Caring for the smallest hearts
with Jeanine M. Swenson, M.D., pediatric cardiologist with Advanced Healthcare
Among the most frightening words new parents can hear are a pediatrician telling them their baby may have a heart problem. Yet most problems detected through well-baby exams turn out to be benign, while others are treatable with close clinical observation or the modern arsenal of cardiac drugs. Some problems, detected through fetal ultrasound, are even treatable before birth.
Dr. Jeanine Swenson, a pediatric cardiologist with Advanced Healthcare, sees a wide range of problems from newborns up to adults with congenital heart disease. She notes that the most common problem that leads to referrals is heart murmurs, but she also sees patients with stenosis (stiff and narrowed valves in the heart), syncope (insufficient blood flow, often causing loss of consciousness), shortness of breath and other problems. She also does fetal echocardiograms if a problem is suspected.
Treating the unborn child
Though fetal echocardiograms have been in use for over 10 years, they are usually only done on a select group of expectant mothers. These would include those with a previous child with congenital heart disease or if there is a history of congenital heart problems in the family. Another group who might be referred to a pediatric cardiologist are mothers whose ultrasounds detect an abnormal fetal heart rhythm or an abnormality on the Level II ultrasound.
"The technology is so advanced that we can pick up a lot through regular ultrasound screening. Also, if the obstetrician suspects any chromosomal problems, the mother may be referred for a fetal echocardiogram," Dr. Swenson said.
If there is a rhythm problem in the developing child, the mother may be treated with drugs that will pass through the placenta and correct the problem. For other structural problems, pediatric cardiologists counsel parents on where and how the baby should be delivered and what sort of treatments will be needed right away. Most of the time, parents can anticipate a regular vaginal delivery.
Dr. Swenson said that no one is certain why heart problems occur in some infants. "Everything about this is genetic, but we don't know what causes congenital heart disease," she said.
Heart murmurs
Dr. Swenson sees children of all ages with heart murmurs. The term merely means an extra sound is present when physicians listen to the heart. Up to 75% of healthy children or adolescents have heart murmurs. In most cases, pediatricians do not refer their young patients to a cardiologist, instead they merely note the murmur and follow its progress. "Some of the murmurs may resolve on their own. A small hole in the heart may close, for example," Dr. Swenson said.
In most cases, a referral is made only if the sound is loud or unusual or if the patient has symptoms of cardiac disease.
Parents may be concerned if a murmur is first noticed in an older child. Often the murmur was present from birth but is only noticeable in a routine exam as the child ages. "Innocent murmurs come and go and also may be very soft. So it's not that unusual to have a child be referred at four or five years of age after the pediatrician finally gets a really good listen," the doctor said.
Symptoms parents should know
In infants, most symptoms of cardiac problems present during feedings because that is usually the only time babies really exercise. Symptoms parents might notice include fast breathing, sweating, tiring with feeds, poor growth or cyanosis (a bluish coloration of the skin caused by lack of oxygen in the blood).
Older children may complain of chest pain, shortness of breath or say their heart is racing. Toddlers may just point to their chests and say they hurt. Children may also have trouble keeping up with other children their own age. They may not grow properly, or gain weight. In rare cases, their skin may have a bluish cast due to a lack of oxygen in their blood. "These are quite different symptoms than we see in adults," Dr. Swenson said.
Diagnostic tests for children
The good news for parents, and their children, is that most of the tests to diagnose congenital heart problems are non-invasive.
These include:
- Electrocardiograms which map heart rhythms
- Chest X-rays which look at heart size and the pulmonary vascular system
- Echocardiograms, much like the prenatal ultrasounds most expectant mothers get, which reveal much about the structure and workings of the heart
- Oximeters that measure blood oxygen by passing a beam of light through a translucent part of the skin
- Only on rare occasions is an invasive cardiac catherization needed.
Treatments
"We have something to offer almost every patient, which is good news," Dr. Swenson said.
Treatments for children include medications to treat heart failure, rhythm problems and heart muscle problems. In the rare cases that intervention is needed, non-invasive procedures may be an option for some patients.
Pediatric cardiologists are now doing balloon dilatation for narrowed valves or arteries. A new treatment for atrial septal defects repairs a hole in the heart between the left and right atriums without having to open the chest wall. If the hole is small enough and the location accessible, a special device can be passed to the area and put in place to seal the hole. This is done via the femoral vein, in much the same way stents are put in place. The procedure is performed on adults and older children at Columbia St. Mary's.
"Much progress has been made in pediatric cardiology over the last fifty years. The advances have been phenomenal," Dr. Swenson said.
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