Children shouldn’t die. Especially from the heart. This is ridiculous to say the least. And scary. It’s a real shock for me. In the last almost 20 years, being exclusively medical, I have never touched on heart disease in children. It turns out that over the past two decades, the prevalence of all pathological conditions with heart damage, with the exception of rheumatic ones, has significantly increased in Russian children. And today it has reached 3.7% in the country’s population – among children aged 0 to 14 years old and 6.5% – among children aged 15-17 years.
But this problem, according to experts, is quite common: “heart disease develops even in babies.” Why exactly in the last 20 years have heart diseases in children started to grow so rapidly, and in all age groups? Deviations from the norm are detected even in utero. And where to look for a way out of this situation?
Answers to these and many other questions were given in an interview with MK by the chief pediatric cardiologist of the Ministry of Health of the Russian Federation, scientific director of the Scientific Research Clinical Institute of Pediatrics named after Academician Veltischev of the V.I. Pirogova, President of the Association of Pediatric Cardiologists of Russia, Professor Maria SHKOLNIKOVA.
“Sudden death syndrome can be prevented”
– Maria Alexandrovna, what is happening with our children? Why have they had such a surge in heart disease in recent years?
– In general, cardiovascular diseases (CVD) have been the main cause of death and one of the main causes of morbidity in most countries of the world for many years. Russia is no exception. We are witnessing an ever earlier onset of many diseases in children that were recently considered adults: arterial hypertension, atherosclerosis, dystrophic changes in the myocardium … Moreover, about 40% of heart diseases in children have a long course. Carditis and cardiomyopathies, pulmonary arterial hypertension, life-threatening hereditary heart rhythm disturbances, familial hypercholesterolemia and a number of other diseases make their debut in childhood and can accompany a person throughout his life.
But if the disease is detected as early as possible and modern treatment technologies are applied, the prognosis will improve many times over. And if left untreated, most of these diseases will lead to early disability. And I would not talk about a surge in the incidence rate, although statistically it looks like that. The reason for the increase in the number of children with diagnosed heart diseases is largely due to the dramatic improvement in diagnostics in Russia.
– Heart disease in adults is in the first place among all deaths in our country. Now it turns out that there are big problems with a child’s heart. What do these percentages mean: 3.7% among children aged 0-14 and 6.5% among children aged 15-17?
– We are talking about the number of identified and registered diseases of the heart and blood vessels in children in Russia. Growth statistics are due to the fact that in recent years, the diagnosis of these pathologies has become more accessible and more perfect: ECG, Holter monitoring, ultrasound and MRI of the heart, stress tests, etc. or for complaints. Now an ECG is taken for each child at 1 year old, at 6 years old and then 3 more times up to 18 years old; Ultrasound of the heart is done in the first month of a child’s life and at 6 years old. And in general, Holter was previously prescribed only after the detection of diseases, and only in hospitals. Today it is a routine examination method in polyclinics.
Therefore, more often in our days, they began to identify heart diseases in children. In adolescents, for example, today we register two times more such diseases than in 1999. But all this against the background of a decrease in mortality from diseases of the heart and blood vessels in children, since not only the diagnosis has improved, but new possibilities for therapy and surgery have also appeared.
– Is it a lot or a little in absolute terms?
– That’s a lot. In figures, the statistics looks like this: about 460 thousand people under the age of 14 with heart diseases are now registered with pediatric cardiologists and about 130 thousand – at the age of 15-17 years. A total of 1 million 300 thousand such children are registered. And these are only registered patients. In fact, there are more of them.
– Are the reasons for such frequent heart failure in children known today? Are genetics, parents’ lifestyle to blame?
– Both. In addition, infections suffered by the child, as well as neurocirculatory functional disorders (formerly called vegetative vascular dystonia), have a great influence on the health of the child’s heart. Violations of neurovegetative regulation in children can be manifested by cardiovascular, respiratory disorders, poor stress tolerance and physical exertion. Such conditions in children can occur due to, among other things, excessive workload in school, emotional and mental overload. By the way, increased blood pressure and heart rhythm disturbances were increasingly noted.
Certainly, in the formation of heart diseases in children, and especially in adolescents, there is a fault and some parents, their way of life. Especially dangerous in this sense are smoking, alcohol, unhealthy diet, which leads to obesity. Willy-nilly, children copy models of family behavior and with age, like their parents, fall into risk groups. Therefore, it is very important that future parents give up bad habits even before the appearance of an heir in the family.
There is such a thing as sudden infant death syndrome. So the “chance” of suffering from this syndrome is several times higher in children if a woman, being pregnant, smoked or drank alcohol. In addition, in children who have experienced the influence of these harmful factors in utero with their mother, not only the heart, but also the nervous system and other organs can suffer. For example, morbidity and mortality from diseases of the circulatory system in children grows more rapidly from the age of 12. And starting from the age of 15, mortality from all cardiovascular diseases overtakes the rest, with the exception of perinatal ones, and grows exponentially (increasing).
From 40-50 years of age, diseases of the circulatory system become the main cause of death in Russia.
“The coronavirus does not spare even babies”
– It is known that the elderly and children are more difficult to tolerate any virus. How dangerous is COVID-19 for children with heart disease?
– A significant part of childhood diseases of the heart and blood vessels is inflammatory lesions of the myocardium. At the same time, heart failure progresses, heart rhythm and conduction disturbances, and even sudden death are possible. The peculiarity of SARS-CoV-2 is that it is a trigger (trigger) for the development of many pathological conditions in the body. Also, this infection can be accompanied by heart damage in children. There are no clear statistics on this yet. But it is known that babies can become infected even in the first hours after birth, with all the ensuing consequences.
A new infection can provoke the development of Kawasaki syndrome in children. This is an insidious disease, complicated by the appearance of aneurysms of the coronary arteries. Subsequently, the child may even need coronary artery bypass grafting. Therefore, during a pandemic, children with any heart pathology require special attention.
– This means that there are no councils for COVID-19, which, among other things, can affect the heart of a child. Or did they find salvation somewhere in the world? What are the chances of recovery from this virus in Russian children?
– There is still little experience in treating children with heart disease who are also affected by the new virus, both in the world and in Russia. In Russia and the United States, for example, they began to maintain registers of children who fell ill with Kawasaki syndrome against the background of coronavirus. The Ministry of Health of the Russian Federation has also developed recommendations for the treatment of coronavirus infection in adults and children. But the main thing with covid lesions is early diagnosis. And this depends not only on doctors, but, first of all, on parents. It is relatives and friends who can be the first to notice the symptoms characteristic of this virus in sick people: a steady rise in temperature, severe weakness, shortness of breath, etc. But the diagnosis must be made by a pediatrician. It is important not to miss the disease early.
“Hereditary factors are visible already in childhood”
– Maria Alexandrovna, what place do you assign to the prevention of heart disease in children? Which ones are the most insidious? And how realistic is it to warn them?
– In children, in the first place among heart diseases – congenital heart defects (25% of all CVD); on the second – arrhythmias or cardiac arrhythmias (18–20%). At the same time, in contrast to adults, in children, rhythm disturbances are mostly formed in the absence of organic damage to the heart, that is, in the intact myocardium. The majority of arrhythmias in children are caused by hereditary pathologies, disorders of neurovegetative regulation of heart rhythm, and other functional, potentially correctable, disorders.
– What does “potentially fixable” mean? Can such diseases be cured?
– It has been proven that in the last three decades of the twentieth century, blood pressure control, new surgical methods and effective drugs have helped to dramatically reduce mortality from CVD in adults in most countries of the world. Today is the time when more attention should be paid to the treatment and prevention of cardiovascular pathology in children. It is often during childhood that the foundations of many heart diseases are laid. And even hereditary factors in the formation of cardiovascular pathology in most cases should be established already in childhood.
It is extremely important from the point of view of preventing CVD in the general population, as I have already mentioned, the prevention of the main behavioral risk factors, first of all in parents, and then in growing offspring. Improper diet, alcohol abuse, physical inactivity, etc. If these harmful factors are eliminated in childhood, then in the next generations more Russians will lead a healthy lifestyle and significantly improve their heart health.
– There is evidence of an increase in rare heart disease in children. What are we talking about? What is the reason? And what are the most dangerous heart diseases in children?
– Many rare (orphan) diseases of the heart and blood vessels are caused by gene mutations and manifest in childhood. Untimely diagnosed, in adulthood they are accompanied by a large number of complications and often have an extremely poor prognosis. And this is pulmonary arterial hypertension, familial hypercholesterolemia, hereditary life-threatening arrhythmias, hereditary cardiomyopathies and a number of others. They should be identified as early as possible, then the consequences will be minimized. And without treatment, they will lead to early disability and premature death.
At an early age, congenital heart defects predominate, and mortality from them is the highest in the structure of mortality from diseases of the cardiovascular system in children. Therefore, it is also necessary to diagnose these defects as early as possible, starting from the prenatal period. Today in the world with timely diagnosis and adequate treatment, more than 85% of children born with congenital heart defects live to a ripe old age. Along with congenital heart defects, cardiac arrhythmias are taking the leading positions.
A lot has already been done in Russia to treat these diseases.
– So, heart disease in children can become chronic?
– Of course. About 40% of heart diseases in children acquire a long course. Carditis, cardiomyopathies, pulmonary arterial hypertension, hereditary heart rhythm disorders, familial hypercholesterolemia and a number of others make their debut in childhood. All patients with these pathologies require long-term observation, treatment and rehabilitation. Children who have undergone extensive surgical interventions on the heart, as well as those with implanted pacemakers and cardioverter-defibrillators, also need long-term treatment.
All these patients must be registered with pediatric cardiologists. If serious pathologies in children are not diagnosed in time, if treatment is delayed, this will inevitably lead not only to an increase in the number of chronic patients and invalids in older age groups, but also to death “from the heart” at a young age.