Kids can have heart disease, too

By Donya Betancourt

SANUR, Bali (JP): It seems like a strange question, as we are so accustomed to seeing older people with heart problems, but can children have heart disease?

Unfortunately, the answer is yes.

Heart disease found in newborns and younger children can be categorized as "congenital" and "acquired" heart disease. Congenital means existing at birth, and it occurs in about eight out of every 1,000 births around the world.

In most cases, the doctors do not know why the heart failed to develop properly. The defects develop during pregnancy; some cases are associated with genetic disorders, some may come from exposure to the wrong medication during the first trimester of pregnancy, for example, the anticonvulsant phenyltoin, skin medication acutane or the manic-depressive medication lithium, but most are not associated with any one particular cause.

Acquired heart disease can be from a viral infection to the heart muscle, rheumatic heart disease or a secondary affect from an other illness such as hypertension, Kawasaki disease (infantile polyarteritus) or diabetes.

Knowing that your child has a congenital heart defect can be frightening, but if you understand the heart muscle and are able to picture how it looks and works then you can make a plan and know how to share information with your child's doctor.

The heart is a muscle sac divided into four chambers, two upper and two lower. The two upper chambers are the right and left atrium, the two lower chambers are the right and the left ventricles, and the septum is the wall that separates the left and right sides of the heart.

There are a total of four valves that act as one-way gates for blood flow at the atrium and ventricle chamber openings. The following describes the blood journey through a normal heart. The heart functions as a blood pump. It is made of very strong muscle and this muscle contracts (squeezes) blood from the right to left heart valve in a one-way direction. Blood from the body returns to the heart via veins to the right atrium, when the right atrium contracts, the blood will move through the tricuspid valve to the right ventricle.

When the right ventricle contracts, the blood moves through the pulmonic valve to a large blood vessel, the pulmonary artery, and from there to the lungs. Once the blood is in the lungs it picks up the oxygen it needs and returns to the heart via the left atrium and passes through the mitral valve to the left ventricle. From the left ventricle, the blood flows through the aortic valve to another large blood vessel called the aorta, and supplies oxygen-rich blood to all of the body. Blood through the heart is on a one-way path, and the path is from the heart to the lungs and then back to the heart again. Blood on the right side of the heart is oxygen-poor and on the left is oxygen-rich.

Now, what can go wrong? The heart develops in the first eight weeks of fetal life, and defects can occur in the chambers, the septum in the middle of the heart, the valves or the blood vessels. There are approximately 30 separate types of congenital heart disease, so what are the effects from a defective part in the heart? Blood can mix from the left side with the right side, there can be blockage of the blood flow, abnormal blood flow from the vessels leaving the heart, or a combination of them all.

The symptoms depend on what the defect is -- some defects may never cause a problem, others may not become a problem until later in life and some cause major problems immediately or soon after birth.

Pain is not common, and many newborns with congenital heart disease have no symptoms. Some may have rapid breathing or tire quickly after eating but mostly they feel no different than any other newborn. Most heart defects can be corrected or rectified with surgery, and many children with congenital heart defects live normal, productive and healthy lives.

Part two of this article next week will examine the different types of heart disease in children. The writer is a pediatrician based in Sanur, Bali. If you have questions, please contact her at drdonya@hotmail.com, or you can reach her at features@thejakartapost.com.