In the Pediatric Cardiology Department, diagnostic and therapeutic services are offered for cardiac problems of fetus, infant, minor child, child and adolescent (until age of 18 years).Most common pediatric cardiac diseases include congenital heart diseases (hole, stenosis), acquired heart diseases (rheumatoid valve diseases, infectious diseases) and cardiac rhythm disorders.

The baseline complaints of our patients often include murmur, cyanosis, poor exercise capacity, chest pain, palpitation, dizziness, syncope or high blood pressure.The diagnosis is usually made with diagnostic methods such as electrocardiography (ECG), telecardiography and echocardiography (ECHO).Heart of fetus can be assessed with fetal ECHO during intra-uterine life.If necessary, other methods are used including but not limited to exercise test, HOLTER monitoring, cardiac catheterization and angiography.Moreover, children who are doing sports should be assessed for the risk of heart disease.Please see following titles for further details.

STRUCTURE OF HEART

The heart consists of four chambers.The upper chambers are called atrium where veins drain into, while lower chambers are called ventricle that pumps blood to the body.The wall between two atria is septum. Congenital holes on this wall are called atrial septal defect (ASD).The wall between two ventricles is ventricular septum. The holes on this wall are called ventricular septal defect (VSD).

The valve between right atrium and right ventricle is called tricuspid valve, while the valve between left atrium and left ventricle is called mitral valve.The great artery originating from the right ventricle is pulmonary artery and it pumps oxygen-poor venous blood to the lungs.The great artery originating from the left ventricle is aorta and it pumps oxygen rich arterial blood to the body.Pulmonary valve is located between right ventricle and pulmonary artery, while aortic valve is located between left ventricle and aorta.

FUNCTION OF HEART

A child's heart usually beats 100.000 to 150.000 times a day.It depends on the child's heart rate.Heart rate is modified according to needs of the body. Heart rate slows down when the child falls asleep, as body's oxygen need decreases, but the heart rate accelerates when the child moves and does exercise, as the body needs more oxygen.For some cardiac rhythm disorders, heart rate may be too slow or fast.

WHAT SHOULD THE CHILD WITH CONGENITAL HEART DISEASE WATCH FOR?

It should be remembered that there are various types of congenital heart diseases and each disease may require specific supervision.However, general measures are mostly similar. The child should use antibiotic for some specific interventional conditions to prevent the heart from infection (infective endocarditis).The primary physician should inform the family above the conditions that require prevention and dose and duration of antibiotic treatment and the families should be given “Infective Endocarditis Prevention Guideline" (seeInfective Endocarditis).

Most children with congenital heart disease do not require restriction of activity.On the contrary, sports and physical activity should be encouraged in order to psychologically support the children and improve cardiac performance.For some diseases, activities requiring strenuous effort such as “contest" are forbidden. These conditions should necessarily be determined by the pediatric cardiologist and the child should not be needlessly kept away from sports.These measures should be determined according to type and severity of the disease.Those children are encouraged to do less strenuous activities.

SYNCOPE IN CHILDREN

Temporary loss of consciousness as a result of sudden decrease in blood flow to the brain is called syncope.It is common in healthy children and adolescents.Half of children who reached adolescence have fainted at least once.It doesn't indicate a serious condition although it is scary for the family.“Simple syncope" (vasovagal syncope) develops secondary to activation of autonomous nervous system and accounts for a substantial part of all syncope cases in childhood.This type of syncope is mostly provoked by sudden-onset severe pain, severe anxiety, serious excitement, standing still for extended period of time, sight of blood and exposure to heat, but they do not last long.

On the other hand, syncope can also be a sign of a very important heart disease.Children may develop syncope in certain heart muscle conditions, congenital heart diseases and cardiac rhythm disorders (heart rate below or above the normal beats of heart per minute, respectively).Cardiovascular system should be carefully reviewed for exertional dizziness and syncope, syncope associated with chest pain and palpitation, history of poor exercise capacity and family history of syncope and sudden death.

Syncope can be preceded by dizziness, fatigue, blurry vision, nausea and hot flashes.Injuries may be faced, if the patient falls down secondary to syncope.For simple syncopes with non-cardiac etiology, it is usually sufficient to elevate legs of patient.Patient usually gains consciousness a few minutes after first aid is applied.Excluding simple syncopes, treatment method varies depending on the underlying cause.