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Cardiovascular disease in children and youth

Types of heart disease observed in children and adolescents

 

 

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Congenital heart disease

Congenital heart disease (CHD) is the type of heart disease that a baby is born with.  In reality, it is a defect, or abnormality of the heart or blood vessels near the heart, and not a disease, so many people use the term “congenital heart defect”. The majority of children born today with CHD will survive and with proper treatment be able to lead a normal or near-normal life.  Some kinds of CHD are mild and may not be diagnosed in infancy. Other types of CHD are severe and will be diagnosed soon after birth.  Some will also be diagnosed in prenatal screening. Examples of CHDs are:

  • Atrial septal defect (a hole between the upper 2 chambers of the heart).
  • Ventricular septal defect (a hole between the lower 2 chambers of the heart).
  • Coarctation of the aorta (the main artery leaving the heart [aorta] is constricted).
  • Transposition of the great arteries (the 2 large arteries leaving the right and left sides of the heart are switched).
  • Tetralogy of Fallot (a complex condition involving several structural defects).


Acquired heart disease

This type of heart disease is not present at birth.  Two major types of acquired heart disease in children are rheumatic heart disease and Kawasaki disease.

Rheumatic heart disease

  • Rheumatic heart disease is the most common acquired heart disease in many countries of the world, especially in developing countries.
  • It is a condition where the heart muscle and heart valves are damaged due to rheumatic fever.
  • Rheumatic fever is caused by streptococcal bacteria, and usually begins as a consequence of strep throat in children that were undiagnosed or were not treated or undertreated.
  • The global burden of disease caused by rheumatic fever and RHD currently falls disproportionately on children and young adults living in low-income countries and is responsible for about 233,000 deaths annually.
  • At least 15.6 million people are estimated to be currently affected by RHD with a significant number of them requiring repeated hospitalization and, often unaffordable, heart surgery in the next five to 20 years.
  • The worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and indigenous populations of Australia and New Zealand.
  • Up to 1 per cent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region, and Latin America show signs of the disease.
  • Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by treatment of acute throat infections caused by group A streptococcus. This is achieved by up to 10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.
  • People who have had a previous attack of rheumatic fever are at high risk for a recurrent attack, which worsens the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever is known as secondary prevention. This involves regular administration of antibiotics, and has to be continued for many years. Secondary prevention programmes are currently thought to be more cost-effective for prevention of RHD than primary prevention and may be the only feasible option for low- to middle-income countries in addition to poverty alleviation efforts.
  • Surgery is often required to repair or replace heart valves in patients with severely damaged valves, the cost of which is very high and a drain on the limited health resources of poor countries.

Kawasaki disease

  • Kawasaki disease is characterized by fever, rash, swollen hands and feet, bloodshot eyes, swollen lymph nodes, a strawberry appearance to the tongue, and an acute inflammation of the blood vessels, especially the coronary arteries.
  • Its cause is unknown but may be some kind of infectious agent.
  • Occurs in young children – 80% or more are less than 5 years old, and occurs more in boys than in girls.
  • Kawasaki disease is most common in Japan, but has been seen in virtually every country in the world and is the leading cause of acquired heart disease among children in developed countries.
  • In some children, especially those who are undiagnosed or untreated or not treated soon enough, serious heart damage can occur.

Other heart disease types

Other heart disease types that have been observed in children, but that are also seen in adults, include Chagas disease – a parasite borne infection that primarily affects rural populations in low-income countries –, cardiomyopathy and infectious endocarditis.  Children can also develop abnormal heart rhythms, especially those with certain kinds of CHD.  

Childhood overweight/obesity can lead to heart disease risk in later life

Risk factors for CVD are determined to a great extent by behaviours learned in childhood and continued into adulthood – such as dietary habits.

Childhood and adolescent overweight is one of the most important current public health concerns.

  • The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings.
  • Overweight and obese children and adolescents are likely to develop a number of precursors for CVD, such as type-2 diabetes, hypertension, dyslipidemia and the metabolic syndrome.
  • There is strong evidence that an epidemic of childhood obesity has led to a significant increase in the prevalence of cardiovascular risk factors, which, if left unchecked, is likely to lead to an epidemic of premature CVD.

The burden of childhood obesity

  • Worldwide, one in 10 school-aged children are estimated to be overweight .
  • Globally, in 2010 the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries.
  • Childhood obesity is already an epidemic in some areas and on the rise in others. For example, in the USA, the number of overweight children has doubled and the number of overweight adolescents has trebled since 1980.

Environmental factors contributing to childhood obesity
Societal changes associated with economic growth, modernization, globalization, as well as changes in nutrition habits across the world, are driving the obesity epidemic.

  • Many factors are fuelling the obesity epidemic in children, such as increased consumption of energy-dense, high-calorie foods and drinks, and decreased physical activity.
  • Schools have a very important role in preventing obesity by providing more nutritious food, offering greater opportunities for physical activity, and providing obesity-related health services6.
  • Some countries, such as the UK, are taking action to ban advertising of high fat, salt and sugar products during or around programmes made for children, or that are likely to appeal to children, due to the link between food advertising and childhood obesity.