Pediatric Cardiology

Pediatric cardiology is a critical medical specialty that focuses on the diagnosis, treatment and follow-up of congenital or acquired cardiovascular diseases in all children and adolescents, starting from the heart development of babies in the womb until the age of 18. 

Ço What are the Areas of Interest in Pediatric Cardiology?

This specialty has a wide range of interests. Congenital structural defects include heart holes (atrial septal defect - ASD, ventricular septal defect - VSD), tetralogy of Fallot and valvular heart disease. Acquired heart diseases include rhythm disturbances, heart defects, heart failure, cardiomyopathies (heart muscle diseases), pulmonary hypertension, Kawasaki disease and rheumatic heart disease. Pediatric cardiology offers a seamless model of care from diagnosis to treatment and long-term follow-up of these diseases. The possibility of early diagnosis with fetal echocardiography and the specialists' role in the long-term follow-up of patients reveals that this discipline adopts a lifelong health management approach.  

What are the most common heart diseases in children?

Heart diseases in childhood can be divided into three main groups: congenital heart disease, acquired heart disease and heart rhythm disorders. These diseases are not limited to the heart, but can have a significant impact on a child's overall health and development. For example, babies with heart disease may have difficulty gaining weight and may experience growth retardation because they do not receive adequate nutrition. There may also be an increased risk of frequent lung infections.  

Congenital Heart Diseases (Congenital)

Congenital heart disease refers to structural abnormalities that occur during a baby's development in the womb and is the most common group of heart diseases in childhood. These anomalies can occur in the chambers, valves or large vessels of the heart. The course of heart disease in children is not static; it can change and progress dramatically from the fetal period through childhood and adolescence. For example, some congenital heart defects (small VSDs) can close spontaneously and Patent Ductus Arteriosus (PDA) is a vessel that should close naturally after birth.  

Non-Cyanotic Heart Diseases

In this disease group, although there is a hole in the heart, stenosis or defects in the vessels or valves, there is no obvious bruising (cyanosis) because the dirty blood does not enter the vücut circulation. Usually, signs of heart failure are in the foreground.  

• Atrial Septal Defect (ASD): is an opening in the wall between the heart's upper chambers (ear chambers). About 40% of small ASDs may close spontaneously by adulthood.  
  
• Ventricular Septal Defect (VSD): A hole in the wall between the lower chambers (ventricles) of the heart. 50-60% of small VSDs tend to close spontaneously by the age of 5 years.  
  
• Patent Ductus Arteriosus (PDA): A condition in which the vascular connection between the aorta and the pulmonary artery remains open, which should close after birth.  

Cyanotic Heart Diseases

In this group of diseases, due to structural defects in the heart, dirty blood is mixed with clean blood and sent to the body. This is manifested as bluish discoloration (cyanosis) of the skin and mucous membranes.  

• Tetrralogy of Fallot (TOF): Colloquially known as "blue baby disease", this is a complex congenital heart defect that combines four different heart defects: ventricular septal defect (VSD), pulmonary valve stenosis, ascending aorta and right ventricular hypertrophy (thickening).  
  

• Transposition of the Great Arteries (TGA): This is the displacement of the main arteries (aorta and pulmonary artery) from the heart. This is a life-threatening condition that requires urgent intervention.  
  
• Hypoplastic Left Heart Syndrome (HLHS): A serious congenital heart disease characterized by underdevelopment of the left side of the heart.  

Heart Valve and Vascular Stenosis

Strictures in the valves and vessels of the heart can cause various problems by making it difficult for the heart to pump blood.

Aortic Stenosis: A narrowing of the aortic valve.  

• Pulmoner Stenoz (Pulmoner Darlık): Akciğer atardamarına giden kapakta darlık olmasıdır.  
  
• Aortic Coarctation (AoCoA): A narrowing of the aortic artery, usually just after the arteries to the head and arms exit.  

Edited (acquired) Heart Diseases

 Another important group of childhood heart diseases are non-congenital, acquired conditions.  

• Rheumatic Heart Disease:This is a heart damage that develops after rheumatic fever caused by group A streptococcus bacteria. It especially affects the heart valves.  
  
• Kawasaki Disease:Also known as mucocutaneous lymph node syndrome, it is a disease that occurs in children and is characterized by fever and vomiting. It can affect the heart vessels, especially the coronary arteries. 
  
• Cardiomyopathies (Diseases of the Heart Muscle): These are structural and functional disorders of the heart muscle that can adversely affect the heart's ability to pump.  
   Dilated (Congestive) Cardiomyopathy:This is the most common type of cardiomyopathy. The contractile function of the heart is impaired.  
   Hypertrophic Cardiomyopathy:It is characterized by thickening of the ventricular muscles of the heart.  
   Restrictive Cardiomyopathy:The walls of the ventricles have become excessively stiff and their relaxation is restricted.  
• Heart Infections:
   Infective Endocarditis:Inflammation of the heart's innermost tissue and valves.  
   Myocarditis: It is an inflammation of the heart muscle. The most common cause is viruses.  
• Pericarditis:Inflammation of the membrane around the heart.  Ço;childhood Çnetwork Hypertension: This is a condition in which blood pressure is higher than normal and can also occur in children.  

Heart Rhythm Disorders (Arrhythmias)

Heart rhythm disorders are conditions in which the heart beats out of its normal rhythm and are commonly referred to as "arrhythmias". These disorders are caused by disruptions in the heart's electrical conduction system and can occur in congenital heart disease or in a structurally normal heart. Symptoms of arrhythmias in children include chest pain, feeling of not being able to breathe, palpitations, feeling tired, feeling faint, feeling faint, feeling faint, and feeling faint.It can manifest as darkening of the eyes, head dizziness, fainting (especially during sports) and attacks of nausea and vomiting.  

The main types of arrhythmia are:

• Tachycardia: A condition in which the heart rate is faster than normal.  
  
• Bradicardia: A condition in which the heart rate is slower than normal.  
• Other types include premature beats (extrasystole), cardiac arrest, block (e.g. grade 3 AV block), supraventricular tachycardias (SVT), Wolf-Parkinson-White syndrome (WPW), ventricular tachycardias (VT) and long QT syndrome (LQTS).  

What are the Symptoms of Heart Disease in Children?

Heart disease in children can present with a variety of symptoms that should be carefully monitored by parents and health professionals. The most common symptoms are shortness of breath and fatigue, which can be particularly pronounced during breastfeeding or physical activity. Bluish discoloration (cyanosis) of the skin and mucous membranes, especially the lips and the tips of the fingers and toes, and increased bruising when crying is also an important warning sign.  

Other important symptoms include palpitations and irregular heartbeat, fainting (syncope) and headaches, especially during sports or exertion. Heart disease can also lead to developmental problems in infants and children, such as growth retardation and failure to gain weight or malnutrition. Recurrent lung infections and swelling (swelling) in the vücut (legs, abdomen, chest) can also be a sign of heart problems. Excessive sweating, unexplained epilepsy or pain and swelling in the knees after a febrile throat infection (a symptom of rheumatic fever) should also be considered. While the majority of göaugh pain in children is benign, cardiac causes are rare but potentially dangerous (1-4%).  

When to Consult a Specialist?

If any of the above symptoms are recognized, it is of utmost importance to consult a pediatric cardiologist immediately. Furthermore, certain situations call for a proactive expert assessment:  

• Family history of heart disease: Early evaluation of children at risk due to genetic predisposition is important.  
  
• Regular check-ups: Especially if there is a known heart disease, the child should be followed up regularly by a pediatric cardiologist.  
  
• Pre-sports assessment: Heart health assessment of children who are going to play sports is a critical step in preventing potential risks.  
  
• Chance of cardiac involvement in children being followed for another disease: Since some systemic diseases may affect the heart, cardiologic evaluation should be performed in these cases.  

Pregnant women should be referred to a pediatric cardiologist when there is a suspicion of heart problems in the unborn baby (for fetal echocardiography). These conditions include congenital heart disease in the mother or father, diabetes or collagen tissue disease in the mother, giving birth to a baby with congenital heart disease in a previous pregnancy, digestive system in the baby, b & oThe detection of any abnormality such as breech, brain, too little or too much water in the baby, irregular heartbeat of the baby and multiple pregnancies.  

What are the Diagnostic Methods in Pediatric Cardiology?

Accurate diagnosis in pediatric cardiology is the basis for effective treatment planning. This process involves a combination of several modern diagnostic methods.

Detailed Öykü and Physical Examination

The pediatric cardiology examination begins with a thorough assessment of the child's general health and heart function. This first step involves obtaining comprehensive information from the parents about the child's medical history, symptoms and family history of heart disease. This is followed by a physical examination, which includes listening to heart sounds, checking the pulse, monitoring blood pressure, and assessing the child's general developmental status by taking height and weight measurements.  

Electrocardiography (ECG)

Electrocardiography (ECG) is a non-invasive test that detects rhythm disturbances by monitoring the electrical activity of the heart. By recording the electrical impulses of the heart muscle, it plays an important role in the diagnosis of arrhythmias, heart palpitations and other rhythm problems.  

Echocardiography (ECHO) and Fetal Echocardiography

Echocardiography (ECHO) is the cornerstone of the diagnostic process in pediatric cardiology. It is a radiation-free and painless visualization method that uses ultrasound waves to assess the structure (chambers, valves, valves, vessels, size) and function (pumping force, blood flow) of the heart. ECHO is used to diagnose a wide range of conditions such as perforated heart, valvular disease, cardiomyopathy, heart enlargement, pericardial fluids and tümörs.  

Different ECHO equations are tailored to specific clinical needs:

• Transthoracic Echocardiography: It is the most widely used type of ECHO. Sound waves are transmitted through the wall of the göğüs wall to visualize the heart's dört chamber, dört valve and nearby vessels.  
  
• Transözophageal Echocardiography (TEE): With a thin probe lowered through the mouth into the esophagus, the posterior neighborhood of the heart is accessed and clearer and more detailed images are obtained.  
  
• Stress Echocardiography: Assesses the performance of the heart during physical activity or exertion.  
  
• Color Doppler Echocardiography: Shows blood flow problems and pressures with color images.  
  
• 3D Echocardiography: It is used to provide multiple açrüntüsüsüntüsü of the heart, especially before heart valve surgery and to detect complex heart conditions in children.  
  
• Fetal Echocardiography: This is a special type of echocardiography used for early detection of congenital heart disease in the unborn baby. It is usually performed between 18-24 weeks of gestation and allows for treatment planning before delivery.  

Holter Monitoring

Holter monitoring is a test that allows a patient's heart rhythm to be continuously recorded for 24-48 hours. This method helps to detect transient or intermittent rhythm disturbances during daily activities.  

Heart Catheterization and Angiography

• Cardiac Catheterization: It is an invasive diagnostic method that allows the insertion of a thin catheter into the heart and blood vessels for detailed visualization of pressure, oxygen saturation and oxygen saturation in the heart.  
• Angiography: It is a visualization method used to determine the anatomical details of vascular blockages and congenital heart diseases by administering contrast material during cardiac catheterization.  

Other Screening and Laboratory Tests

Despite the central role of ECO, other diagnostic methods such as ECG, Holter monitoring, cardiac catheterization, angiography, X-ray and stress testing are also routinely used.  

Röntgen (chest X-ray): Used to assess the size of the heart and blood supply to the lungs.  
Exertion Test: Evaluates the performance of the heart during physical activity.  
Laboratory Tests: Laboratory examinations such as blood tests are also performed if necessary.  

What are the Treatment Methods of Heart Diseases in Children?

Monitoring and Treatment

Some mild heart problems require only regular monitoring and may resolve on their own over time. However, in some cases, medication may be needed. Drugs that regulate heart rhythm, control heart failure or stabilize blood pressure help relieve the child's symptoms and improve overall quality of life.

Interventional and Surgical Treatment Methods

Depending on the severity of the disease, more advanced treatment methods may be required. Interventional cardiology procedures involve catheterized procedures that usually do not require incisions. This can be used to close holes in the heart or dilate narrowed vessels. Cardiac surgery is performed for more complex structural disorders and is performed by pediatric cardiac surgeons in specially equipped centers.

Follow-up and Lifestyle Support

The treatment process is not limited to medical intervention. Family awareness, regular medical check-ups, balanced nutrition and proper planning of physical activities are also an important part of the process. When early diagnosis is combined with appropriate treatment, most children can lead a healthy life.