound that the doctor can hear with a stethoscope. Normal sounds of
vibration or flow within the heart can be heard during routine examination, and
these normal sounds are called "innocent" heart murmurs. Innocent
murmurs are normal and harmless, and might disappear and reappear from one
examination to the next. In most cases, the family doctor or pediatrician can
determine which sounds are innocent murmurs and which require further
evaluation.
Some murmurs can indicate a heart defect. A pediatric cardiologist can
evaluate an unusual or suspicious murmur and determine if further testing is
needed. If your child has an innocent murmur, he or she does not have to
limit his or her activity, take antibiotics before dental work, or follow any
other special precautions.
How are pediatric heart diseases treated?
The treatment and outlook for each child depends on the disease
and its severity. In some cases, no treatment is necessary and life expectancy
is normal. Many forms of congenital heart defects require some type of treatment
at some point in life. The treatment needed might be surgery or treatment using a
catheter, a tube passed into an artery and up to the heart. In most cases,
treatment for congenital heart disease results in normal or near normal heart
function.
In rare cases, the cardiac defect is so severe that normal heart function
cannot be established, but surgery is performed to reduce symptoms, improve
survival, and allow a normal or near normal quality of life for the child.
Surgery for most congenital heart defects currently carries a low risk of death
or serious complications (less than 2 percent), and requires a short hospitalization
with a rapid return to normal activities.
Although surgery seldom makes the heart completely "normal," most
children are able to pursue normal activities, and experience excellent growth
and development. Similarly, young adults who have undergone surgical correction
of congenital heart defects during childhood generally enjoy good health, pursue
normal activities, and maintain an excellent quality of life.
Almost every individual born with a heart defect requires lifetime follow-up
and routine cardiac evaluations. An increasing number of adults have survived
childhood despite a congenital heart defect, and such individuals benefit from
evaluation in a center specialized in adult congenital heart disease. Important
issues for young adults include pregnancy, employability, insurability, and
activity and exercise prescriptions.
Can heart disease in children cause sudden death?
Sudden death as a result of a heart disease very rarely occurs in children
and adolescents. Injury and trauma are much more likely than heart problems to
cause death during childhood. Sudden infant death syndrome is only rarely
associated with any heart defect or abnormality.
Sudden death during exercise in adolescent athletes is a rare occurrence.
Potential cardiac causes of sudden death in this population include:
- Hypertrophic cardiomyopathy (enlarged heart muscle)
- Myocarditis (inflammation of the heart muscle due to infection)
- Marfan's syndrome (an inherited muscle and bone disorder that, in the
heart, can cause breaking of the elastic fibers in the walls of the aorta.)
- Coronary artery abnormalities
- Long QT syndrome (an abnormal heart rhythm)
Careful history and physical examination can identify risk factors for sudden
death in most young athletes.
Do children develop hardening of the arteries?
The medical term for hardening of the arteries is "atherosclerosis."
Atherosclerosis is the buildup of plaque (hard deposits) in the artery walls.
This buildup can block the artery and promote the formation of blood clots.
Atherosclerosis of the arteries around the heart is a type of coronary artery
disease. Children generally do not develop problems from coronary artery
disease. However, mild abnormal changes can be seen in the walls of arteries of
children, and damage to the arteries can begin during childhood.
Risk factors for the development of atherosclerosis include:
- A family history of atherosclerosis
- A sedentary lifestyle
- Obesity
- Smoking
- Abnormal serum lipids (high levels of fat, including cholesterol, in the
blood)
Nearly all of these factors can be modified during childhood. Avoidance of
cigarette smoking and increased aerobic exercise — along with weight control and
blood pressure monitoring — should be encouraged to promote a healthy
cardiovascular lifestyle and to reduce cardiovascular risk factors in children,
adolescents, and young adults.
In rare cases, a lipid disorder, such as familial hypercholesterolemia, might
be present. This disorder causes excess amounts of cholesterol in the blood and
requires following a special diet and taking medicines.
Summary
- Most children with heart disease are born with a congenital heart defect.
The life expectancy and quality of life for most of these children are
excellent.
- Most heart murmurs in children are innocent and require no treatment.
- The risk of sudden cardiac death in children and adolescents is very low.
Many cardiac causes can be identified by taking a careful history and
performing a physical examination.
- The risk factors for the development of atherosclerosis are present in
childhood. Adoption of healthy lifestyles during childhood should reduce the
impact of atherosclerosis in adults.
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Copyright 1995-2008 The Cleveland Clinic Foundation. All rights reserved
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