The Medical Minute: When is a visit to a pediatric cardiologist in order?

Johnny was in the front of the pack when running laps in gym class last fall, but this spring, he’s winded easily and lagging behind. Mary tells her mom that her heart is “beeping.”

These changes may turn out to be no cause for concern, but parents shouldn’t ignore sometimes subtle warning signs of a structural heart defect or heart condition.

“Although 80-85% of structural heart defects are often caught before or at birth, some don’t present themselves until later, so it’s important to tell your child’s pediatrician or family doctor about any changes you or your child notice,” said Dr. Stephen Cyran, pediatric cardiologist with Penn State Health Children’s Heart Group. “Unlike adults who often self-refer to a cardiologist, the referral to the pediatric cardiologist almost always comes through the pediatrician or family physician.”

The top three reasons for referral to his office are a heart murmur, dizziness/passing out and chest pain. Evaluation is necessary to make sure nothing is missed that could become life threatening, Cyran said.

Causes vary

That “beeping” that Mary noticed could be a tip off for an irregular heart beat because she was born with an extra electrical connection in her heart, a condition called Wolff-Parkinson-White syndrome. While episodes of fast heart beating usually aren’t life-threatening, over time they can damage the heart. Finding them early can lead to preventative treatment, Cyran said.

In Johnny’s case, exercise intolerance could be an early sign of atrial septal defect – a hole in the wall between the two chambers of the heart – which may show itself later in childhood with a murmur, which is an extra sound when listening via stethoscope. Any needed treatment depends on the size of the opening.

Dizziness or passing out associated with exercise, however, is a major red flag for an inherited condition called hypertrophic cardiomyopathy and requires immediate attention.

“You often hear about this happening to high school athletes when football practice starts up in the fall,” Cyran said. “If this happens even once, your child should be restricted from physical exercise until evaluation.”

It’s less likely that chest pain signals an underlying heart condition. Often, this is muscular in nature – akin to what used to be referred to as “growing pains,” he said.

Warning signs for babies

Unrecognized heart conditions in babies may present with these warning signs, which should always be taken seriously and discussed with baby’s doctor.

• Blueness of the lips in an otherwise warm environment
• Sweating during feedings – eating is one of baby’s biggest stress tests
• Changes in feeding behavior, such as going from taking 2 ounces of milk in 15 minutes to 2 to 3 ounces of milk in 45 minutes.

Family history important

Family history of high cholesterol, early heart attacks and pacemakers can be significant when anticipating risk for heart conditions, Cyran said.

“If Granddad died at age 35 while running, he probably had an irregular heartbeat due to hypertrophic cardiomyopathy. These types of historical facts should make any parent, coach or physician concerned,” he said.

A strong family history of heart attacks before age 60 could be a tip off for familial hypercholesterolemia, or high cholesterol. In that case, cholesterol screening should begin between ages 4 to 7, Cyran said. Otherwise, the American Academy of Pediatrics recommends screening for elevations in cholesterol between ages 9 and 12.

Check-ups are key

“Regular health maintenance exams are so important because they can detect a new murmur, change in heart rate or high blood pressure,” he said. “We know that blockages in blood vessels to the heart and brain start when kids are 2 and 3 years old, so it’s never too early to be thinking about addressing these factors.”

Cardiologists can work with young patients to help them adopt a more active lifestyle and healthier eating habits, or direct the use of statins when those changes aren’t enough to lower cholesterol, he said.

Healthier futures ahead

In the past 10 years, a whole new field of adult congenital heart disease has opened up, thanks to dramatic advances made in identifying structural heart defects before and at birth that lead to longer life, Cyran said.

“The beauty of Penn State Health is that we have the full breadth of providers’ expertise here – from before birth through pediatrics to adult care,” he said. “This allows us to plan forward for the best care possible and much longer into adulthood than ever before.”

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• Penn State Health Children’s Heart Group

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