Advice to Take to Heart
By Derek A. Williams, D.O., Pediatric Cardiologist, Wake Forest Baptist Health – Brenner Children’s Hospital
For many parents with middle and high-school aged children who are gearing up for spring sports, getting the screening physical exam is part of the process.
Most children will sail through the exam without any problems. But occasionally, the doctor or physician assistant will spot a red flag – literally, in a heartbeat. It may come in the form of a murmur, an abnormal heart rhythm or shortness of breath.
So what does it all mean? And when is a heart condition serious?
Common Heart Conditions are Rarely Worrisome
The most common heart condition in children is a heart murmur. This is an extra heart sound occurring during the heart rhythm. It is estimated that 80 to 90 percent of children will have a heart murmur during their growing years. Most murmurs are benign (innocent), caused by blood flowing through the normal chambers of the heart. The next most common condition we see is chest pain, and the majority of these are benign as well. The third most common condition is a tie between fainting and complaints of abnormal heart rhythms, once again most of these conditions are benign.
These conditions are extremely common, and rarely worrisome. The later in childhood these problems are detected, the less likely they are to represent a true problem.
The More Serious Problems
Only about one percent of the population has true congenital heart disease (birth defects of the heart) which translates to about 8 to 12 babies born out of a 1000. The majority of congenital heart disease cases involves a portion of the heart not having developed as it should have, or a problem with the heart functioning in a coordinated fashion.
The most dangerous heart conditions in children are those that can cause sudden death. Most cases involve an abnormal portion of the heart that causes it to strain to work appropriately, especially when a child is playing hard, or a heart arrhythmia that causes poor heart function.
Hypertrophic cardiomyopathy (HCM)is the most common cause of sudden death in young athletes. The overall prevalence of HCM has been estimated to occur in less than one percent of the population. There are some other heart rhythm abnormalities that can cause sudden death but are even less common than HCM. These abnormalities typically have a strong genetic component. Children with a family history of HCM or sudden death in a young family member (first or second degree) should have an evaluation by a cardiologist performed before participating in sports.
Signs of Heart Problems
Parents should be concerned if a child fails to gain weight normally, or begins to show a decrease in activity level. Other signs of potential problems may include chest pains, tiredness, dizziness, shortness of breath, or feelings of heart abnormalities, especially during activity. It’s especially important to listen to your child’s concerns about his body. Any of these symptoms should be brought to the attention of the child’s primary care provider, who may refer you to a specialist for further evaluation.
Parents’ worries are never silly. My favorite part of my job is when I get to reassure parents that their child has a strong and healthy heart. Most children do not have problems with their heart, but those who do can be treated by a pediatric cardiologist and live normal lives.
For information about the Heart Program at Brenner Children’s Hospital, visit Brenner Children’s Hospital online.To make an appointment with one of our physicians, call 336-716-WAKE (9253).
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