children running in open field
A healthy heart starts very early, with good prenatal care. Many heart conditions can be diagnosed in utero. If your obstetrician thinks there may be an issue, a pediatric cardiologist will be called in. Early detection allows for proper planning: delivering at a hospital with the necessary staff and facilities, so that precious minutes after birth are not wasted.
Thirty years ago, most babies with severe heart defects did not become adults. The good news today is that because of advancements in medicine, there are few heart defects babies are born with where surgeons do not have something to offer. Those babies now can grow into adults, although they often have heart issues to deal with as adults, like high cholesterol and blocked arteries. “
Early intervention
As your child grows, spend time talking about healthy lifestyle issues. This can make marked difference on your child’s heart health. “You should start early on in life and focus on nutrition and getting your kid active so he does not develop weight problems because that is what will prevent him from getting a heart problem when he is older,” says Dr. Salvatore Lacagnina, vice president of health and wellness and internist at Lee Memorial Health System.
Many children today are less active and have poorer diets than the past. This leads to obesity, hypertension, cholesterol issues and diabetes. “You should emphasize that physical education is as important as math,” says Dr. Robert Vot-Lowell, pediatric cardiologist at NCH Healthcare System.
Visits to your child’s pediatrician are important, too. “All kids should be going at least for a yearly checkup and at that time, the doctor will take a listen to the heart and examine them for evidence of a heart problem,” says Lacagnina. The most important screen is choosing a pediatrician that has experience, listens and dedicates time to you because he is like the gatekeeper,” says Vot-Lowell. The pediatrician should check your child head to toe and refer him to a pediatric cardiologist if he suspects a problem. “Kids should be screened for high cholesterol particularly if there is a family history of heart disease or high cholesterol,” says Lacagnina.
If your child’s doctor does have concerns, you likely will be referred to a pediatric cardiologist. Most commonly, pediatricians refer children out when they hear a murmur. This is usually insignificant. “You hear a squirting noise from the heart but it squirts blood so you are just hearing the normal passage of blood through the valves and arteries, nothing more,” says Vot-Lowell.
The field of pediatric cardiology is fairly new and so are the related diseases. “It is a difficult field because the population pool is small and most children will never see us,” explains Vot-Lowell.
HCM
While being physically active is crucial for a healthy heart, your child should be evaluated by his doctor before getting involved in competitive or organized sports to rule out conditions like hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy (HCM) is a thickening of the heart muscle. The heart must pump harder to force blood out of the heart. Many times there are no symptoms, but the condition can be detected during a routine medical exam. When a seemingly healthy high school or college athlete collapses on the field or court and dies, HCM very often is to blame.
Vot-Lowell explains that in the same way an athlete is more muscular on the outside than a non-athlete, the heart also may be more muscular. “Sometimes there is a grey area as to how muscular is normal,” he says. The doctor should take a family history and obtain genetic testing if he feels the child may have a mutation associated with hypertrophic cardiomyopathy.
An electrocardiogram (EKG) should be obtained to make sure there is nothing wrong with the heart or electrical system. If the EKG is suspicious, an echocardiogram is done which is an ultrasound of the heart that decides if the heart is abnormally thick or not. Sometimes diagnoses are made by accident. “If the child has a cold or cough and the doctor suspects pneumonia, he may get a chest x-ray to look at the lungs and may find that the heart looks a little big,” says Vot-Lowell.
Kids with pediatric heart issues can be managed medically. “We use medications that slow the heart rate and decrease blood pressure with the theory behind it being that you can prevent further thickening of the heart muscle,” says Vot-Lowell. These kids are susceptible to heart rhythm abnormalities so they should be followed closely and sometimes may need to be put on a defibrillator so they can be shocked out of a bad arrhythmia. “The key for children with conditions like hypertrophic cardiomyopathy is not to overdo it with exercise and harm themselves but they can live full, normal lives,” he adds.
Family tree
Family history plays a major role in determining your child’s heart health. HCM “is one of these genetic conditions that is dominant so as long as you receive one defective gene from one of your parents you have a good chance of getting it,” Vot-Lowell says. This is not always the case. “A lot of conditions are recessive where you need both parents to have the bad gene and you need to be unlucky enough to get both copies that are bad to get the disease,” he says. Then, there are cases where neither parent has the gene which is called a spontaneous mutation.
Remember that you know your child best. “Sometimes kids know they have an issue while other times the symptoms are so gradual and progressive that the child has nothing to compare it with and does not know that what he is feeling is different,” says Vot-Lowell. By paying attention to your child, taking him to the pediatrician on an annual basis and being familiar with warning signs, such as chest pain or palpitations, you can stay out of trouble. “If you could just focus on the simple things, we would have much less heart disease in the country,” adds Lacagnina.
Jamie Lober, author of Pink Power (www.getpinkpower.com), is dedicated to providing information on women’s and pediatric health topics. Jamie is a freelance writer and frequent contributor to Neapolitan Family.