Jan 31, 2018 5 min read

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February is American Heart Month, and so often we focus on the signs and symptoms of heart attack or stroke in adults. But, the reality is that cardiovascular issues affect children, too. We spoke to Dr. Lee Beerman, director of both the Electrophysiology Services and Pediatric Arrhythmia programs at Children’s Hospital of Pittsburgh of UPMC. He’s also a professor of pediatrics at University of Pittsburgh School of Medicine, where he’s excited to teach students about advances in the field. “There have been truly remarkable advances in the management of children and adolescents with heart disease, beginning in the 1960s and rapidly accelerating over the past 10-20 years,” he says. “These advancements have been in imaging techniques, medical therapy, applications of interventional catheterization techniques to a multitude of cardiac defects and innovative surgical procedures with greatly improved outcomes. The pioneers of pediatric cardiology and congenital heart surgery of the 1960s and 1970s could hardly have imagined the progress that has been made in taking care of these patients and their families.”

While there are too many conditions to get incredibly specific, Dr. Beerman gives us a general overview and understanding of pediatric cardiology.

How common is a heart condition in a baby, child or teen?

Heart disease is most commonly congenital in origin, but may also be acquired any time after birth. Congenital structural heart disease is one of the more common types of congenital malformations and has an incidence of approximately 0.8 per 100 live births. There are hundreds of types of congenital malformations of the heart, and they range in severity from life threatening in the first months of life to being completely asymptomatic in childhood and adolescence and not presenting until adulthood.

Are you seeing an increase in heart issues in our youth due to increased overall rising weight and inactivity?

Congenital heart disease is multifactorial and frequently genetic in etiology and is not directly influenced by those factors. However, there is no doubt that the increase in obesity and sedentary life styles plants the seeds of a great increase in the prevalence of acquired heart and vascular disease in the next generation of adults.

Generally speaking, what are the most common heart conditions for those under 18?

Congenital structural heart disease is the predominant form of heart disease in young individuals. The most common malformations include holes between the chambers of the heart (ventricular or atrial septal defects), obstruction of the cardiac valves (bicuspid aortic valve with aortic stenosis, pulmonic stenosis) and narrowing of major arteries (coarctation of the aorta). More complex heart disease can lead to low levels of oxygen (cyanotic heart disease) and include tetralogy of Fallot, transposition of the great arteries and single ventricle. Acquired heart disease can be due to infections of the heart (myocarditis or pericarditis), Kawasaki’s disease or involvement of the heart by systemic diseases.

How are they typically diagnosed? Do symptoms sometimes present as those of other, more common conditions?

Heart disease can be diagnosed in a variety of ways. Structural defects are often detected in the fetus by routine screening obstetrical ultrasounds. Symptoms of heart failure, cyanosis and respiratory distress may lead to the diagnosis, particularly in the first several months of age. Later, heart disease may be suspected because of symptoms of chest pain, exercise intolerance, syncope or palpitations. However, it is important to realize that these latter symptoms are extremely common in children and adolescents and the great majority of cases are not due to heart disease. Certain red flags, such as association of these symptoms with exercise, increase the likelihood that there may be an underlying cardiac disorder and should prompt a referral for pediatric cardiology consultation. A careful physical exam by primary care providers, paying attention to murmurs, pulses and blood pressure, can uncover important clues of a possible heart condition. Heart murmurs are present in many normal children, and the vast majority are innocent in nature and do not indicate any heart disease. Therefore, it is important to recognize those murmurs that require further evaluation by a specialist. Once heart disease is suspected, EKG’s and echocardiography allow specific diagnoses.

Depending on the condition, once diagnosed and treated, can the child go on to lead a normal quality and length of life?

The wide spectrum of type and severity of congenital heart disease precludes a general answer to this question. However, there have been great advances in the management of this group of patient, including the ability to correct or improve many lesions by interventional catheterization techniques, thus avoiding open heart surgery, and the remarkable skills of congenital heart surgeons allowing repair of the most complex malformations at any age even in the smallest of infants. This had led to a growing population of adults who are survivors of complex congenital heart disease who require lifelong care by adult congenital heart disease specialists. Today, most children diagnosed with heart disease can expect to lead a long and healthy life.

Are there any local resources for parents whose children have a heart problem (support groups, informational sessions, financial aid, etc)?

There are great resources available in this area for families through the American Heart Association and the Heart Institute at Children’s Hospital of Pittsburgh of UPMC. One of the nation’s first heart camp for children and adolescents with heart disease was founded over 25 years ago by a former director of cardiology at CHP, Dr. William Neches. A parent/family support group, Heart to Heart, has been active for many years, and a multidisciplinary team of nurses, therapists, support staff, doctors and social workers are available through the Heart Institute. There is also a team dedicated to the care of adults with congenital heart disease at the Heart Institute.