Heart disease Heart disease

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Associate Professor Gary Sholler
Director Adolph Basser Cardiac Institute
Head, Department for Cardiology
The Heart Centre for Children, Head, Department for Cardiology
The Children’s Hospital at Westmead
NSW Australia

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DET websites


  • Heartline Association, 1992, Heart Children, Heartline Association, UK.

    Available from Kids Health, The Children’s Hospital at Westmead.
    Ph: +61 2 9845 3585

What is heart disease?

In many cases heart disease will neither limit children during their school years, nor require special intervention. For most only minimal precautions are necessary.

The language used to describe many medical conditions including heart disease, can be complex and often confusing. Here are a couple of common misconceptions:

  • Murmurs’ are actually simply sounds made by the heart. They are not diseases, abnormalities or ‘holes’.

  • Abnormalities’ are not necessarily ‘problems’ and may not do harm, or limit children in any significant way.

The mystical and central nature of the heart to our lives often heightens emotions and so concerns. The consequence is that clear thinking is often the casualty.

Heart disease in children encompasses three main areas: congenital heart disease, acquired heart disease and arrhythmia.

Congenital heart disease is made up of a wide array of abnormalities of heart structure which have evolved during pregnancy, are present at birth, and become evident at various times including the foetal period (some abnormalities only), the newborn period, or later during infancy or childhood. In approximately 50% of cases little to not intervention is required.

Congenital heart disease is divided into two varieties:


  • significant health risk

  • lower than normal oxygen in the blood

  • blue tinge to lips, tongue and fingers

  • surgery usually before 4-5yrs old


  • normal oxygen in the blood

  • may involve holes, blockages or abnormalities of heart valves

  • surgery will depend on the seriousness of the abnormality

Acquired heart disease in childhood is relatively uncommon in Australia. Some of the more commonly seen varieties are:

  • Rheumatic fever

  • Myocarditis

  • Cardiomyopathy

  • Endocarditis

  • Kawasaki disease

  • Genetic abnormalities.

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Serious heart rhythm irregularities are also uncommon in children. They mostly occur because of abnormalities in the heart’s electrical conduction system.

Most importantly arrhythmia is characterised by rapid beating of the heart.

Symptoms include:

  • palpitations

  • dizziness or fainting

  • chest discomfort.

A rarer type of heart rhythm irregularity is heart block which results in abnormally slow heart rhythms.

Many of the symptoms and signs of heart disease can be mimicked by other illnesses or even by exaggerated ‘normal’ responses to common stimuli. Children with suspected or established heart problems are usually assessed and managed by paediatric cardiologists in major paediatric teaching hospitals.

Symptoms include:

  • blueness of the lips, tongue, fingernails and skin accentuated by cold weather or activity.

NB: any child with a normal heart who is cold or faint cyanosis of the hands, feet and lips only (but not the tongue), and so is not an invariable indicator of heart abnormality.

  • excessive shortness of breath which usually appears only on exertion, generally relieved by rest.

NB: This can be a feature of many illnesses, and is not specific to heart abnormality.

  • inability to perform a normal amount of exercise or keep up with other children

NB: this is surprisingly uncommon as a feature of heart abnormality in school-aged children.

  • a very rare manifestation of heart abnormalities in children and the likely association is increased if fainting occurs with exercise.

NB: Fainting is a relatively common reason for loss of consciousness in the community.

  • The sensation of rapid beating of the heart.

NB: Palpitations can occur in normal individuals who become over-aware of normal body activity.

  • A heart murmur is a sound emanating from the heart and heard with a stethoscope. Often the heart is normal and the murmur of no consequence. Sometimes, murmurs are produced by heart abnormalities (eg heart valve problems, hole-in-the-heart).


The majority of children with heart abnormalities do not require any regular medication. If required it is generally given only once or twice a day and therefore not usually required at school.

They may:

  • improve heart muscle function eg digoxin

  • assist with the elimination of excess fluid from the body eg diuretics

  • lower blood pressure eg captopril, propranolol

  • control heart rhythm various medications

  • reduce the blood’s capacity to clot eg anticoagulants such as warfarin, or low dose aspirin.

Externally evident devices and appliances are generally not used in children with heart disease. Implanted devices such as pacemakers will usually not be obvious. Devices include pacemakers and artificial heart valves.

  • A pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms.

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  • An artificial heart valve is a device which is implanted in the heart of someone who suffers from a disease involving a valve in their heart. Replacing the valves in the heart requires open heart surgery.

  • Children with such valves usually require anticoagulant medication.