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Introduction Heart disease are not uncommon in childhood and constitute a significant proportions of children admissions in hospital. In particular, congenital heart disease account for 30% of all heart diseases for all ages.
Functions of the heart The human heart is a muscle that works like a pump. The right side of the heart receives deoxygenated or "blue" blood from the body and pumps it to the lungs to add oxygen. The left side receives this re-oxygenated "red" blood from the lungs and pumps it back out to the body.
If the heart and blood vessels are abnormal in any way or the heart does not pump properly, the patient can get sick and have heart disease.
Different Types of Heart Disease Heart disease in children may be congenital or acquired.
Congenital Heart Disease Congenital heart disease is the kind that a patient is born with, but it's not that common. The incidence is 8-10 per 1000 livebirths. It can be caused by heredity or viral diseases like rubella. Acquired Heart Disease Acquired heart disease develops sometime during childhood as a result of illnesses like rheumatic fever, myocarditis, endocarditis, pericarditis etc.
Arrhythmia
Arrhythmia is an abnormal rhythm of the heart. Normally, the heart beats at 60-150 beats per minute in older children and adults, and 100-140 beats in infants and young children, but a person's heart can beat very fast (tachycardia) or very slow (bradycardia).
Symptoms and signs of heart disease in children Depend on type and severity of the heart disease a patient has. They include: Cyanosis; Shortness of breath on exertion (breathing and feeding problems); Cardiac failure Recurrent lower chest infections Poor growth (failure to thrive
Precordial bulging;
Squatting
Hypoxic spells
Cardiac murmur
In older children
Palpitations
Syncope
Heart Murmurs
A heart murmur is a whooshing sound between each heartbeat. The whoosh isn't serious, but is just an extra noise that the blood makes as it flows through the heart. However, sometime murmurs can be a symptom of larger problems. The intensity of the murmur is not proportional to severity of the heart disease
1. Cynosis .
a. Peripheral cyanosis (i.e. bluish coloration around the mouth and over the eyelids but not of the mucous membranes) is normal in infants
Dyspoea on exertion
Feeding difficulty in infants and young children Difficulty in growth (failure)
Squatting.
Syncope
Palpitations 3.Familial disorders Some cardiovascular disorders (e.g. hyperlipidaemia, hypertension) may be familial
4. Chest pain
It is common in the pediatric age-group, particularly in adolescents but it is rarely of cardiac origin. Analysis of specific features (e.g. quality, distribution, relationship to level of activity) helps to distinquish anginal pain from pain due to more benign causes
B. Pysical examination
a.Abnormal weight (failure to thrive).
2. Pulses
The presence or absence of peripheral pulses should be noted. It is important to palpate both brachial arteries simultaneous for timing and volume. If both are equal, a brachial artery and a femoral artery should be palpated simultaneously to rule out a coarctation of the aorta. If there is carctation of the aorta the femoral pulse will be weak and delayed.
3. Blood pressure
Should be measured over the brachial and popliteal arteries The cuff should have a bladder approximately two thirds the size of the extremity and that completely covers its circumference
4. Precordial palpation
a. Location of the apex beat i. Displacement downwards and outwards indicates cardiomegaly ii.Displacement to the opposite side indicates dextrocardia b. Presence of heave. i. Apical heave = LVH. ii. Left parasternal heave = RVH
5. Cardiac auscultation.
Heart sounds.
1)The first heart sound (S1) may be single or split. 2)The second heart sound (S2) is split during inspiration but the split is narrow. Abnormalities of S2: i. Wide fixed split occurs in ASD, RBBB, Pulmonary valve stenosis
ii. Accentuation of S2
The puomonary component of S2 is accentuated in pulmonary hypertension The aortic component of S2 is accentuated in: systemic hypertension; transposition of the great arteries
b. Clicks
Ejection clicks are heard shortly after S1. Originate from opening of stenotic semi-lunar valves namely: i. pulmonary stenosis, and ii.aortic stenosis Mid- or late systolic clicks indicate: i. mitral valve prolapse, or ii.ticuspid valve prolapse
c. Cardiac murmurs
(i)Innocent (functional) murmurs. Almost universally present at some time during childhood. They: i. Are soft, ii. Localized, iii. Systolic ejection except venous hum which is continuous, and iv. Not associated with a thrill, v. They do not radiate, and vi. They change with posture.
Aortic stenosis
Pulmonary stenosis
C. Laboratory evaluation
1.Chest X-ray. Permits evaluation of: Heart size, Status of the pulmonary vasculature which may be: normal, diminished (oligaemic) or increased (pleonaemic)
2. Electrocardiography (ECG)
The ECG:
Permits diagnosis of cardiac arrhythmias Reflects anatomic changes e.g. ventricular or atrial hypertrophy that develop in patients with cardiac disease Indicates presence of myocardial infarction
4. Cardiac Catheterization
Cardiac catheterization allows: Measurement of intra-cardiac and intravascular pressures Determination of pressure gradients across the cardiac valves Oximetry to determine type, level and size of shunts Cardiac output
D. Principles of treatment
1)Counseling
2)Medical treatment
3)Treatment of cardiac failure if and when present 4)Treatment of hypoxic spells if and when present 5)Prevention of endocariditis
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