Heart of the child. Heart diseases at children

Every year the amount of children having congenital pathologies is enlarged. Among children diseases one of the first places is occupied with the diseases that related to cardiovascular system.  Congenital malformations, arterial hypertension and hypotension, rheumatism, inflammatory diseases and acquired valvular diseases are allocating among heart diseases at children.

All these diseases are dangerous and can lead not only to the disability, but also to the premature death of the child.

Сердце ребенка

Children's heart compared with the adult has several physiological features that change with age.

Heart of newborns is more than at adults if to compare with the total body weight. Both ventricles are approximately equal, and their wall thickness of about 5 mm. Mass of the heart increases in parallel maturation of the child: the 8-month heart doubles, the third year of life - the mass of the heart tripled, and for six years in mass increases by 11 times. Newborn heart is located above and lowered with the age. At children pulse rate in norm more often than at adults. This phenomenon is due to higher contractility of cardiac muscle, which is due to increased metabolic rate and less influence of the vagus nerve on a cardiac performance. Normal pulse rate - 120-140 beats per minute for newborns. With age, the pulse rate gradually decreases. Normal pulse rate for children compared with adults is unusual (there is respiratory arrhythmia) pulse becomes frequent on a breath and it becomes less often on an exhalation. In addition, in the heart of a newborn baby has anatomic prerequisites for the unnatural blood flow - the oval window through which can communicate the right and left atrium and arterial duct, which connects the pulmonary trunk with the descending aorta. These formations function during the prenatal period and can remain active at a healthy baby quite a long time. Arterial duct may remain open during the first two months of life, and the oval window - from 8 days to 4 years and over.

The increase in minute volume of heart at children is associated with higher needs of organs and tissues of the growing organism. Blood pressure at children is lower than at adults and increases gradually with age of the child. Normal systolic pressure is approximately equal to 70 mm Hg. for newborns, to the 1st year of life, it averages about 90 mm Hg. Further raise of pressure occurs rapidly in the first two or three years of life and during puberty. Further pressure raise in parallel increase in the rate of pulse wave through the vessels of the muscles and depends on the tone.

Summing up the above, we can see that in childhood there are a number of factors that facilitate the circulation of blood through the vessels and cameras of the heart. Specifically, a large mass of the heart relative to body weight and fairly wide opening between its divisions and main vessels. The low systolic blood volume is compensated at young children by a high heart rate, so the minute blood volume relative to body mass is more than at adults.  Also children have uncharacteristic structures for the adult person through which the connection between large and small circulation possible. All these factors pose a certain danger except their adaptive function. Namely they considerably restrict reserve abilities of heart at early age because of a rigidity (weak elasticity) of cardiac muscle, high heart rate and, consequently, a shorter diastole.

The main heart diseases that occur at children:

Congenital heart diseases

Congenital heart disease called anatomic defect in structure of heart or main vessels if it is present from the moment of a birth. Congenital malformations are caused by disturbances of embryonic development of the cardiovascular system, or formed as a result of the negative influence of adverse factors on newborn organism, for example, respiratory disorders. This is especially important for premature babies.
All defects can be divided into three major groups.

  1. Congenital heart disease pale type - with arteriovenous shunts: interatrial septum defect, interventricular septum defect, patent ductus arteriosus.
  2. Cyanotic heart disease - with venoarterial shunt: Fallot's tetrad, transposition main vessels, etc
  3. Congenital heart disease without a shunt, but with the barrier blood flow: aortic stenosis and pulmonary artery.

Unfortunately, the occurence of children born with heart defects has increased during the last years.

Causes of disease

Several distinct groups among the causes that lead to congenital heart disease.

  1. Chromosome abnormality - 5%. In this case, a congenital heart defect is part of polysystem malformation syndrome. For example, it is frequently observed defects in interatrial and interventricular septum with Down's syndrome. Down syndrome is a variant of chromosomal disease which often occurs in perfectly healthy parents.
  2. Mutations in individual genes - 2-3%. As in the first case, congenital heart prophets that are associated with gene mutations are combined with anomalies of other organs. Gene mutations are inherited.
  3. Environmental factors- 1-2%.Among the most important factors in this group can be identified somatic disease in pregnancy (eg, diabetes), exposure to X-rays on the mother's body in the first trimester of pregnancy, certain medications, viruses, alcohol, etc.
  4. Polygenic multifactorial inheritance - 90%. In most cases of hereditary predisposition to vice, which is triggered by environmental factors. They operate on the embryo (fetus) or newborn.

Congenital heart defects are detected by planning ultrasound examination during pregnancy, with relatively high accuracy. This procedure allows to identify up to 90% of congenital heart disease.


Сlinical presentation

A variety of anatomical and functional disorders show clinical signs at each of the malformations. Identify several general symptoms that are characteristic of all congenital heart defects:


The main method of congenital heart diseases treatment is a surgical technique for today. Surgical correction should be made as early as possible it is important.

Noncyanotic congenital heart disease

This group includes defects and interatrial and interventricular septum, patent ductus arteriosus. For each of these malformations is the anastomosis between the left and right departments of heart or main vessels. Since the pressure in the left departments of heart and aorta is much greater than on the right departments, there is discharge of blood from left to right. That is, part of the arterial blood mixes with venous blood, and again goes to the pulmonary circulation. It leads to an overload of small (pulmonary) circulation. Therefore, the main clinical manifestation of these malformations will be dyspnea for physical activities. Pallor occurs only with a considerable amount of shunting. Heart failure symptoms appear on both circles with age.

Diagnosis is based on data from echocardiography or cardiologic ultrasound examination.
In an open ductus arteriosus surgical treatment is recommended only.

When interventricular septum defect in the lower (muscular) part may inadvertently close of the defect or its significant reduction in size. If the hole is located in the upper, membranous, parts, then it is possible only surgical treatment. Treatment of interatrial septum defect also surgical. In some cases, when the interatrial septum defect is patent foramen ovale, this defect may never appear with heart failure. Therefore unclosed foramen ovale belong to a group of small abnormalities.

Cyanotic congenital heart disease

This group got its name because of cyanotic skin color of children who suffered from such malformations. Cyanotic skin color caused by hit the venous blood from the right departments to the systemic circulation.

Fallot's tetrad

Fallot's tetrad — is complex congenital heart disease. Four features discover in the classical variant: ventricular septal defect, stenosis of the right ventricle of heart, wrong location of the aorta and right ventricular myocardial hypertrophy. Since incorrect position of the aorta is secondary to high location ventricular septal defect, it is often said about the divergence of the aorta between the left and right ventricles.

Symptoms of Fallot's tetrad.
The main symptom is cyanosis, which reaches its peak-to-year life. One of the regular features is dyspnea, which, with Fallot's tetrad is characterized by arrhythmic deep breathing with a normal rate. Thickening of the fingers nail bone with increasing size of the nail plate are formed quickly. The most severe manifestation of Fallot's tetrad are attacks apnea with cyanosis. The mechanism of their occurrence is associated with spasm of the right ventricle of heart. Because of this, almost all the blood that is depleted of oxygen gets into the aorta from the right ventricle. The consequence of this is the strongest hypoxia of the brain, manifested by anxiety, fear, loss of consciousness and convulsions. The lack of blood flow to the lungs manifested by a sharp attack of apnea. Fatal outcome is possible.
Treatment. For all children with Fallot's tetrad operative treatment is recommended, which is conducted in two phases. Prevention of bacterial complications by antibiotics is carried out in the preoperative period.

Complete transposition of main vessels

At the same congenital heart blood arrives in aorta from the right ventricle, and from the left - into the pulmonary artery. Severe dyspnea and cyanosis occur immediately after birth. The life span of patients is typically less than two years without surgery.

Congenital malformations that block the blood flow

Stenosis (narrowing) of aorta

The subaortic stenosis creates an interrupting to a blood flow from a left ventricle to aorta. Narrowing may be at the level of the aortic valve, above or below its. Because of this heart defect pulmonary circulation is suffering from congestion, and the systemic circulation - from lack of blood.
Pale skin, tachycardia, dyspnea, palpitation, precordial pain, headache and giddiness, syncopes  are symptoms.
These symptoms are greatly aggravated by physical activity, so children can not engage in sports and perform heavy physical exertion. This may not only lead to aggravation of symptoms, but also to the child's death.
Treatment. Aortic stenosis treated surgically. Treatment is prescribed, when there are severe symptoms.

Coarctation of aorta

Coarctation of the aorta – is segmental narrowing of the aortic canal. The length of stenosis area may be different, but begins as a rule, above the place of left subclavian artery origin. Thus, in the upper half of the body has elevated blood pressure, lower - reduced blood pressure and signs of tissue ischemia. Headache, nausea, vomiting, vision changes, frequent nosebleeds occur when there is severe arterial hypertension in the upper half of the body. Circulatory deficiency in the lower half of the body causes numbness of the lower limbs, appear gooseflesh, weakness in walking, pain in the legs, constantly cold legs. On the feet detect reduction in blood pressure when measured. These symptoms greatly increase with physical activity.
Diagnostics. Coarctation of aorta diagnostics is usually not difficult and it is based on clinical and instrumental methods – ECG and echocardiography. However, sometimes this congenital heart disease remains undiagnosed, because the children can grow and develop normally in the first year of life.
Treatment. Treatment of coarctation is surgical only. Without such treatment, children usually do not liveup to 2-3 years of age.

Isolated pulmonary artery stenosis

Pulmonary artery stenosis is characterized by a barrier to blood flow from the right ventricle to the pulmonary circulation.
If the stenosis is small, then the growth and development of the child are not violated, and clinical symptoms may occur during adulthood. If the stenosis is expressed, in this case, there are early symptoms such as dyspnea, heart pain, palpitation, and later - edema of the legs, fluid in the cavities. If this defect occurs in such a way that required surgery.

Arterial hypertension and hypotension at children

Arterial hypertension and hypotension are the most likely signs of vasoneurosis,which is evident not only in the form of changes in pressure but also dyspnea, weakness, pain in the heart area, fatigue, neurotic disorders. All these disorders have functional character and are not dangerous for life and health of the child. But it would be better if these children will be registered at pediatrician, because functional disorders can be transformed into organic changes with age.


Acute attack of rheumatic fever should not be missed in childhood. It is extremely important. β-hemolytic group A streptococcus causes it. Acute attack of rheumatic fever occurs after a quinsy for 1-5 weeks. Antibodies are formed against his own body tissues during acute rheumatic fever, but his heart is suffering the most.
Clinical presentations. Fever appears temporary inflammation of large joints, carditis – it is inflammation of the myocardium and endocardium. Appear small painless subcutaneous nodules on the hands and feet, skin rash can be in the form of annular erythema. Defeat of the nervous system leads to a change in the emotional sphere and the appearance of seizures, which manifests itself in the form of occasional jerks – named chorea. All manifestations of acute rheumatic fever are temporary, except carditis. Even myocarditis may pass without a trace. Rheumatic endocarditis is extremely dangerous, because inflammation of the endocardium spread to the heart valves. It leads to the formation of various acquired valvular diseases. Most often affects the mitral valve. Mitral insufficiency is formed, or stenosis, or a combination of these defects.
If acute rheumatic fever is not recognized in time, it acquired heart disease for a long time remain undiagnosed and it progresses. Signs of heart failure begin to appear in 20-30 years. Stagnation of blood in the pulmonary circulation occurs first. This is manifested in the form of dyspnea and nocturnal attacks of breathlessness. Stagnation in a large circle in the form of edema, fluid accumulation in the cavities and internal organ involvement occurs when there is decompensation of mitral defect.

For the prevention of acquired mitral defect should be:

  1. Prevention of purulent tonsillitis, and when they occur, require adequate treatment and only in a hospital.
  2. Recovering from purulent tonsillitis should be the district pediatrician supervision for a period not least a year. Early detection of systolic murmur at the apex of the heart allows the pediatrician to take timely measures to prevent the occurrence of mitral defect.

Cardiac inflammatory diseases

Myocarditis is an inflammation of the heart muscle for various reasons. Rheumatism is an important etiologic factor in the development of myocarditis. Myocarditis may be the result of bacterial and viral infections. Sometimes the allergic process, and otherless important reasons can cause it.

Clinical presentations. Myocarditis manifested by weakness, fatigue, dyspnea, palpitation, breathlessness, feeling of heaviness in the chest. If myocarditis is combined with endocarditis, it shows signs of emerging heart disease. It is accompanied by severe pain syndrome when combined with pericarditis.
Diagnosis of myocarditis is based on the ECG, echocardiography, X-ray data, the results of physical (visual examination of the child) and laboratory examination.
Treatment is directed at eliminating the causes of myocarditis and prevention of complications.

Nuances of Pediatric Cardiology

Pediatric Cardiology has its own characteristics. Unlike adults, children rarely complain of symptoms associated with diseases of the cardiovascular system. In this connection it is necessary conduct a survey the child more thoroughly and to focus on the physical and instrumental examination. Also, be aware that a child can grow and develop normally for a long time to play and run together with healthy children in the event that defect is not very pronounced. However, delayed diagnosis of heart disease can lead to severe heart failure in man and his early death. Cardiovisor may help you in diagnosing the disease. Ecg4me.com service lets you control work of the child heart. Device can be used even at home.

Risk of children heart disease

Such defects as Fallot's tetrad, transposition of great vessels, and others represent a direct threat to the life of the child immediately after birth. Sick children should be undergone surgery, or they will soon die. Postoperative mortality in these cases is also high.

But many congenital heart diseases pose a hidden danger. Doctors recommend surgical treatment of malformations at children, but the parents refused the operation, because the child does not look sick. If symptoms of heart failure manifested in 20-25 years, then do the operation is already too late because there is a very high operational risk. Thus, the remaining people live in the past few years as disabled person and dying at a young age.

Recommendations for children with heart disease

Parents whose children have heart disease should carefully monitor the general state of health, child nutrition, daily routine, as well as physical activity and emotional stress.

First, parents should make for the child a strict regime of work and rest, not allowing long and heavy physical activity. However, physical activity should not be completely ruled out, since this would lead to a dramatic weakening of the heart muscle. You also need to limit the mental load and emotional stress.
Diet is of great importance. The food should be rich in complete proteins (meat, eggs, fish, cheese), fresh fruits and vegetables, which contain potassium and magnesium (dried fruits, teas from them).
For prevention of children heart disease, the most important measure is the timely detection and treatment of bacterial and viral infections. This is especially true for purulent quinsy.
Do not forget about the hardening and physical training.

Regular visits to the pediatrician and the children's cardiologist is necessary. Nowadays there is a unique opportunity to monitor the child's heart. Always existed the difficulty of children ECG analysis. This is due to the peculiarities of children's cardiovascular system. Today we have an opportunity to monitor children's health due to Ecg4me.com service. Monitor the work of a small heart, you can use CardioVisor. Parents will always be informed about health of their child, if they will use the service Ecg4me.com. Invaluable assistance service Ecg4me.com may have in monitoring cardiac operated children, because after a heavy heart surgery, the risk of complications is very high. At this stage of life CardioVisor always be near and assist in the detection of impending pathological state.

Take care of the child's heart!

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