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PEDIATRIC HEART CONDITIONS: TYPES, SIGNS, DIAGNOSIS, AND WHEN TO SEEK IMMEDIATE CARE

Dr. Mersad Alimoradi 06 Jun 2023
PEDIATRIC HEART CONDITIONS: TYPES, SIGNS, DIAGNOSIS, AND WHEN TO SEEK IMMEDIATE CARE

In most cases, the exact cause of heart problems in kids is unknown. Sometimes, heart-related diseases in children are genetic (there is a family history of heart defects), or they can happen because of viral or bacterial infections or certain illnesses in childhood that cause heart damage.

There are several types of pediatric heart problems: Congenital heart defects (present at birth) and acquired heart diseases (caused by infections, inflammation, or other factors).

Regardless of the cause, recognizing the symptoms of pediatric heart conditions can help your child get the treatment they need on time.

Chest pain, excessive tiredness, bluish skin and lips, irregular heartbeats, difficulty breathing, and fainting episodes could all be signs of heart problems in children and teens.

Read on to learn more about pediatric heart diseases, how they are diagnosed, how to spot them, and when you should be concerned.

What Are The Most Common Heart Problems In Children? And How Are They Diagnosed?

Heart diseases in children can be congenital (present at birth) or acquired (they occur later in life because of an infection, inflammation, chest trauma, or another condition).

Congenital heart diseases

Congenital heart diseases (CHD) are heart problems that children are born with – something different or not quite right since birth with the heart's structure or how it works.

These problems happen because the heart does not develop normally during pregnancy. Doctors still do not know what causes congenital heart diseases exactly, but they suspect genetics, infections during pregnancy, or certain medications taken during pregnancy to play a role.

Congenital heart diseases can vary in type and severity. A few of the most common congenital heart defects in children are as follows:

  • A hole in the heart (Atrial septal defects, ventricular septal defects, or patent ductus arteriosus)
  • A heart valve that does not function well (Heart valve disorders)
  • A narrow or blocked blood vessel (Coarctation of the Aorta)
  • The heart's left side is underdeveloped and smaller than the right side (hypoplastic left heart syndrome)
  • A combination of four heart defects: A hole in the heart, narrow heart arteries, thickness in the heart's right side, and an enlarged heart valve (Tetralogy of Fallot)

Children with congenital heart disease may experience the following symptoms: Difficulty breathing, rapid breathing, bluish skin or lip color (cyanosis), poor weight gain, and fatigue during feeding or physical activity. However, some children may not show any noticeable symptoms.

Diagnosis of congenital heart diseases:

A doctor may be able to diagnose congenital heart disease during pregnancy by taking ultrasound pictures of your baby’s heart (while still in the womb) using an instrument called a fetal echocardiogram.

In other cases, the heart defects would not appear on the echocardiogram until after birth or later in life.

Rheumatic heart disease

Rheumatic heart disease happens after a kid or infant gets strep throat.

A strep throat is an infection – called rheumatic fever – that usually starts with a sore or scratchy throat caused by bacteria (called Streptococcus pyogenes or group A Streptococcus).

When this infection is not promptly treated with antibiotics, it can harm the heart valves, which direct blood flow. This can cause problems like trouble breathing, swelling in the feet and ankles, tiredness, and chest pain in teenagers or kids.

Diagnosis of rheumatic heart disease in children:

Sometimes, rheumatic heart disease can cause a heart murmur in kids – a whooshing sound the doctor can hear with a stethoscope.

To confirm a rheumatic heart disease diagnosis, the doctor may perform the following tests:

  • An echocardiogram (heart ultrasound)
  • An electrocardiogram (records heartbeats)
  • Chest X-ray (to check if the heart is enlarged)
  • Cardiac MRI (takes detailed pictures of the heart)
  • Blood tests (to investigate infection or inflammation)

Kawasaki disease

Kawasaki disease is a rare disease that can affect children, mainly under five years old.

It causes inflammation (redness, swelling, and pain) in different body parts like the mouth, lips, throat, hands, and feet. It also causes a high fever in kids that usually lasts several days. Children with Kawasaki disease may also have other symptoms like red eyes, a body rash, and a swollen tongue.

Doctors are not exactly sure what causes Kawasaki disease, but they think it might be related to the immune system’s response to an infection.

If left untreated, Kawasaki disease can cause heart damage in children, like an aneurysm (abnormal swelling in the heart’s blood vessels) or arrhythmia (irregular heartbeats).

Diagnosis of Kawasaki disease in children:

Doctors usually diagnose Kawasaki by ruling out other diseases that may cause similar symptoms. They could also confirm a Kawasaki disease diagnosis if the child had a fever for five or more days with cracked lips and strawberry tongue (red, bumpy, and swollen tongue).

The following tests may be requested by the doctor to help with the diagnosis:

  • Blood and urine tests (to investigate signs of Kawasaki, such as high white blood cells, anemia, and inflammation)
  • An echocardiogram (to examine problems with the heart’s blood vessels)
  • An EKG electrocardiogram (to check for heart rhythm problems)

Arrhythmia

Arrhythmia means a child has abnormal heartbeats – the heart beats too fast (tachycardia), too slow (bradycardia), or irregularly. Issues with the heart's electrical system may cause this.

Typically, a child’s resting heart rate should be:

  • 80-130 beats per minute (children 1-2 years old)
  • 80-120 beats per minute (children 3-4 years old)
  • 75-115 beats per minute (children 5-6 years old)
  • 70-110 beats per minute (children 7-9 years old)
  • 60-100 beats per minute (children ten years and older, including teenagers)

For example, while resting (not exercising and awake), below 60 or above 100 beats per minute is often a dangerous heart rate for a teenager.

Children can have arrhythmias for different reasons. Sometimes, they are born with a disorder that makes their heart beat abnormally (cardiomyopathy in children). Other times, medications, infections, or even feeling very stressed or scared can cause unusual heartbeats. 

You might suspect arrhythmia if your child is complaining of chest pain and fast heartbeats. When kids have an arrhythmia, they may feel their heart beating too fast or skipping beats. They might also feel dizzy and tired. Sometimes, they can even faint.

Diagnosis of arrhythmia in children:

The doctor may order blood tests to negate infections and medications as the cause of your child’s arrhythmia. To confirm the diagnosis, doctors may perform the following tests:

  • An EKG electrocardiogram (to check for heart rhythm problems)
  • A portable EKG electrocardiogram test (For a few days or months, the child wears a portable heart monitor that records their heartbeats at home)
  • An electrophysiology test (the doctor inserts a small, thin tube into the heart through a blood vessel in the arm or leg to find the source of the arrhythmia)
  • A tilt table test (to monitor heart rate and blood pressure changes in children who frequently faint)

Atherosclerosis

Atherosclerosis is when fat deposits (called plaque) build up inside the heart's blood vessels, causing them to become narrow and hardened. Although this heart condition affects adults more frequently, it can affect kids as well, especially those with a family history of the disorder.

Pediatric atherosclerosis can happen for many reasons: Genetics, unhealthy lifestyle, and certain medical conditions. It is frequently linked to having an unhealthy diet rich in sugar and fat, not getting enough exercise, and being overweight or obese.

If your child has atherosclerosis, they may not experience symptoms at first. However, as the condition progresses, they may have chest pain and shortness of breath. They may also get tired quickly. In severe cases, kids are prone to heart attacks because of atherosclerosis, which may eventually cause pediatric heart failure.

Diagnosis of atherosclerosis in children:

Doctors can confirm an atherosclerosis diagnosis by performing the following tests:

  • Blood tests (to check the blood levels of fats, cholesterol, sugar, and proteins)
  • An EKG Electrocardiogram (to monitor the heartbeats)
  • An echocardiogram (to take ultrasound pictures of the heart and check how well the heart chambers and valves are working)
  • A chest X-Ray (to take pictures of the heart and look for signs of heart problems)
  • An Ankle/Brachial Index test (to compare the blood pressure in the arm and the ankle in order to determine how well the blood is flowing)
  • A computed tomography CT scan (to look for narrow or hardened arteries)

Pericarditis

Pericarditis is another type of heart disease in young adults and children. This condition occurs when a sac of protective tissue surrounding the heart (called the pericardium) becomes inflamed.

Pericarditis in kids can happen for different reasons, such as bacterial infections (like Tuberculosis), autoimmune disorders (like lupus), a chest injury, or after heart surgery.

Since it causes discomfort and chest pain, it can occasionally be mistaken for a heart attack in children. The pain might get worse when taking deep breaths or lying down. Other symptoms may include fever, fatigue, and difficulty breathing. 

Diagnosis of pericarditis in children:

Healthcare providers can confirm a pericarditis diagnosis by performing the following tests:

  • Blood tests (to examine signs of inflammation)
  • A chest X-Ray (to check if the heart is inflamed or enlarged)
  • An echocardiogram (to check how well the heart is working)

Myocarditis

Myocarditis is a condition in which the heart's muscle (the myocardium), which normally pumps blood to the body's other organs, becomes inflamed.

It can happen when a kid’s immune system overreacts to a bacterial or viral infection (like the flu or respiratory tract infections), causing inflammation in the heart.

In children, myocarditis can cause various symptoms: Chest pain, difficulty breathing, rapid or irregular heartbeat, fatigue, and sometimes fainting episodes. Some children may also have symptoms that can be mistaken for a cold or flu, such as fever, cough, and body aches.

In extreme cases, myocarditis can cause a heart attack, heart failure, and sometimes death in children.

Diagnosis of myocarditis in children:

  • Cardiovascular magnetic resonance (a set of magnetic resonance imaging (MRI) techniques that can assess the heart’s structure and function)
  • Chest X-Ray (to see if the heart muscle is enlarged or inflamed) 
  • An echocardiogram (to check for problems in the heart’s structure or function and search for blood clots) 
  • A biopsy during cardiac catheterization (through a blood vessel in the arm or leg, the doctor inserts a short, thin tube into the heart and takes a tiny piece of the heart muscle to look at it under the microscope)

How to Look Out for Heart Problems in Kids? And When To Seek Immediate Care?

It is a natural parental instinct to be concerned about your child’s health. Although heart problems in children are relatively rare, it is critical to be aware of warning signs and symptoms that may indicate a childhood heart disease. A few warning indicators are listed below:

  • Difficulty breathing: If your kid often has trouble catching their breath or becomes easily winded during activities that do not usually cause breathlessness, it can be an indication of a heart condition.
  • Poor growth or development: If your child is not meeting developmental milestones or seems to be growing much slower than children of the same age, you should bring it up with a pediatrician. Sometimes, heart problems can affect a kid’s growth and development.
  • Cyanosis (bluish skin color): If your baby’s lips are blue, this could be a sign of heart problems – bluish discoloration of the lips, fingers, or toes may indicate low oxygen in the blood, which can occur if the heart is not functioning as it should. Rush to the ER if your baby’s lips or skin suddenly turn blue. 
  • Fatigue and low energy: While it is normal for children to get tired after physical activity, excessive fatigue or lack of energy without an apparent cause could be a symptom of an underlying heart condition.
  • Chest pain or discomfort: Although chest pain is less frequent in children than adults, it can still happen. If your child (or a 15-year-old) complains of chest pain, pressure, or discomfort, you should have them evaluated by a healthcare professional. 
  • Fainting or dizziness: If your child often feels dizzy or faints, it may be related to a heart issue. Fainting or near-fainting episodes should never be ignored – contact your child’s healthcare provider immediately if they happen. It can be a sign of insufficient blood flow to the brain.
  • Rapid or irregular heartbeat: While it is normal for children's heart rates to go up and down sometimes, a very fast or irregular heartbeat may be a concern. Pounding, racing, or skipping heartbeats should be evaluated by a doctor.

Even if your child experiences one or more of these symptoms, a cardiac condition may not be the cause. Often these symptoms can result from other ailments or are just a normal part of growing up. However, you should seek medical advice if these signs persist or worsen with time.

If you suspect a cardiac condition in your child, consult a healthcare professional who specializes in pediatric cardiology. They can perform a thorough evaluation, including a physical examination and additional tests – such as an electrocardiogram (ECG) or echocardiogram (a type of heart ultrasound) – to assess your child's heart health.

To search for the best Pediatric Cardiology Doctors and Pediatric Cardiology Healthcare Providers worldwide, please use the Mya Care search engine.

To search for the best doctors and healthcare providers worldwide, please use the Mya Care search engine.

About the Author:
Dr. Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

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