Infantile heart

It is therefore very important to timely identify any potential symptoms while the role of a comprehensive prenatal screening is also very crucial.

Written by
Maria Topouzi – Hatzigeorgiou
Pediatrician, Scientific Partner of MITERA Children’s Hospital

An infant’s heart is a complicated electromechanical pump with four (4) cavities that pumps about 160,000 times per day in order to circulate blood throughout the body. Any pathology that obstructs normal functioning of the heart is characterized as heart disease.

Heart diseases in infants are classified to congenital and acquired. Congenital and acquired heart diseases are among the most frequent chronic diseases of childhood.

Congenital heart diseases are caused by incomplete or abnormal development of the fetus heart and of the vessels surrounding the heart. About 5 to 8 out of every 1,000 newborns have congenital heart defects. Their time of occurrence and severity can vary. More specifically, congenital heart diseases may occur immediately after childbirth or remain unnoticed for years.

It is estimated that 2 to 3 out of 1,000 infants born with congenital heart diseases will present clinical symptoms during their first year of life. Moreover, it is estimated that 40 to 50% of the cases will be diagnosed during the first week of life and about 50 to 60% of them during the first month of life.

Congenital heart diseases in infants can include various types of myocardial diseases and some types of arrhythmias. The later often comprise concomitant clinical findings of other congenital anatomic abnormalities of the heart or appear as complications after surgical procedures that aim to treat those abnormalities.

The acquired heart diseases in infants are very rare. These include endocarditis, myocarditis, Kawasaki disease, pericarditis and acquired arrhythmia.

In order to diagnose heart diseases in infants it is very crucial to have the following data:
Detailed family history.
Detailed clinical examination.
Any potential clinical and laboratory findings related to the heart.

Family History

Family history should include detailed data on the following: existence of other children or siblings in the family that suffer from heart diseases or any sudden death incidents. Moreover data should be available for the pregnancy period particularly in the case that the mother suffered from diabetes or diffuse lupus erythematosus, phenylketonuria, congenital rubella or used teratogenic substances and drugs such as lithium, alcohol, warfarin, thalidomide, antimetabolites, or anticonvulsants.

Clinical examination

Clinical examination of the infant includes assessment of its overall body condition and of any potentially insufficient body weight gain rate. Moreover, special attention should be paid to any signs of cyanosis either accompanied or not by a heart murmur, to any development abnormalities and to any signs of breathing difficulty or heart failure.

Cyanosis (bluish discoloration of the skin) is seen more readily on the lips and tongue, in the beds of the fingernails and toenails and the mucus membranes. Cyanosis is a serious symptom when it appears throughout the body and is accompanied by respiratory distress and fever.

As regards heart murmurs, it should be noted that in many cases these are functional murmurs. Functional murmurs are benign (innocent murmurs). However, in order to conclude on their cause, a pedo-cardiologic should evaluate them.

Other signs that can reveal an underlying heart disease or heart failure in an infant are the following: decreased appetite and, frequently, difficult and lengthy process of feeding (small and frequent meals), tachypnea (more than 40 to 55 breaths per minute for full-term infants and babies), difficult and laborious breathing, coughing, pale and cold hands and feet as well as sweating without overheating during feeding. It is a common symptom that an infant suffering from heart failure or arrhythmias has an obstructive sleep disorders.

Laboratory screening

In order to diagnose congenital heart diseases, apart from family history and clinical examination, a chest X-Ray (CXR) and an electrocardiogram (EKG) should be conducted. However, in order to conclude on this diagnosis and on the type of the congenital heart disease, the physician should rely on the EKG and on the hemodynamic screening of the heart’s functioning. Although, the prenatal cardiologic examination of a fetus’s heart by an EKG has evolved rapidly in the last years, it is still very difficult to determine with absolute with absolute certainty and precision all congenital heart diseases.

The role of the parents

Despite the fact that during the last 30 years there was an impressive evolution on the diagnosis and surgical treatment of children suffering from congenital heart diseases and taking also into account that their life expectancy has also been significantly increased, congenital heart diseases still are a main cause of deaths for children born with congenital defects.

Early diagnosis of particular congenital heart diseases is very important. More specifically, at the age of two months the pulmonary resistance subsides and it is possible for specific heart diseases to get worse. In that case, the infant should quickly visit a specialized pedo-cardiologist.

Parents’ role on the early diagnosis of a heart disease is crucial. Parents should ensure that the mother has a comprehensive prenatal screening to detect any potential congenital infections. Moreover, parents should have increased awareness on the matter in order to be able to identify any data from their family history as well as from the infant’s clinical examination and development that could assist on the diagnosis of a congenital heart disease.

About five to eight infants out of 1,000 are born with a congenital heart disease that is not easily treated.