Heart disease risk factors and development in children

Heart Disease in Children

AGE DOES NOT MATTER

Heart disease refers to a range of diseases, which affect the heart and, sometimes, also the blood vessels (Mayo Clinic Staff, 2009). The broad range of heart disease includes coronary artery disease, arrhythmias or abnormal heart rhythm, and congenital heart defects. In heart disease, also called cardiovascular disease, blood vessels are blocked or narrowed, a condition that can lead to angina, heart attack or stroke. Infections and abnormalities of the heart's muscles, valves or rhythm are other forms of heart disease. Heart disease remains the number one killer in the world, including the United States, where it accounts for 40% of all deaths. It kills more than all forms of cancer combined (Mayo Clinic Staff).

Atherosclerosis is the build-up of fat and cholesterol-filled plaques in the arteries, which increases the risk of cardiovascular or heart disease. The build-up affects the arteries that supply blood to the heart and brain (Ferranti & Newburger, 2009). It takes many years for the build-up to happen and, therefore, it is unusual for children and teenager to suffer a heart attack or stroke as a result. But the process begins in childhood and goes slowly in most children. In some, it is fast (Ferranti & Newburger).

Risk Factors

A child can develop atherosclerosis from overweight, high blood pressure, family history of the disease, exposure to cigarette smoke and underlying medical conditions (Ferranti & Newburger, 2009). Obese or overweight children are at an increased risk of developing high blood pressure, diabetes and high cholesterol. They are also likely to be overweight or obese adults. Furthermore, childhood obesity increases the risks of heart disease in early adulthood, such as high blood pressure and diabetes. Children and other young people with high blood pressure are also likelier to develop high blood pressure in adulthood. Children whose parents or grandparents suffered a heart attack or stroke when still young stand twice the risk of developing cardiovascular disease. Family history means that a parent or grandparent suffered a heart attack, stroke or peripheral vascular disease before age 56, if male, or 66, if female. Children or young people who smoke themselves or are exposed to smoking tend to smoke up to adult years. This increases their risk of developing cardiovascular disease. Underlying medical conditions, which further increase the risk include diabetes, chronic kidney disease, heart transplantation, Kawasaki disease and receiving treatment for cancer in childhood (Ferranti & Newburger).

Every year, thousands of infants are born with congenital cardiovascular defects (AMA, 2010). Of the total, 4-10% have atrioventricular septal defect; 8-14% with coarctation of the aorta; 9-14% with tetralogy of Fallot; 10-11% with transposition of the large arteries; 14-16% with ventricular septal defects; and 4-8% with hypoplastic left heart syndrome. The rest of these children may develop acquired heart disease, such as arrhythmias, cardiomyopathy, Kawasaki disease, rheumatic fever, familial hyperchrolesterolemia or acquired immune deficiency syndrome with myocarditis (AMA).

Cyanotic Heart Disease

This is a congenital heart defect, which lowers blood oxygen levels, and may involve more than one defect (Weinrauch & Zieve, 2009). Under normal conditions, blood returns from the body and goes through the heart and lungs. Then it flows from the heart and carries enough oxygen to the rest of the body. There is abnormal blood flow when there is a heart defect. The amount of blood flowing also reduces the amount of oxygen that is taken to the rest of the body. A child or infant with cyanotic heart disease has bluish appearance, especially in the lips, fingers, toes or during exercise. It may be caused by chemical exposure, genetic or chromosomal syndromes, infections, diabetic pregnant mothers with poorly controlled blood sugar levels, and some prescription medicines. Symptoms include cyanosis, dyspnea or breathing problems, anxiety, and hyperventilation. Complications include arrhythmias, brain abscess, heart failure, hemopthysis, impaired growth, infectious endocarditis, polycythemia, pulmonary hypertension and stroke (Weinrauch & Zieve).

Diagnosis

Health experts recommend screening every child older than two years who have a family history of high cholesterol or lipids, early cardiovascular disease or diabetes; associated medical conditions; who are overweight or obese and who have high blood pressure or high cholesterol or lipids levels themselves (Ferranti & Newburger, 2009). They recommend that such children be subjected to fasting cholesterol and lipid blood testing and fasting blood sugar testing. Children at risk of atherosclerosis should have yearly blood pressure measurement, height and weight and body mass index calculation, and review of their lifestyle conditions, specifically exposure to tobacco smoke, exercise, diet and sleep (Ferranti & Newburger).

Treatment

Children at risk for cardiovascular disease are managed with lifestyle changes and certain medications to address high cholesterol and/or high blood pressure (Ferranti & Newburger, 2009). Treatment of atherosclerosis in children may prevent or delay the development of cardiovascular disease in adulthood. Treatment is started according to the severity of the risk, probability of side effects and effectiveness. Lifestyle changes are more effective and have few risks. Greater care is taken in medicating children and according to an individualized treatment plan, which will yield the greatest benefits and the fewest risks (Ferranti & Newburger).

Ibutilide

A study of 19 patients, including children, with congenital heart disease showed that treatment with ibutilide is effective and safe (Hoyer & Seshardi, 2007). The respondents were tested from 1996 to 2005 and 15 of them, including four children, had normal heart structure. Of the 74 episodes of atrial flutter and four of atrial fibrillation, Ibutilide converted 55 at 71%. The medicine proved to be the first success in 12 of 19 patients at 63%. Fourteen episodes in six patients needed electrical cardioversion when ibutilide failed. The study concluded that ibutilide could be an effective tool in cardioversion of atrial flutter with careful monitoring (Hoyer & Seshadi). #