Although they represent a small percentage of overall pediatric disorders, cardiac problems in children affect a vital organ and therefore require special attention from doctors and parents. In Italy, the quality of neonatal and pediatric screening allows for the early detection of most anomalies and their effective management, ensuring young patients receive timely and safe treatment.
We talked about it with Dr. Cecilia Del Vecchio, a specialist in pediatric cardiology who collaborates with the Salus Institute of Genoa, the Centocannoni Radiology Studio of Alexandria and the Newima Radiology Studio from Acqui Terme. The doctor explained the main childhood heart conditions, how to recognize their symptoms, and when it might be appropriate to consult a specialist.
Heart problems in children can be divided into two main categories: congenital heart disease, present at birth, and acquired heart disease, which develops later, often due to infections or inflammation.
In congenital heart disease, the heart develops differently from normal during the fetal period. This can lead to small anomalies, such as a hole in the wall separating the heart chambers, or more complex defects involving valves or blood vessels. Acquired heart disease, on the other hand, results from inflammatory processes such as myocarditis and pericarditis, caused by common viruses or bacteria that, in some cases, can also affect the heart.
Thanks to early diagnosis and collaboration between pediatricians and cardiologists, most of these situations are managed effectively, reducing the risk of complications.
Congenital heart defects result from abnormal heart formation during pregnancy. The most common forms are atrial septal defects (holes between the atria), ventricular septal defects (holes between the ventricles), and certain valvular anomalies, such as pulmonary or aortic stenosis. The most common abnormalities also include the persistence of the ductus arteriosus, a tube that should close after birth.
The causes aren't always identifiable: in most cases, they're genetic abnormalities, but family factors or problems during pregnancy can also contribute. Prenatal testing and fetal ultrasounds now allow for early detection of many of these malformations and treatment planning even before birth.
Acquired heart disease, on the other hand, develops after birth and affects a structurally healthy heart. Unlike in adults, it is not linked to unhealthy lifestyles but to viral or bacterial infections that can inflame the heart muscle (myocarditis) or the pericardium (pericarditis). In most cases, these are mild forms, but sometimes they may require prolonged monitoring to prevent complications.
Heart murmurs in children are a very common finding during pediatric visits. They are an additional sound heard during auscultation, but they do not automatically indicate a medical condition. In many cases, these are innocent or functional murmurs, not indicative of structural defects and requiring no treatment.
The cardiologist prescribes an echocardiogram, a noninvasive test that allows visualization of the heart's structure and function. Most children, including newborns, experience transient murmurs that disappear as they grow. Only rarely does a murmur indicate a heart abnormality, such as a septal defect or a malfunctioning valve.
Pediatric heart failure is a condition in which the heart fails to pump blood adequately. The main causes are significant congenital heart disease or arrhythmias that cause the heart to beat too rapidly, especially in newborns.
When the heart is forced to work under abnormal conditions, it can fatigue and reduce its efficiency. In these cases, it is essential to intervene quickly to restore a normal heart rhythm and promote recovery of function.
Symptoms of heart problems in children vary depending on age. In newborns, the main signs are difficulty finishing feedings, fatigue during breastfeeding, slow growth, and labored breathing.
In older children and adolescents, warning signs may include a rapid or irregular heartbeat, chest pain, fainting, or abnormal fatigue during exercise. However, many of these symptoms may not be related to heart disease. Therefore, it's important to always discuss them with your pediatrician first.
The pediatrician is the key person for recognizing any heart problems, because they know the child and can notice changes in behavior or growth. A newborn who isn't feeding well, a child who tires easily, or a teenager who reports palpitations should be carefully evaluated.
When the pediatrician suspects an anomaly, he or she refers the family to a pediatric cardiology clinic, where the necessary in-depth tests are performed.
The diagnosis of heart problems in children is based on a combination of clinical examination and instrumental tests.
The examination allows us to listen to heart sounds and identify any murmurs. An electrocardiogram (ECG) analyzes the heart's electrical activity, while an echocardiogram uses ultrasound to safely assess its structure and function.
If arrhythmias are suspected, a Holter monitor may be ordered, which records the heart rhythm for 24 hours or more. In young people who participate in sports, a stress test can assess the heart's response to physical activity.
When necessary, advanced tests, such as magnetic resonance imaging or cardiac CT scan, are used to analyze the morphology of the heart and vessels in detail.
It is advisable to contact a pediatric cardiologist when the pediatrician detects a persistent murmur, if the child shows difficulty breathing or growth, or in the presence of episodes of fainting, palpitations, or unexplained fatigue.
Timely diagnosis is crucial: a condition identified and treated promptly can be completely resolved, while a delayed diagnosis can make the process more complex. Thanks to advances in pediatric cardiology, most heart diseases can now be successfully treated, allowing children to live full and happy lives.
