Children and adults with congenital heart disease are at an increased risk of having a heart infection. Whilst this is rare the chances of it occurring can be reduced by taking precautions.
Infections in the heart can occur for no apparent reason but are more common if the teeth are rotten. Germs spread into the blood stream and infect the heart. Good dental hygiene is therefore important as are regular visits to the dentist.
If dental treatment is required then some procedures can cause germs to spill into the blood and infect the heart.
It is therefore important that the dentist is informed about the heart condition before treatment. The usual method of avoiding this problem is to give a single dose of antibiotics one hour prior to the treatment to kill any germs beforehand.
Children who have Kawasaki Disease with persistent coronary artery problems are restricted to light exercise (like golf, cricket). Exercise is important even in those with heart disease. It improves the heart function and general sense of well being. It is associated with increased life expectancy and a reduced risk of heart disease in later life. In addition physical activity helps with controlling weight and reducing blood pressure.
There are different types of exercise. In static exercise the muscles contract but there is little joint movement eg weight lifting. In dynamic exercise the muscles contract and also move the joints eg running. Each places a different stress on the body and cardiovascular system. In general most types of sports are a mix of the two.
Children usually take part in more rigorous exercise at school as they grow older. In Singapore, physical education (PE) tends to teach games skills rather than competitive sports. However, pupils may take sports for their co-curricular activities (CCA), where training is more intense and competitive. Training for the NAPFA test is also intensive, and some pupils with heart problems may have difficulty with the 2.4km run as they often do not perform as well at endurance-type activities.
As always, parents should seek the doctor's advice when deciding how much exercise is safe and to what level. This is particularly as there are no published guidelines for activity levels in children.
However some children with an immune deficiency (DiGeorge syndrome or an isomerism), and those who are receiving immunosuppression, for example following transplantation, require a different vaccination schedule.
Before travelling anywhere unusual or a long distance make sure that your child has:
- Had a recent medical check up
- Appropriate insurance cover
- Adequate supply of medicine
- Acess to quality local health care in your destination country
- Relevant documentation about their heart condition
Those with cyanotic heart disease ("blue" due to reduced oxygen in the blood) can still travel, but aircraft at altitude have less oxygen in the air than at ground level and so the blueness may be more apparent. This does not usually cause symptoms but if necessary, airlines can arrange for additional oxygen to be available on the aircraft.
For long aircraft flights, it is sensible to use the support stockings and take aspirin or an equivalent unless your doctor advises against it.
Special diets are not normally necessary for those with heart disease. As with everyone, it is important to have a balanced diet and not to eat to excess. It is however important to maintain a normal weight - excess weight means more work for the heart.
Most children with heart disease are no more prone to infections than any other children. Some however are likely to get chest infections - particularly those with holes in the heart (ASD, VSD, PDA).
In addition, some heart diseases are also associated with an immune deficiency and infections, and therefore are more common. The majority of childhood infections are viruses and get better without antibiotics. In any case of doubt, professional medical help should be sought and the doctor will decide if antibiotics are necessary.
Most children with heart disease do not require medication. Some however need them to:
- Reduce the body fluids
- Assist the pumping action
- Control rhythm problems
- Thin the blood
The majority of these medicines have been used for many years and are very safe, but like all drugs, side effects may occur. This is especially if there is another illness or a change in other medication. If unusual symptoms or side effects occur whilst on medication, it is important to inform the doctor immediately.