Pediatric Cardiology and Cardiac Defects

Cardiac conditions can affect individuals at a very young age…In this video we will look at some common cardiac conditions of childhood.

A Congenital Heart Defect is when the heart or blood vessels near the heart don’t develop normally before birth. There are at least 18 specific types of congenital heart defects, but diagnosis and treatments continue to advance, making it possible to fix most problems.

Some common heart defects you may come across include:
Aortic valve stenosis – narrowing or obstruction of the aortic valve, causing the left ventricle to hold trapped blood & build up pressure.
Pulmonary valve stenosis – the pulmonary valve is narrowed, causing an obstruction to blood flowing from the right ventricle.
Atrial septal defect (ASD) – a ‘hole’ in the wall separating the atrium.
Ventricular Septal Defect (VSD) – a hole in the wall separating the ventricles.

Coarctation of the aorta – is a narrowing of the aorta, which carries blood to the body. This can cause high blood pressure or heart damage.
Patent Ductus Arteriosus (PDA) – is an unclosed hole in the aorta, which is normal for the fetus, since blood does not need to go to lungs to get oxygenated, however, this hole is supposed to close when the baby is born.

Congenital heart defects can sometimes improve without treatment or may be so small they don’t require treatment. However, most of the time, congenital heart defects are serious and require surgery and/or medications, such as diuretics or digoxin, which strengthens the contraction of the heart. In some cases, surgery is required to restore circulation back to normal, sometimes requiring multiple surgeries. Most patients require specialized care from a cardiologist throughout their lifetime.

Heart failure simply describes a heart that is not functioning properly. It hasn’t stopped working yet, but it’s not working as well as it should. Heart failure in children is either caused by overcirculation, when blood is mixing inside the heart due to a congenital heart defect, or pump failure, when there is damage to the heart muscle and it no longer contracts normally.

Possible symptoms of heart failure in children include:

 
Many of the causes of heart failure can be repaired or treated with medication, especially as newer techniques and medications become available.

Heart murmurs are common in children and are usually innocent or harmless. They often disappear as the child reaches adulthood, but some adults still have them. A heart murmur may also be an indication of a problem.

Murmurs are often caused by defective heart valves. If a valve can’t open or close completely, regurgitation occurs. Murmurs can also be caused by congenital defects as well as fever and anemia.

Arrhythmias – Arrhythmias, also called dysrhythmias, can occur at any age and many times they have no symptoms. They can cause the heart rate to be irregular, fast, or slow. Many of the same arrhythmias that affect adults can also affect children. It is important for the arrhythmia to be properly diagnosed, so it can be properly treated.

The nurse should teach the parent important things to know for a child with an arrhythmia, including CPR, checking the child’s heart rate, knowing how to slow the child’s heart rate, knowing what to avoid, and understanding the child’s medications or pacemaker.

Cardiomyopathy is relatively rare in children and refers to a diseased state of the heart involving abnormalities of the muscle fibers. There are four types of cardiomyopathy, including:

 
Each type has different clinical features and treatments.

Rheumatic Heart Disease and Rheumatic Fever
Rheumatic heart disease is a rare condition in which permanent scarring of the heart valves is caused by rheumatic fever. Rheumatic fever usually occurs in children ages 5 to 15 that have had an inadequately treated or untreated strep throat infection.

Prevention is the best treatment for rheumatic heart disease. Antibiotics can usually treat a Streptococcus bacterial infection (strep throat), which will prevent the acute rheumatic fever from developing. Children that develop rheumatic fever are often given ongoing antibiotic treatments to prevent subsequent inflammation of rheumatic fever and lower the risk of heart damage. If heart valve damage does occur, surgical repair or replacement may be necessary.

Kawasaki Disease (mucocutaneous lymph node syndrome) is a rare childhood disease that causes inflammation in the walls of blood vessels. It is most common in infants and young children and is characterized by fever, rash, conjunctivitis, swelling of the hands and feet, swollen lymph glands in the neck, and irritation and redness of the mouth, lips, and tongue.

The cause of the disease is unknown, but it may be the result of an infection triggering an autoimmune response. The heart may be affected, causing damage to the coronary arteries and to the heart muscle itself.

Kawasaki disease is treated with aspirin, to reduce fever, rash, joint inflammation, and pain, and to prevent blood clots from forming. Also IV immunoglobulin therapy decreases the risk of developing heart disease.

Reassure parents that there is no known prevention for the disease and there is nothing they could have done to prevent it. The goal in treatment is to make the child as comfortable as possible while the illness runs its course over 10-14 days.

Kawasaki disease (mucocutaneous lymph node syndrome)
– Causes inflammation in the walls of blood vessels
– Most common in infants and young children
– Characterized by fever, rash, conjunctivitis, swelling of the hands and feet, swollen lymph glands in the neck, and irritation and redness of the mouth, lips, and tongue
– May be the result of an infection triggering an autoimmune response
– Treated with aspirin, to reduce fever, rash, joint inflammation, and pain, and to prevent blood clots from forming, also IV immunoglobulin therapy decreases the risk of developing heart disease
– No known prevention for the disease
– Goal in treatment is to make the child as comfortable as possible while the illness runs its course over 10-14 days

Cholesterol & High Blood Pressure is another heart issue that can affect children of all ages.

Buildup of fats & cholesterol in the arteries begins in childhood and progresses slowly into adulthood, often leading to coronary heart disease, the leading cause of death in the U.S. Cholesterol levels and the risk for coronary heart disease are affected by eating patterns & genetics.

Children can also develop high blood pressure. It may be associated to lifestyle-related factors such as obesity, or it may be hereditary. The high blood pressure can also be secondary to certain diseases or some medications. The American Heart Association recommends that all children have yearly blood pressure checks to allow for early detection and intervention.

Patient Education
The nurse should teach parents & children about healthy eating habits, regular aerobic exercise, reducing or avoiding obesity, discouraging cigarette smoking, and treatment of high blood pressure and diabetes.