CHILDREN AND HEART DISEASE,murmur,physiologic,vibratory murmur,pediatric cardiologist,electrocardiogram,chest x-ray,echocardiogram,fetal echocardiogram,bradycardia,supraventricular tachycardia

Learn About Your Heart...
Made Simple

By Nicolas Shammas, MD

A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics

Statistics about Heart and Blood Vessel Diseases in the United States
Structure and Function of the Heart and Blood Vessels
Diseases of the Blood Vessels of the Heart
Surgical Therapies for the Cardiovascular Patient
Peripheral Vascular Disease
Diseases of the Blood Vessels of the Head and Neck
Strokes: How to Survive Them and How to Prevent Them
Valvular Heart Disease
Heart Rhythms: How to Recognize Them and Treat Them
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test


Vickie Pyevich, MD

Our child was recently diagnosed with an innocent heart murmur. What is this condition and is it serious?

Simply stated, a murmur is a sound, heard with the stethoscope, of the blood traveling through the chambers and valves of the heart. Certain murmurs heard in children are suggestive of structural heart disease, though the vast majority of murmurs heard in children, especially those of early childhood age, are truly "innocent" or normal. An innocent murmur, also known as a physiologic or vibratory murmur, has a very characteristic sound and does not equate to a heart defect.

These innocent murmurs may become louder during times of fever, illness, or stress. This is a normal characteristic of the innocent murmur. Innocent murmurs are often noted in the child between the ages of 2 and 5 years. They are so common that at least 80% of all children are felt to have had innocent murmurs at some point in time. These heart sounds often come and go. Thus, your doctor may hear the murmur during a clinic visit and then not detect it on a follow-up exam. Many innocent murmurs resolve or are no longer heard as the child grows into the preteen years.

Your child's doctor may elect to have the murmur evaluated by a children's heart doctor (pediatric cardiologist).The cardiologist may order 2 relatively simple tests. One may be an electrocardiogram and the other a chest x-ray. These are helpful tools to the cardiologist in determining the "innocence" or "guilt" of the murmur. If the cardiologist is concerned that the murmur may be reflective of congenital heart disease, he or she will consider performing a special type of ultrasound known as an echocardiogram. This very safe, noninvasive test provides detailed pictures of your child's heart anatomy and function. Hence, it will either confirm or refute congenital heart disease or a heart defect that has been present since birth.

Once the murmur is deemed innocent or normal, no additional cardiac testing is indicated. The child does not need to return to the cardiologist. No physical activity restrictions should be placed on your child. Your child should not have any symptoms of concern as a direct result of the murmur. Your child's heart is healthy, and you should not worry about the presence of the murmur.

I am 30 weeks pregnant. During a recent OB exam, my physician noted that my baby's heart rate was irregular. As a result, she is sending me for a fetal echo. What is this special test and will it harm my baby?

A fetal echocardiogram, performed by a pediatric cardiologist, is a special ultrasound test to examine the fetus's heart anatomy and rhythm. It is a safe, noninvasive test that has no adverse side effects.

An irregular heartbeat is often detected in utero (in the uterus), particularly in the third trimester. The normal fetal heart rate is typically between 120 and 160 beats per minute (bpm). A sustained rhythm of over 200 bpm is of concern and may suggest an abnormally fast heartbeat (tachycardia), which may require treatment. A consistently slow heart rate, often defined as less than 100 bpm, is referred to as bradycardia. There are different subtypes of bradycardia, some of which are associated with congenital heart disease. This rhythm needs to be evaluated promptly, as prolonged slow heart rates can lead to heart failure in the womb and intrauterine demise, also known as a miscarriage.

Most often an irregular fetal heart rhythm is a normal finding that is not associated with structural heart disease in the fetus. An irregular beat may imply that an occasional early heartbeat is produced though it does not interfere with the fetus's well being. These beats originate from the upper chambers of the heart a little earlier than normal but, if isolated and infrequent, are of no significance. An occasional early fetal heartbeat with a structurally normal fetal heart is not cause for concern. These early beats will disappear close to delivery or within the first few weeks of life. No medical treatment is necessary for this condition.

A pediatric cardiologist should further evaluate the fetus if these irregular beats are persistent. In rare instances, these frequent early beats or premature atrial contractions (PAC) can develop into a serious fast heart rhythm abnormality referred to as SVT, or supraventricular tachycardia. This condition can be detected in utero and treated by giving the mother special medications that will slow the fetus's fast heart rate. If untreated, in prolonged cases of tachycardia, the fetal heart enlarges and does not contract or squeeze effectively. The fetus proceeds to develop heart failure, and delivery may be induced in order to more effectively treat the baby's heart rhythm abnormality.

An abnormally slow heart rate may be the result of a condition where the upper and lower heart chambers do not communicate effectively, which is essential for normal heart conduction in the fetus. A condition known as complete heart block, or CHB, is suspected when the fetal heart rate is slow, often 60 80 bpm. Many times this slow rate is tolerated well by the fetus. This is in contrast to a fetal heart rhythm less than 50 bpm, which is detected in a fetus with complex congenital heart disease. The combination of CHB with structural heart disease often places the fetus at high risk for developing heart failure and even fetal death. Certain maternal conditions, such as systemic lupus erythematosus (SLE), have been associated with CHB. In this illness, it is suspected that antibodies damage the electrical conduction system of the fetal heart that leads to the heart block. If the CHB is thought to be secondary to this type of maternal illness, the obstetrician may treat the mother with oral steroids in an effort to delay further deterioration of the fetal rhythm.

My 10-year-old daughter complains of chest pain while playing tennis. She also complains of chest discomfort at other times, such as watching TV or doing her homework. Should I be concerned about this?

It is a terrifying feeling for a parent to hear his or her child complain of chest pain. The natural assumption is that the chest pain is a consequence of a heart abnormality. After all, many of us know of individuals who, when experiencing their heart attacks, reported chest pain as their very first symptoms.

However, it is important to keep in mind that cardiac diseases seen in adults are vastly different from the cardiac problems observed in children. It is atypical for a pediatric patient with chest pain to have an underlying heart defect directly responsible for the discomfort. Most chest wall pain is due to costochondritis, or an inflammation of the cartilage. The cartilage acts as the "glue" securing the ribs to the breastbone. Many children complain of this type of chest pain specifically when they are very active in sports where a muscle sprain may have occurred. This type of pain is often accentuated or reproduced by applying firm pressure over the site.

Other noncardiac causes of chest pain include stomach acid reflux or heartburn, exercise-induced asthma, or a lung infection, such as pneumonia. In the case of pneumonia, typically other signs will be present, such as fever and cough.

There are indeed rare cardiac causes of chest pain that demand prompt evaluation by your child's physician. Typically, these more serious causes of pain are associated with other symptoms as well. For instance, if your child appears pale or sweaty with the complaint of chest pain or voices feeling dizzy or loses consciousness, you should seek medical attention immediately. Heart rhythm abnormalities and viral illnesses also can present with the above-described symptoms in children as well. Hence, it is important to contact your doctor if these problems occur in your child.

Because of my husband's history of elevated cholesterol, our physician recommended that our children have their cholesterol levels screened. Is it common to detect elevated cholesterol values in children?

Cholesterol is a fat-like substance found in our blood and our body's cells. Cholesterol is packaged in proteins called low-density lipoproteins (LDL) and high-density lipoproteins (HDL). HDL is considered the "good" cholesterol because it carries the "bad" LDL cholesterol back to the liver for removal. It is the LDL cholesterol that forms plaque that builds up in the artery walls, increasing the risk of heart attacks.

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