Heart disease in children: What you need to know

David Malpass, MD

Pediatric Cardiology

While most of us think of heart disease as something that affects older adults, heart disease in children may happen more often than you think. Heart disease, whether present at birth or developing later in childhood, can change the structure of the heart, make it more difficult for the child’s heart to function or affect the rate and rhythm of their heartbeat.

Pediatric cardiologist David Malpass, MD, answered common questions about heart disease in children and how caregivers can lower a child’s risk for developing heart disease.

What are the most common causes of heart disease in children?

“For most, it’s going to be a congenital heart defect that causes the problem,” said Dr. Malpass. “A congenital heart defect is a problem with the development of the heart during pregnancy, something that the child will be born with.”

There are many factors that affect whether a congenital heart defect occurs. Children with certain genetic conditions like Down syndrome, Turner syndrome, Noonan syndrome or Williams syndrome are at a greater risk of being born with congenital heart defects. Environmental factors can also make a child more likely to be born with heart defects, including fetal exposure to alcohol, certain medications, maternal infections during pregnancy with illnesses like influenza or rubella (also called German measles) or maternal medical conditions like diabetes.

Most of the time, however, there is no clear reason why a congenital heart defect happens.

Children may also develop heart disease during childhood and have many of the same risk factors for heart disease as adults. These risks include obesity, high blood pressure and high cholesterol levels. Other causes for acquired heart disease in children include:

• Kawasaki disease
• Myocarditis
• Cardiomyopathy
• Pericarditis
• Infective endocarditis
• Rheumatic fever

Can children have abnormal heart rhythms?

“Yes, some children do have abnormalities in their heart rate or rhythm,” said Dr. Malpass. “In the case of bradycardia, where a heart beats too slowly, the defect may be caused by ‘complete heart block,’ a condition where those electrical signals that travel from the top to the bottom of the heart are disrupted.”

Children can also develop abnormal tachycardia, or a very rapid heart rate. In the case of tachycardia, there are two kinds, the kind which starts from the top chambers of the heart or those that start from the bottom chambers. Syndromes like Wolff-Parkinson-White syndrome, Long QT syndrome and Brugada syndrome can all make children more likely to develop these conditions.

How many children have congenital heart defects?

“On average, congenital heart defects happen in about 1% of births,” said Dr. Malpass. “In the United States, that equals out to about 40,000 children each year born with a congenital heart defect.”

Congenital heart defects usually operate in one of three categories:

• Abnormal connection between heart chambers or major arteries
• Obstruction of blood flow
• Complex congenital heart disease

How do you evaluate a child for heart disease?

Beyond the usual pediatric checkup measurements of height, weight, blood pressure and heart rate, a medical provider who suspects heart disease in a child might also order tests like:

• Oxygen saturation (SpO2)
• Electrocardiogram (ECG)
• Chest X-ray
• Echocardiogram (ultrasound of the heart)
• Holter monitor (multi day heart monitor)
• Cardiac computed tomography angiography (CTA)
• Cardiac MRI
• Cardiac catheterization

What are some signs and symptoms of heart disease in children?

“Children with mild heart disease may not experience any symptoms,” said Dr. Malpass. “In this case, they are usually identified because they are discovered to have a heart murmur (the sound caused by blood flowing through the heart) or an abnormal ECG or chest X-ray.”

Children with more significant heart disease might have signs and symptoms like:

1. Poor weight gain
2. Rapid breathing
3. Increased effort when breathing
4. Bluish discoloration of the skin, lips and tongue
5. Pale discoloration of the skin
6. Increased heart rate
7. Easy fatigue
8. Exercise intolerance
9. Dizziness or fainting
10. Excessive sweating
11. Chest pain
12. Swelling of the face, abdomen or legs

Are there ways to improve a child’s heart health?

Although the cause of most congenital heart defect remains unknown, there are steps that pregnant women can take to help reduce the risk for having children with heart defects.

• Get proper prenatal care
• Take a multivitamin with folic acid
• Do not drink alcohol or smoke cigarettes or use electronic cigarettes
• Get the rubella vaccine (usually given as part of the MMR vaccine)
• Control blood sugar if diagnosed with diabetes
• Only take medications that are necessary

Are there ways to prevent acquired heart disease in children at risk?

“Absolutely. For children who have risk factors for developing acquired heart disease, what we want to focus on is improving overall health,” said Dr. Malpass. “Keeping up a healthy lifestyle will mitigate many of those risk factors for heart disease.”

To help your child lower their risk, focus on:

• Exercising 30–60 minutes a day
• Refraining from using nicotine containing products (smoking or vaping)
• Eating a wide variety of fruits and vegetables every day
• Treating high blood pressure
• Treating diabetes
• Treating high cholesterol
• Practicing good dental hygiene
• Maintaining a healthy weight

Any caregiver who has concerns about their child’s heart health should schedule an appointment with the child’s pediatrician to talk over their worries and get an idea of how they can best provide their child with the healthiest start to life.