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Associate Professor Gary Sholler
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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:
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:
Acquired heart disease in childhood is relatively uncommon in Australia. Some of the more commonly seen varieties are:
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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.
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.
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.
NB: This can be a feature of many illnesses, and is not specific to heart abnormality.
NB: this is surprisingly uncommon as a feature of heart abnormality in school-aged children.
NB: Fainting is a relatively common reason for loss of consciousness in the community.
NB: Palpitations can occur in normal individuals who become over-aware of normal body activity.
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.
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.