Pediatric Cardiology

Pediatric cardiology is a medical specialty that deals with the diagnosis, follow-up, and treatment of congenital or acquired heart and vascular diseases seen in infants, children, and adolescents. Conditions such as holes in the heart, heart murmurs, rhythm disorders, congenital heart diseases, heart muscle diseases, and pulmonary hypertension are evaluated within the scope of pediatric cardiology.

Heart diseases in children may sometimes show symptoms immediately after birth, while in some cases they may become noticeable at later ages. Symptoms such as shortness of breath, bluish discoloration, easy fatigue, palpitations, fainting, growth retardation, and feeding difficulties should be evaluated in terms of heart diseases. Early diagnosis and regular follow-up are of great importance in protecting children’s heart health.

What Is Pediatric Cardiology?

Pediatric cardiology is the medical specialty that diagnoses, treats, and monitors heart and vascular diseases seen during childhood. Structural, rhythm-related, and functional problems of the heart from the newborn period to adolescence are evaluated within this field.

A child’s heart has different characteristics from an adult heart. For this reason, the evaluation of heart diseases in children should be performed by physicians specialized in pediatric cardiology.

Which Diseases Does Pediatric Cardiology Deal With?

Pediatric cardiology deals not only with congenital heart diseases but also with acquired heart and vascular diseases.

The main diseases within the scope of pediatric cardiology include:

• Congenital heart diseases
• Holes in the heart
• Heart murmurs
• Heart valve diseases
• Rhythm disorders
• Heart muscle diseases
• Heart failure
• Pulmonary hypertension
• Kawasaki disease
• Chest pain
• Fainting
• Palpitations
• Fetal heart diseases
• Pre-sports cardiac evaluation
• Familial heart diseases

Not every palpitation, chest pain, or murmur seen in children indicates a serious heart disease. However, it is important that these symptoms are evaluated by a specialist.

When Should a Pediatric Cardiologist Be Consulted?

Some symptoms may be warning signs of heart diseases in children. These symptoms may appear differently in infancy and in older children.

Conditions that may require consultation with a pediatric cardiologist in infants include:

• Getting tired easily while breastfeeding or feeding
• Sweating during feeding
• Bluish discoloration
• Rapid breathing
• Inability to gain weight
• Growth retardation
• Frequent lung infections
• Detection of a heart murmur

In older children, the following symptoms should be evaluated:

• Getting tired easily during physical activity
• Chest pain
• Palpitations
• Fainting
• Dizziness
• Shortness of breath
• Feeling unwell during exercise
• Bluish discoloration of the lips or fingers
• Family history of sudden cardiac death

When these symptoms are noticed, a pediatric cardiology evaluation is recommended.

What Are the Heart Diseases Seen in Children?

Heart diseases in children can be evaluated under two main groups: congenital and acquired diseases. Congenital heart diseases occur due to structural differences in the heart during the baby’s development in the womb. Acquired heart diseases may occur due to infections, immune system diseases, rhythm disorders, or heart muscle problems.

Heart diseases that may be seen in children include:

• Congenital heart diseases
• Holes in the heart
• Tetralogy of Fallot
• Heart valve diseases
• Rhythm disorders
• Heart murmurs
• Heart failure
• Cardiomyopathies
• Pulmonary hypertension
• Kawasaki disease

Congenital Heart Diseases

Congenital heart diseases occur when the structure of the baby’s heart develops differently than normal during pregnancy. Some congenital heart diseases may have a mild course, while others may require early diagnosis and treatment.

Congenital heart diseases may include:

• Holes in the heart
• Valve stenosis
• Vascular connection anomalies
• Tetralogy of Fallot
• Transposition of the great arteries
• Structural problems related to the heart chambers or vessels

The need for treatment varies depending on the type of disease, the degree of the defect or narrowing, the child’s symptoms, and heart function.

What Is a Hole in the Heart?

A hole in the heart refers to an opening in the wall between the atria or ventricles of the heart. The most commonly known types are ASD and VSD.

Small heart defects may close spontaneously over time in some children or may only require follow-up. In larger defects or those affecting heart function, interventional procedures or surgical treatment may be considered.

What Is Tetralogy of Fallot?

Tetralogy of Fallot is a congenital heart disease in which multiple structural abnormalities are present together in the heart. In this disease, the oxygen level in the baby’s blood may be affected, and bluish discoloration may occur.

Infants with Tetralogy of Fallot may experience symptoms such as bluish discoloration of the lips, fingers, or skin, feeding difficulties, and easy fatigue. The treatment plan is determined by pediatric cardiology and pediatric cardiac surgery teams.

Heart Valve Diseases

Heart valve diseases occur when the heart valves cannot open fully or close completely. This condition may affect blood flow and cause the heart to work harder.

Heart valve diseases in children may be congenital, or they may develop after certain infections or rheumatic diseases. Treatment may include follow-up, medication, interventional procedures, or surgical options.

Rhythm Disorders

A rhythm disorder means that the heart beats faster, slower, or more irregularly than normal. In children, it may present with symptoms such as palpitations, dizziness, fainting, discomfort in the chest, or feeling unwell during exercise.

While rhythm disorders may be benign in some children, further evaluation and treatment may be required in some cases. ECG, Holter monitoring, and advanced rhythm evaluations may be used for diagnosis when necessary.

Heart Murmur

A heart murmur refers to additional sounds heard when listening to the heart. A significant proportion of murmurs in children may be innocent murmurs and may not indicate a serious disease. However, some murmurs may be associated with congenital heart diseases, valve problems, or openings inside the heart.

To determine whether a murmur is innocent, a pediatric cardiology examination and, if necessary, echocardiography may be performed.

Heart Failure

Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. In children, it may develop due to congenital heart diseases, heart muscle diseases, rhythm disorders, or infections.

In infants, feeding difficulties, inability to gain weight, rapid breathing, and sweating may be seen. In older children, easy fatigue, shortness of breath, and decreased exercise capacity may occur.

Cardiomyopathy

Cardiomyopathy refers to diseases that affect the structure and function of the heart muscle. The heart muscle may become thickened, weakened, or stiff.

In children, cardiomyopathy may develop due to genetic causes, after infections, or in association with certain metabolic diseases. Treatment is planned according to the type of disease and the degree to which heart function is affected.

Pulmonary Hypertension

Pulmonary hypertension is a serious circulatory problem that occurs when the pressure in the lung vessels increases. It may cause the right side of the heart to work harder.

In children, it may present with symptoms such as shortness of breath, easy fatigue, fainting, bluish discoloration, or chest pain. Early diagnosis and regular follow-up are important.

Kawasaki Disease

Kawasaki disease is an inflammatory disease seen in childhood that can affect the blood vessels. Pediatric cardiology follow-up may be required because it can particularly affect the coronary arteries.

Symptoms may include prolonged fever, rash, redness of the eyes, cracked lips, and swelling of the hands and feet. Early diagnosis and appropriate treatment may help reduce risks related to the heart vessels.

What Are the Symptoms of Heart Disease in Children?

Heart diseases in children may show different symptoms depending on age. Some diseases are noticed immediately after birth, while others become apparent during school age or adolescence.

Symptoms of heart disease in children include:

• Shortness of breath
• Easy fatigue
• Bluish discoloration
• Palpitations
• Irregular heartbeat
• Fainting
• Dizziness
• Chest pain
• Feeding difficulties
• Inability to gain weight
• Growth retardation
• Feeling unwell during exercise
• Frequent respiratory tract infections
• Swelling in the legs or around the eyes

If these symptoms are present, a pediatric cardiology evaluation should be performed.

Symptoms of Heart Disease in Infants

Heart diseases in infants often present with symptoms related to feeding and breathing.

Symptoms that should be taken into consideration include:

• Getting tired easily while breastfeeding or feeding
• Sweating during feeding
• Rapid breathing
• Bluish discoloration of the lips
• Inability to gain weight
• Growth retardation
• Feeding with frequent pauses
• Restlessness
• Breathing difficulty

When these symptoms are noticed, a pediatrician or pediatric cardiologist should be consulted without delay.

Symptoms of Heart Disease in Older Children

In older children, heart diseases may become more noticeable during exercise.

Symptoms that may occur include:

• Getting tired easily while running or playing
• Chest pain
• Palpitations
• Fainting
• Dizziness
• Shortness of breath
• Decreased exercise capacity
• Difficulty participating in school sports
• Feeling of irregular heartbeat

Fainting or chest pain, especially during exercise, is an important symptom and must be evaluated.

Diagnostic Methods Used in Pediatric Cardiology

Different tests and imaging methods may be used to diagnose heart diseases in children. The necessary method is determined according to the child’s complaints, examination findings, and suspected disease.

Diagnostic methods used in pediatric cardiology include:

• Physical examination
• Echocardiography
• Electrocardiography
• Holter monitoring
• Exercise stress test
• Fetal echocardiography
• Cardiac catheterization
• Angiography
• Cardiac MRI
• Computed tomography
• Blood tests

What Is Echocardiography?

Echocardiography is a method that uses ultrasound waves to visualize the structure and function of the heart. It is frequently used to evaluate holes in the heart, valve diseases, heart muscle problems, and congenital structural heart diseases.

It is a painless imaging method and does not contain radiation.

What Is Electrocardiography?

Electrocardiography is a test that evaluates the electrical activity of the heart. It is also known as ECG. It helps in the evaluation of rhythm disorders, palpitations, fainting, and some heart muscle problems.

It is a painless test that can be performed in a short time.

What Is Holter Monitoring?

Holter monitoring is a method that records the heart rhythm for 24 hours or longer. It may help detect temporary rhythm disorders that occur during the child’s daily life.

It may be used in cases of palpitations, fainting, dizziness, or suspected intermittent rhythm disorders.

What Is Fetal Echocardiography?

Fetal echocardiography is an ultrasound-based examination that allows detailed evaluation of the baby’s heart in the womb. It may be recommended especially in pregnancies with a risk of congenital heart disease.

If heart disease is suspected during pregnancy, it is important for prenatal diagnosis and planning of postnatal treatment.

Cardiac Catheterization and Angiography

Cardiac catheterization is an interventional method used to measure pressures in the heart and vessels, evaluate oxygen levels, and examine certain structural problems.

In some cases, treatment can also be performed along with diagnosis. For example, closure of some heart defects or widening of valve stenosis can be carried out with interventional methods.

How Are Heart Diseases Treated in Children?

The treatment of heart diseases in children varies depending on the type and severity of the disease, the child’s age, and overall health status. Some diseases require only regular follow-up, while medication, interventional procedures, or surgical treatment may be needed in some cases.

Treatment methods include:

• Regular follow-up
• Medication therapy
• Lifestyle modifications
• Interventional cardiology procedures
• Pediatric cardiac surgery
• Pacemaker implantation
• Treatment of rhythm disorders
• Rehabilitation and supportive care

The treatment plan may be determined through joint evaluation by pediatric cardiology, pediatric cardiac surgery, and relevant medical specialties.

Medication Therapy

Medication therapy in pediatric heart diseases is planned according to the type of disease. Medications may be used in heart failure, rhythm disorders, pulmonary hypertension, or certain valve diseases.

Medications should not be started, stopped, or have their dosage changed without a doctor’s recommendation. Regular check-ups are important during the treatment process.

Interventional Cardiology Procedures

Interventional cardiology may allow some heart diseases to be treated with catheter-based methods without open surgery. These procedures are not suitable for every patient; suitability is determined according to the child’s heart structure and the type of disease.

Procedures that may be performed with interventional methods include:

• Closure of certain heart defects
• Balloon dilation of valve stenosis
• Opening of vascular narrowings
• Procedures for certain rhythm disorders

Pediatric Cardiac Surgery

Surgical treatment may be required in some congenital heart diseases. The surgical method aims to correct the structural problem in the heart or to make blood circulation more appropriate.

The decision for surgery is made according to the type of disease, the child’s age, weight, symptoms, and heart function.

Pacemaker and Rhythm Treatments

In some children, a pacemaker may be required due to a very slow heartbeat, serious rhythm disorder, or electrical conduction problem. A pacemaker is a medical device that helps the heart work more regularly.

Regular device checks, monitoring of battery life, and activity adjustments are important in children with pacemakers.

Prevention and Follow-Up of Heart Diseases in Children

It may not be possible to prevent every heart disease. Congenital heart diseases in particular are related to development during pregnancy. However, regular follow-up, healthy lifestyle habits, and reducing risk factors can support children’s heart health.

Points to consider for protecting heart health in children include:

• Not neglecting regular pediatric check-ups
• Consulting pediatric cardiology in cases of murmur or suspected heart disease
• Encouraging balanced eating habits
• Supporting age-appropriate physical activity
• Keeping children away from cigarette smoke
• Ensuring adequate sleep routines
• Reducing the risk of obesity
• Informing the physician if there is a family history of heart disease
• Having a cardiac evaluation before sports when necessary
• Not neglecting check-ups in children diagnosed with heart disease

Why Are Regular Cardiology Check-Ups Important?

The course of heart diseases in children may change over time. Some small heart defects may close spontaneously, while some diseases may require close follow-up. Regular check-ups are important for treatment success in conditions such as rhythm disorders, valve diseases, or pulmonary hypertension.

Through regular check-ups:

• The course of the disease can be monitored.
• The need for treatment can be determined.
• Medication doses can be adjusted.
• The timing of interventional or surgical treatment can be planned.
• The child’s growth and development can be followed.
• Sports and activity recommendations can be personalized.

When Is Emergency Medical Attention Required?

Some symptoms may require emergency evaluation. In the following situations, a healthcare institution should be contacted without delay:

• Fainting of the child
• Feeling unwell during exercise
• Significant bluish discoloration of the lips or face
• Severe shortness of breath
• Chest pain lasting for a long time
• A very fast or irregular heartbeat sensation
• Confusion
• An infant who cannot feed and breathes rapidly
• Sudden weakness or paleness

These symptoms may be associated with serious heart or circulatory problems.

Frequently Asked Questions About Pediatric Cardiology

What is pediatric cardiology?

Pediatric cardiology is the medical specialty that deals with the diagnosis, treatment, and follow-up of heart and vascular diseases seen in infants, children, and adolescents.

Which age group does pediatric cardiology treat?

Pediatric cardiology generally evaluates infants, children, and adolescents from birth to 18 years of age. Some congenital heart diseases may require follow-up into adulthood.

What are the symptoms of heart disease in children?

Shortness of breath, bluish discoloration, easy fatigue, palpitations, fainting, chest pain, growth retardation, inability to gain weight, and feeding difficulties may be symptoms of heart disease in children.

How can heart disease be recognized in infants?

In infants, getting tired while feeding, sweating during feeding, rapid breathing, bluish discoloration, inability to gain weight, and frequent lung infections should be evaluated in terms of heart disease.

Is a heart murmur dangerous in children?

Most heart murmurs in children may be innocent. However, some murmurs may be associated with congenital heart disease or valve problems. A pediatric cardiology examination is required to distinguish between them.

Can a congenital hole in the heart close on its own?

Some small heart defects may close spontaneously over time. Larger defects or those affecting heart function may require follow-up, interventional procedures, or surgical treatment.

How is a rhythm disorder recognized in children?

Palpitations, fainting, dizziness, discomfort in the chest, or feeling unwell during exercise may be signs of a rhythm disorder. ECG and Holter monitoring may be used for diagnosis.

What is Tetralogy of Fallot?

Tetralogy of Fallot is a congenital heart disease in which multiple structural abnormalities are seen together in the heart. It may present with bluish discoloration and low oxygen levels. Treatment is planned individually.

Can heart failure occur in children?

Yes. Heart failure in children may develop due to congenital heart diseases, heart muscle diseases, rhythm disorders, or infections.

Is pulmonary hypertension serious in children?

Pulmonary hypertension is a serious disease characterized by increased pressure in the lung vessels. Early diagnosis, regular follow-up, and appropriate treatment are important.

Can Kawasaki disease affect the heart?

Kawasaki disease may affect the coronary arteries in some children. Therefore, pediatric cardiology follow-up may be required in children diagnosed with this disease.

Is echocardiography harmful for children?

Echocardiography is an ultrasound-based imaging method and does not contain radiation. It is frequently used to evaluate the structure and function of the heart in children.

In which situations is a pacemaker implanted in children?

A pacemaker may be required when the heart beats too slowly, in serious conduction disorders, or in certain rhythm problems. The decision is made by pediatric cardiology and relevant specialists.

When should pediatric cardiology be consulted?

Pediatric cardiology may be consulted in cases of murmur, bluish discoloration, easy fatigue, palpitations, fainting, chest pain, shortness of breath, inability to gain weight, growth retardation, or a family history of heart disease.