Pediatric Cardiology with Janet Scheel, MD
What are some common pediatric heart conditions?
Compared to adult cardiology patients, pediatric patients require different types of care and treatment. While many adult cardiac conditions, such as coronary artery disease, may be preventable, many pediatric cardiac conditions are due to structural abnormalities. According to Janet Scheel, MD, Pediatric Cardiologist at GBMC, the three most common reasons children are referred to a pediatric cardiologist are heart murmurs, chest pain and fainting.
There are two types of heart murmurs: innocent and pathologic. Innocent murmurs, also called functional murmurs or flow murmurs, are very common in children, often heard in more than 50 percent of patients. If a heart murmur is innocent (normal), treatment is usually not needed, but if a heart murmur is pathologic, it is usually from a hole in the heart or an obstruction at a heart valve. Treatment may include medication, surgery or a cardiac catherization to close a hole or open a valve with a balloon. “There are many different types of murmurs, but we try to find the pathologic ones that need intervention,” says Dr. Scheel. “The amount of obstruction at a valve and/or the size and location of a hole determines the course of treatment.”
The most common cause of a pathologic heart murmur is a hole between the pumping chambers. This is called a ventricular septal defect or VSD. The condition is characterized by a harsh murmur and is usually discovered during infancy or early childhood. If the hole is small and blood pressure is normal, no intervention is needed. If there is a larger hole with too much blood flow going to the lungs, and a child is not growing or gaining weight, surgery is considered.
Unlike adults, children’s chest pain is usually not the result of coronary artery disease. The most common age to present with a complaint of chest pain is in children who are ages 12 to 16. “Many times, children’s chest pain originates from the musculoskeletal area,” says Dr. Scheel. “It can also be the result of acid reflux from the stomach or a viral illness that causes inflammation of the lining of the lungs. On rare occasions, the chest pain may be from a coronary artery that is not in the normal position or an underlying problem with the heart muscle.”
Treatment depends on the source of the child’s chest pain. The goal of a cardiac evaluation is to rule out these rare, but life-threatening cardiac abnormalities. “If a child has a family history of heart disease and has pain that occurs during exercise, the first thing we do is perform an echocardiogram of the heart,” says Dr. Scheel. “We can also do a stress test to reproduce symptoms to make sure there is no presence of an abnormal heart rhythm, or evidence that not enough blood is getting to the heart muscle.”
Fainting is a common condition that affects children, particularly teenage girls. According to Dr. Scheel, it is not a major cause for concern unless a child experiences dizziness or passes out during exercise, has frequent fainting episodes or has a family history of sudden unexplained death. “Most kids are simply experiencing low blood pressure from standing up too quickly or have sat too long in one position without moving,” she says. “In more serious cases, we try to rule out arrhythmias or abnormal heart rhythms, which are the most common causes of cardiac fainting.” Treatments for arrhythmias may include medication and sometimes an implantable fibrillator.
According to Dr. Scheel, there are an increasing number of children presenting with hypertension. “This is due to the obesity epidemic here in America,” she says. “The danger is that when a child is hypertensive, he or she is more likely to be so as an adult. With hypertension, the heart has to work against high blood pressure. If this begins in childhood, there is a higher risk that the heart will eventually get tired and not be able to function effectively. It is important to address this issue and help children get healthy so they can avoid problems later in life.”
