How to handle heart problems in children

Dr Anuradha Sridhar checks a child with a congenital heart problem. / Lydia Atieno.
Dr Anuradha Sridhar checks a child with a congenital heart problem. / Lydia Atieno.

At La Confiance Wellness Clinic, Kimironko in Gasabo District, a group of medics from India, mainly pediatric cardiologists, last week held a three-day camp where they screened, tested and carried out echocardiography on children below 18 years of age.

Echocardiography is a painless test that uses sound waves to create pictures of the heart. This test, according to medics gives information about the size and shape of the heart and how well heart chambers and valves are working.

According to Dr Anuradha Sridhar, a consultant pediatric and adult congenital cardiologist at Apollo Children’s Hospital in India, there is a misconception that heart problems only happen in adults. She says this is not true as children also have several heart problems that need to be treated to save their lives.

Sridhar notes that among a thousand children born worldwide, 6 to 8 per cent have congenital heart defect, while 20 to 25 per cent of them die in the first year of life without getting access to medication.

“This is a problem that affects the whole world, but access to medical care is easier in developed countries compared to undeveloped countries, Rwanda being among them,” she says.

Although access to cardiac care in children is still not very widely available in Africa, Sridhar says there is need to raise more awareness among people about heart problems in children, as well as the available treatment options.

According to Dr Francis Kazungu, a general practitioner in Kigali, there are two types of heart disease in children; congenital and acquired heart problems.

Congenital problems

Kazungu says these are problems which are present right from birth.

He notes that they can be in form of a hole in the heart or valve blocks, leaks in the valves or a very complex problem where a hole between the two sides of the heart produces an abnormal mixture of oxygenated blood from pulmonary circulation and deoxygenated blood from the systemic circulation.

How to identify the problem

Sridhar says children with a heart defect will have symptoms such as breathing very fast when playing, becoming very tired and breathless.

“Such children are also not in a position to eat as well as normal children and they always have a problem when it comes to feeding them. They tend to breathe very fast and vomit the food. They also experience excessive sweating and have very fast heart beats,” she adds.

Additionally, Dr Robin Jerome, the managing director at La Confiance Hospital in Kimironko, points out that children with heart problems always have a problem of weight loss.

Recurrent respiratory infection is another symptom that always manifests in such children, he says.

All these, Jerome says can delay their development in general. He says the other symptom is the bluish coloration of the skin such as on lips and tongue, especially when they are playing or crying.

Jerome adds that in grown up children, they can have some chest pain, lose consciousness and complain of the heart beating very first.

If the child has any of these signs, he advises that parents should take them for heart screening. He adds that this is because major heart problems can be identified with only simple echocardiography.

In echocardiography, Sridhar says they only do the ultra sound of the heart and this is a very harmless procedure that can help identify the heart problem so that it is treated immediately.

“The earlier the detection, the earlier the treatment which helps the child to live a normal life,” she says.

She also dismisses the misconception that the baby should have at least five or ten kilos to undergo the cardiac surgery.

Sridhar explains that this is not true because medical science is so advanced now that even a newborn baby can successfully undergo cardiac surgery. And this is even better because the earlier they are treated, the better.

She says doing the echocardiography for children with defects helps the parent to know what kind of surgery is required so that they can organise for treatment early enough.

Treatment

Sridhar says not all heart problems require open heart surgeries.

Under open heart surgery, she says the surgeon has to cut the chest open, stop the heart from functioning so that they can close the hole inside, which allows the blood to go through the bypass machine to the brain and other vital organs. After the surgery, the heart is allowed to pump normally.

She says this major surgery is done for complex heart problems. Other simple defects such as simple holes and valve blocks can be treated in a non-surgical manner.

Sridhar explains that for some heart defect repairs, the incision is made on the side of the chest, between the ribs. This is called a thoracotomy. It is sometimes called closed-heart surgery; it may be done using special instrument and a camera.

Another way to fix defects in the heart is to insert small tubes into an artery in the leg and pass them up to the heart.

Sridhar says for such problems, the child can only spend a day in the hospital and leave the following morning, adding that what is required is awareness among the people that such problems, when identified, can be treated easily.

Complications

When they are not identified early and when there is a hole in the heart, Dr Jerome says there is a lot of blood from the left side of the heart gashing into the lungs of the child, the reason a child has difficulty breathing or eating properly.

If this goes on for a long time without treatment, he says the lung pressure will increase and the blue blood will start going into the body making the child to become very blue and at this point they can’t be treated.

Acquired heart diseases and prevention

For acquired heart diseases, Kazungu says children get them after they are born. Here, he notes that the heart muscles become very weak, valves start leaking and pressure becomes very high.

“Majority of acquired heart diseases are rheumatic heart diseases. Here, the child can get throat infections and body’s immunity starts developing against throat,” he adds.

Kazungu advises that children should be protected from throat infections by treating them promptly with correct antibiotics.

He explains that the mother should make sure that they breastfeed their children exclusively for six months, improve their nutrition as well as maintain good hygiene. “This helps keep the child away from infectious diseases that can bring about complicated problems that require a lot of money to be treated.

“Suppose the child has got rheumatic fever, initially, there will be no valve damage but with time, the valve will be temporarily affected. Even if the valve is temporarily affected, if the doctor is able to identify the problem and treat it in time, then they can prevent further progression,” Kazungu says.

Sridhar says children should be given a penicillin injection once in three weeks as this will ensure that they are protected from rheumatic heart disease.

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