Heart Disease In Children And During Pregnancy

Categories: Uncategorized
Sources: Disturbances Of The Heart

A common characteristic in a large proportion of middle-aged or old

patients with heart disease is the presence of degenerative changes

in the myocardium, the valves, or the arteries of the heart. In

children, on the other hand, the most common disturbances of the

heart are acute inflammations affecting its different structures,

and due in most instances to acute infections. Myocarditis and

endocarditis occur frequentl , and pericarditis occasionally. As in

adults, rheumatism is the most common cause of inflammation of the

structures of the heart, but rheumatism causes inflammation of the

heart much more frequently in children than in adults. Besides this

infection, the most frequent causes of inflammation of the heart in

children are diphtheria, scarlet fever, typhoid fever, measles and

influenza, with the frequency, perhaps, in the order named.

Diphtheria frequently gives rise to myocarditis, which results in

dilatation of the heart. This may occur in the second or third week

of the course of the disease, and even up to the eighth and tenth

week from the beginning of the disease. The myocarditis due to

diphtheria is not always the cause of sudden death occurring during

the disease, as such a fatal result may be due to paralysis of

nervous origin. In scarlet fever, inflammation of the heart may be

due directly to the poison of the disease, or it may be secondary to

a nephritis which is so frequent a complication of scarlet fever. It

is probable that the inflammation of the skin in scarlet fever,

preventing normal secretion, may be a cause of a sometimes increased

blood pressure and also of the nephritis, both of which conditions

may predispose to the cardiac complication. Erysipelas may cause

acute inflammation of the heart, perhaps for the same reason.



A certain proportion of cardiac diseases in children, especially

endocarditis, seems to be due to a general septic infection which

results in the so-called septic, infectious or malignant

endocarditis. There is sometimes a tendency in certain children, and

perhaps in certain families, for the heart to become readily

infected during an infectious disease, more than in other children

who suffer from the same disease. Sometimes the heart becomes

inflamed in rheumatic children without any joint affection

occurring; the inflammation in the heart may be the only

manifestation of the disease.



This etiology of cardiac affections of children indicates the

directions in which therapeutic efforts should be aimed. In children

who are under the more or less constant care of the family

physician, the possibility of the occurrence of some cardiac

affection should be borne in mind, especially in children in

families which are known to be affected with what may be called a

rheumatic diathesis--families in which several members have suffered

from rheumatism. It is reasonable to suppose that children who are

delicate and feeble, who do not have sufficient fresh air, who do

not take sufficient exercise, and who are not properly fed are more

liable to be affected with cardiac complications in the presence of

infectious diseases than children who have had plenty of fresh air,

an abundance of exercise and a sufficient amount of proper food.



At the present day it is hardly necessary to insist on the

importance of giving every child an adequate amount of fresh air. It

is possible, however, that this gospel has been overworked, and it

is not infrequently necessary to caution some parents that there is

danger of impairing their children's health by too much exposure.

The old ideas of the influence of exposure to cold and dampness in

the production of rheumatism have not yet been so far abandoned that

we can entirely neglect the possibility of rheumatism being

developed, at least, by the exposure to cold winds and dampness of

children who are otherwise predisposed to this disease. It is

possible that the enormously increasing number of children with

adenoids and enlarged tonsils, who need operative measures for their

removal, may have these conditions aggravated by too much exposure

to the inclemency of variable, harsh weather.



It is not necessary to state that proper exercise develops the

heart, as it does all the other muscles; but at the same time it is

necessary to caution parents against allowing their children to

indulge in too violent and too prolonged exercise. Young children

probably stop often enough in their play not to overwork their

hearts. Older boys and girls, especially boys, are inclined to take

too severe athletics, such as long-distance running, competitive

rowing, violent football and rapid cycling. It should be emphasized

to school-masters, gymnasium teachers and athletic trainers that a

boy who is larger than he should be at his age has not the

circulatory ability that the older boy of the same size has. The

overgrown boy has all he can do to carry his bulk around at the

speed of his age and youth. The addition of competitive labor

overreaches his reserve heart power, and he readily acquires a

strained, injured heart. On the other hand, moderate indulgence in

walking, baseball, swimming, rowing and golf should be commended. It

is not exactly the exercise that does him the harm, it is the

competitive element in it. Until a boy is well developed in his

internal reserve strength, he should not compete with other boys who

are better developed. His pride makes him do himself injury.



Dietetic fads are so prevalent today that there is danger that many

children will not receive an adequate amount of nutriment, that they

will be fed an excess of such foods as are likely to produce damage

to their constitutions, or that they will be given food which does

not contain all the different elements of nutrition to satisfy their

economy and their growth. While it is now generally acknowledged

that an excess of meat is not beneficial to any one, on the other

hand a moderate amount is necessary for individuals who are working

or are mentally active, especially for growing children. Also a too

great limitation of the child's diet to farinaceous foods, and

especially the allowance of too much sugar and sugar-producing food,

is liable to encourage the development of rheumatism. A mixed diet,

not excessive in amount, and prepared so that it will be digested

without difficulty, is most useful, and it should include in

suitable proportions meat, milk, eggs, vegetables, starches and

fruit. These should all be taken at regular intervals, thoroughly

chewed, and should not be taken in excess.



If a child has had an attack of heart inflammation, a myocarditis or

an endocarditis, greater care should be taken of him not only when

he is well but especially when he becomes ill of any other disease.

If the child has had a rheumatic inflammation of the heart, or has

had rheumatism without such a complication, it is considered by some

clinicians wise to give a week's treatment with salicylates at

intervals of three or four months, for two or three years, perhaps.

It is hard to determine how much value this prophylactic treatment

has. If the child's surroundings cannot be changed and lie is

subjected to the same conditions of possible reinfection, it may be

a wise precaution, much like the prophylactic administration of

quinin in malarial regions. If a child has developed a cardiac

inflammation during any disease, the treatment is that previously

outlined.



An important part of prophylaxis and treatment of a cardiac

affection during the course of any disease is the prevention of

serious anemia. During sickness the patient is liable to become more

or less anemic, but the administration of iron, in the manner

previously suggested, during the course of the disease, and

especially during rheumatism, will prevent the anemia becoming rapid

or severe.