What is pediatric cardiology?
Congenital heart disease is the most common congenital disorder in newborn infants. Approximately 25 percent of children with congenital heart disease will require surgery or cardiac catheterization within their first year of life. Therefore, is imperative that pediatric cardiologists be connected to large, extensive medical facilities in order to have available all the special facilities, instruments, and personnel that are required to diagnose and treat heart diseases in children. The medical center should have full nursery facilities, including a neonatology section for the care of newborns and premature babies. It should have a surgical facility competent to deal with the special heart problems of children: Most children with heart disease will be treated surgically at some point in their lives. It should have a wide range of specialized instruments and skilled personnel for diagnosis and treatment.
Heart disease in adults usually involves the coronary arteries and defects in heart rhythms. It may surface in late youth, middle age, or old age, and is often attributable to or associated with lifestyle (a high-cholesterol diet, smoking, and/or stress) and disease (diabetes mellitus or high blood pressure). In children, however, the most common heart diseases are congenital (present at birth) or caused by infections such as rheumatic fever or Kawasaki disease. Approximately eight out of every 1,000 newborns have some form of congenital heart defect. Heart defects may become manifest in the womb, at birth, in infancy or childhood, or later in life.
In the hospital, the pediatric cardiologist has three major patient groups: inpatient neonates and infants; older inpatient children, who are usually in the hospital for surgery; and outpatient infants and children whose disease conditions are being monitored.
Proper diagnosis of the child’s condition is paramount to successful treatment. The cardiac examination begins with the physician’s first glance at the patient, during which he or she looks for signs of respiratory difficulty or cyanosis (a bluish tinge to the lips or fingertips). The physician will also measure the child’s heart rate and rhythm, blood pressure, and growth pattern.
The pediatric cardiologist has an array of diagnostic tools, including electrocardiography, echocardiography, and stress testing. The main instrument, however, is the stethoscope because many pediatric heart problems are most readily detectable through auscultation, listening to sounds of the body. The pediatric cardiologist must develop extraordinary expertise in detecting and analyzing heart sounds. He or she must learn to differentiate between abnormalities in heart sounds that are functional and benign and those that indicate a disease condition. Through the stethoscope, the physician will hear the heartbeat, murmurs, clicks, and other sounds. Differences in loudness, pitch, variability, and timing are among the factors that must be considered in the diagnosis.
The electrocardiogram, echocardiogram, and other instruments will confirm the diagnosis and help the pediatric cardiologist determine the best course of therapy for the child. Many surgical procedures are used to correct defects in the child’s heart: valves can be replaced or repaired, tissue can be repaired, narrow passages can be opened, and gross abnormalities can be corrected. The success rate of these procedures is excellent, but any heart operation is a major surgery with significant risks. The child who undergoes heart surgery must face a wide range of additional perils. Children with severe heart disease who are cured or significantly helped through surgery must be carefully monitored because there are sometimes postoperative residua (conditions that are partially or wholly uncorrected) or postoperative sequelae (conditions that develop as a result of surgery) and other complications of surgery.
This surveillance by the pediatric cardiologist and other members of the medical team must continue for years. Often, long after the operation, the patient may develop significant arrhythmias and other anomalies. Some of these patients will require implanted pacemakers to avoid sudden death. Some will develop new valvular problems, and some patients who were given prosthetic (artificial) valves may develop infections, blood clots, or obstructions at the site.
Pediatric cardiology has made great strides in maintaining life and improving the physical status of these children. As medical specialists, pediatric cardiologists are relative newcomers, the specialty being less than half a century old. Nevertheless, through their efforts and accomplishments, hundreds of thousands of men, women, and children are alive and well, who might otherwise be dead, impaired, or debilitated.
There is still a long way to go. Pediatric heart disease, involving as it often does the physical structure of the heart, would appear comparatively mechanical and straightforward. In fact, these conditions are enormously challenging because of the wide range of anatomic, hemodynamic, and electrophysical problems that they may entail.
Also challenging are the new avenues that have opened for the pediatric cardiologist. Infant heart transplantation, unheard-of a generation ago, is now possible, if not commonplace. The dramatic increase in the number of premature babies who are being kept alive and healthy involves the pediatric cardiologist as a vital part of the neonatal team. There are also constant, persistent efforts to improve the quality of care both for children requiring surgery and for those who can be helped by other means.
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