ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Pediatric Cardiology - Heart Diseases in Children

What is Pediatric Cardiology?

Pediatric cardiology is the medical unit that diagnoses, treats and monitors the heart diseases of all infants, children and adolescents from newborns up to the end of the age of 18.

In the first two months in the mother's womb, the heart completes its own development as the cells differentiate and continue their development. The first heart tissue, initially in the form of a tube, becomes a kind of mechanical heart pump with 4 chambers and 4 valves in about 60 days and starts to work. Thus, it continues to work from the mother's womb until the end of life. Some heart development disorders (anomalies), especially genetic ones, begin to appear when the baby is still in the womb. In this context, it is now possible to diagnose many newborn heart diseases while they are still in the womb. In some congenital heart diseases, interventional procedures or surgical operation may be required as soon as the baby is born. Therefore, early diagnosis and treatment of cardiac anomalies is very important.

Hereditary Heart Diseases in Children

Heart problems in children are gathered in two main groups as congenital and acquire. Unlike adults, most of the heart diseases seen in childhood are congenital. Children with congenital heart diseases are born with some structural problems in their hearts at the time of birth. These anomalies occur in the early stages of pregnancy, sometimes in the very early stages when the mother is not yet aware that she is pregnant, with the disruption of the normal development of the heart. Although the main factor or factors that disrupt the normal development of the heart are often unknown, it is known that some viral diseases (mumps, germs that cause colds, measles, rubella, etc.) can cause it.
Some genetic diseases may also be among the other factors that cause congenital heart diseases. Among these, rhythm disorders and cardiomyopia are the most common. On the other hand, chromosomal diseases such as Down Syndrome and Noonan increase the risk of congenital heart diseases because they cause breaks (microdeletion) in chromosomes. Again, some of the drugs used in the first three months of pregnancy (first trimester) may cause congenital heart diseases by affecting the development of the baby's heart. Apart from these, the mother's metabolic diseases such as diabetes, smoking, alcohol or drug use during pregnancy and exposure to X-rays can also cause heart problems.
Although most of the congenital heart diseases show symptoms in the first year following the birth, some of them can be detected by fetal echocardiography while the baby is still in the mother's womb. The diagnosis can be clarified as a result of being noticed by the pediatrician during the routine examination, which is usually done up to the age of one, and being referred to the pediatric cardiology. Some heart diseases may not show any disturbing symptoms and may not be noticed by the family. However, some congenital heart problems may present with the following symptoms:
breathing hard,
frequent respiratory tract infections,
bruising after running or walking fast,
palpitations,
heart murmur,
fainting,
dizziness,
getting tired quickly,
high blood pressure,
chest pain,
developmental disorder, and
not being able to gain weight.
What is Infective Endocarditis?
This heart disease, which is defined as the involvement or inflammation of the heart valves, inner membrane or vessels, is a rare condition. It occurs when some bacteria, fungi or organisms that are in the mouths of normal people and do not affect them, infect people with heart disease, mix with the blood and reproduce, and cause symptoms such as shortness of breath, fever and murmur. Therefore, a high level of importance should be given to oral hygiene in children with heart disease.
What is a Heart Murmur?
One of the most common pediatric heart diseases is murmur. First heard from a pediatrician, this word comes to the mind of parents and brings up the question "What is a murmur?". The murmur, which is frequently seen among heart diseases, is when the specialist doctor hears a different sound in the form of blowing while listening to the child's heart. Under normal conditions, when the heart is resting, the closing sounds of the valves are clearly heard. However, severe murmurs other than these valve sounds may be a sign of heart disease. In some cases, this murmur is mild. For this reason, murmur types are divided into "innocent" and "pathological" murmurs.
The reason for the presence of an innocent murmur is that the chest wall in children is much thinner than in adults. Over time, the child grows and this wall thickens. Thus, the murmur disappears on its own. In the case of a pathological murmur, structural defects such as holes in the heart, stenosis in the heart vessels and vascular openings cause severe murmurs. The presence and type of murmur in the heart can be easily recognized by the specialist doctor. In some suspicious cases, echocardiography can be used to examine.
Newborn Heart Murmur
A newborn baby is examined by a specialist doctor to see if the heartbeat is healthy and normal. In the meantime, different sounds as a result of the whirlpool that occurs as the blood passes through the great vessels means a heart murmur. Rapid heartbeats are expected in newborn babies. In general, the baby's heart rate is between 120 and 140 beats per minute. This pulse rate can go up to 170 when the baby cries. In such cases, an innocent murmur may occur as the heart beats fast. After detecting the presence of murmur during physical examination, it is possible to make the final diagnosis with the help of imaging techniques such as ECG, Echocardiogram, chest X-ray or cardiac catheterization.

What are the Diagnostic Methods in Pediatric Heart Diseases?

In order to maintain the appropriate treatment and obtain a successful result in pediatric heart diseases, it is necessary to make a correct diagnosis first. For this, first of all, the family history of the child is found out, a physical examination is performed and some tests are applied when the specialist doctor deems it necessary. These tests are:

Heart electrocardiography:This method, also known as ECG, is the graphic visualization of the electrical activity of the heart by means of electrodes adhered to the skin in different parts of the body.

Holter ECG:It is the observation of the heart condition by measuring the patient's activities at regular intervals with a recording device that works with electrodes attached to the chest wall and monitors the patient's activities throughout the day.

Cardiac catheterization and angiography:It is the administration of contrast material through the inserted catheter to measure the pressure in different areas of the heart and observe the anatomical shape and dimensions of the heart.

Echocardiography:With this method, also known as ECHO, the dimensions of the heart chambers, heart valves, intra-cardiac pressure, heart wall movements and the amount of blood expelled during a single contraction can be followed.

Telecardiography:It is a heart-lung film in which the dimensions of the heart, its enlargement and appearance in some cavities are displayed.

Color Doppler Echocardiography:Colored observation of the heart in 2 or 3 dimensions with the help of ultrasonic sound waves. Structural heart problems can be diagnosed with this method by measuring the condition of the heart muscles, the flow rate of the blood in the heart, and the pressure in the cavities of the heart. In addition to the heart health of the baby in the mother's womb, images are obtained with a device called transducer placed on the child's chest.

Electrophysiology:Electrode catheters are sent to the heart through sheaths placed in the vessels in the neck and inguinal region. With the electrical signals received from the heart, it is evaluated whether the transmission is healthy or not. It is preferred in the diagnosis and treatment of conditions such as palpitations, fainting and serious rhythm disorders that other methods cannot explain.

Stress test:It is the observation of data such as pulse and blood pressure through electrodes attached to the chest area. Congenital heart diseases, heart capacity measurement, symptoms that develop as a result of activity, and the stressed state of the heart can be observed with this test.

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