A Normal Heart

The heart is the hardest working muscle in the human body. Located almost in the center of the chest, the heart of a child is about the size of his/her fist.

A child's heart works just as hard as an adult's heart. In fact, a baby's heart may beat up to 190 times a minute, while an adult's heart usually beats between 60 and 100 times a minute. The rate at which the heart pumps gradually slows down from birth to adolescence. The heart rate constantly fluctuates depending on the cardiovascular demands of the body at that moment.

Composed of the heart and blood vessels, the cardiovascular system is responsible for circulating blood (oxygen) throughout the body. 

The heart has four chambers:

1. Upper right atrium

2. Upper left atrium

3. Lower right ventricle

4. Lower left ventricle 

The flow of blood through the heart is controlled by four heart valves. The valves open and close as the blood is pumped through the heart. Each valve has a set of flaps (also called leaflets or cusps). All valves have three flaps, except for the mitral valve. Normally, it only has two. As the heart beats it creates pressure that opens the valves which allows blood to flow through the flaps. They make sure the blood only flows in one direction.

1. Tricuspid valve (between the right atrium and right ventricle)

2. Pulmonary valve (between the right ventricle and pulmonary artery)

3. Mitral valve (between the left atrium and left ventricle)

4. Aortic valve (between the left ventricle and the aorta)

The right side receives blood from the body and pumps it to the lungs. The left side receives the blood from the lungs and is pumped out into the body. The heart receives blood from veins and sends blood out through arteries.

Symptoms and Signs:

If your child is reporting symptoms or complaints, they should be discussed with your medical provider. Sometimes cardiac symptoms can be challenging to discern given that they can be non specific and could be from other causes that are non cardiac in origin. 

Some of the symptoms reported that may require further evaluation:  

  • Exertional or nonexertional chest pain
  • Dizziness associated with fast or irregular heartbeats
  • shortness of breath associated with fast or irregular heartbeats
  • near syncope or syncope

sudden onset fast heart rates, palpitations

Diagnosis:

Testing that may be performed is the following:

A thorough history and physical exam

-12 lead ECG to determine that electricity travels through the heart normally

- Echocardiogram an ultrasound to image the heart structure and function

-Exercise Stress Test this will reveal the heart rhythm during exertion and may be able to reproduce the symptoms that the patient is reporting. Correlating symptoms with the rhythm of the heart can help with the diagnosis process.

24-48 hour Holter monitor is continuous rhythm strip monitoring for the duration that the monitor is worn.  Patients can go home and can engage in their regular activities (other than bathing, swimming, or activities that cause excessive sweating or may cause the leads to become loose or to fall off).  With a continuous Holter, the device is worn for a specific duration, typically 24 or 48 hours, and then returned to clinic so the information can be analyzed. 

Event monitors are a special type of Holter monitor worn for up to 60 days.  They are programmed to automatically record arrhythmias that they detect on their own, but the recorder also has a button you or your child can press to record the rhythm when they have symptoms.  As they are collected, these recordings are typically transmitted to a monitoring service on a regular schedule, which then reports them to your healthcare provider.  Event monitors record every beat while they are worn, but only save “events” that are automatically triggered or patient activated.  The limitation of event recorders is that the child must be able to feel his or her symptoms and be able to press the activator button or communicate their symptoms to an adult to activate the recorder.

Treatment:

Targeted at the cause of the symptoms, this ranges from diet and health education, ongoing follow up and surveillance, medications, possible procedures.

Lifestyle changes:

Ongoing close management with your cardiologist/electrophysiologist is essential if recommended. Depending on rhythm control and medical management, lifestyle changes may be individualized. Encourage healthy heart lifestyle.

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