When we think of heart disease, we commonly think of heart attacks in an older patients with Coronary Artery Disease but children can also be born with and develop cardiac problems. These problems of the heart are often difficult to diagnosis and surprise both parents and physicians alike when they do develop. The obvious signs of congenital heart disease; that of of a “blue baby” (but without lung disease), are not always present. There is no real consistent marker for all types of childhood heart lesions (damage to the interior walls of the heart). Some types of defects are stealthy and have a characteristic heart murmur (the extra sound we listen for). The murmur does not consistently appear in infants and sometimes not until they are almost a month old. Today, we do screen before discharge from the hospital, in hopes of picking up the dangerous silent lesions before they become serious. This screening is done by comparing the oxygen level between the upper and lower extremities of the body; the more dangerous type of heart lesions have central mixing of venous and arterial blood which can cause abnormally low oxygen saturation below the heart compared to that above the heart. The nurse can pick this difference up with a non-invasive electronic clip on the toe and finger, which measures the wavelength of reflected light which changes depending on the amount of venous and arterial blood. Another subtle sign of congenital heart disease is feeding difficulties, particularly if the 1 or 2 month old baby needs to pause and becomes short of breath during the course of a feeding. If those symptoms do appear, that is a good reason for a physician examination.
Older children can also develop heart disease. In fact, the main reason for always swab culturing a sore throat and aggressively treating Strep Throat is not so much to shorten the illness, but more importantly to prevent post Streptococcal Rheumatic Heart Disease, a life-long debilitating heart valve injury. Occasionally, sore throats are treated without taking a throat culture; this is not the standard for today’s care.
Another cardiac concern we all share is Sudden Cardiac Death occurring while playing sports. Actually, the risk of sudden cardiac events in athletes is not any higher than it is of occurring in non-athletes. Fortunately, it is extremely rare and, unfortunately, usually in those who have had no pre-existing heart problems. It is always is a tragedy but there are often clues available to predict the risk. According to the American Heart Association, universal athletic screening with the use of EKG or cardiac ultrasound is not cost effective and has not been found to reduce the rate of these events but a careful 14 question pre-participation screening exam is very important to select out those at risk who would benefit from a more detailed cardiology evaluation. I believe that the increasing availability of automated defibrillators in schools and on the field of play and when applied quickly may reduce the number of these deaths.
Marfan’s Syndrome is a condition which can predispose teens to sudden cardiac events. These patients have a defect which weakens the vessel and can cause sudden aortic rupture, especially during pregnancy. Marfan’s patients have an appearance similar to Abe Lincoln; with long slender arms, thin wrists in which the thumb and fingers can encircle the wrist and long fingers in which the thumb which can extend all the way across the palm. It can be inherited as a dominant condition in which 50 % will pass it on to offspring.
Another rare pediatric heart problem is the development of Supraventricular Tachycardia. These are spontaneous rhythm disturbances which can occur in 2-3 per thousand people and often in teen-aged girls. The rapid heart rate happens to those with anatomically normal healthy hearts, without warning the heart rate suddenly increases to 180 to 200 beats per minute, with a pulse almost too fast to count. Although not usually life-threatening, these children can have symptoms of light headedness, pallor and nausea. The event then stops just as suddenly as it started. Prolonged runs can occur and can be stopped in the ED with IV drugs. A newer treatment using a Cardiac Catheter Ablation (a procedure used to selectively destroy areas of the heart that are causing the heart rhythm problem) can be permanently curative.
Coronary Heart Disease prevention should start in the Pediatric age group with good sensible nutrition and meal portion size. Early cautions against the dangers of smoking (the number one contributor of heart disease) can begin in grade school. If the family has a history of heart disease, especially in any relative under 50, early screening of risk should include blood cholesterol testing in the teen years as well as the office cardiac screening for sports.
Cardiovascular is not limited to adults and children’s heart problems are not the same as adults. Early recognition and close observation can pick up most problems. An ounce of early prevention may prevent pounds of later cardiac care.
Michael R Jordan, MD, CPE, FAAP
Michael R. Jordan, MD, CPE, FAAP, chief of Pediatrics of Newark-Wayne Community Hospital is board-certified in Pediatric Medicine. He attended the College of Human Medicine at Michigan State University and completed his residency training at the University of Rochester. In addition to his leadership role as chief of Pediatrics at Newark-Wayne, he is the medical director of Rochester Regional Medical Group (RRMG) and is also chair of RGMG’s Quality Committee. He works in the Sodus Rochester General Medical Group Pediatric office. To send questions on children’s health, please email Wendy Fisher, Pediatrics’ Practice Manager at wendy.fisher@rochestergeneral.org and write “Ask a Doc” in the subject line. To schedule an appointment, call (315) 483-3214.
