Cardiomyopathy in children is a large group of non-inflammatory heart sac diseases with primary changes in muscle tissue. The disease is not associated with valve lesions, arterial or pulmonary hypertension.
Canadian Pharmacy distinguishes acute (during several weeks), subacute and chronic (during many months) disease course. At early stages of the disease conservative cardiomyopathy treatment is appointed, in case of its inefficiencies and expressed violations of heart functioning, heart transplantation is indicated.
Possible Cardiomyopathy Causes and Mechanism of Development
Exact causes of cardiomyopathy development are not fully understood. Many children have combined effect of several factors. Modern pediatric cardiology distinguishes the following types of cardiomyopathy:
- idiopathic cardiomyopathy (hypertrophic, dilated, restrictive, right ventricular dysplasia);
- specific cardiomyopathy (infectious, metabolic, at systemic lesions of the connective tissue of the whole body, toxic);
- unclassifiable cardiomyopathy (rare idiopathic acute isolated myocarditis and myocardial fibroelastosis).
The disease is based, regardless of child’s age, on profound violation of all metabolic processes of heart sac tissues. As a result of protein, carbohydrate, mineral metabolism violations there observed dystrophic processes of mostly muscle tissue (myocardium), rarely pericardium and endocardium (outer and inner membranes of heart sac). These changes lead to irreversible stretching and reduction of heart elasticity and increasing cardiac insufficiency.
According to Canadian Pharmacy experts, the occurrence of cardiomyopathy is considerably affected by hereditary factors, there are cases of family illness. At newborns leading role in cardiomyopathy, development belongs to genetic aspects, fetal pathology (asphyxia, hypoxia, sepsis), severe systemic diseases (blood and endocrine system pathologies), congenital abnormalities of heart sac.
At children older than one year more important role in cardiomyopathy development belongs to arrhythmia, various infectious diseases, genetic predisposition. At adolescence, cardiomyopathy may occur on the background of rapid growth, excessive physical and emotional stress.
Pediatric Cardiomyopathy Symptoms and Clinical Features
Main features are increased left ventricle with obstruction (sometimes without it) with the gradual deterioration of heart contractility. Other signs of this particular disease form are cardiac arrhythmias (which can be considered as hypertension sign) and frequent fainting. Cardiac insufficiency is rare.
Trickery of this cardiomyopathy type is a long asymptomatic course. Sudden fainting and subsequent sudden death of a child may be the only sign of the disease. Such type of disease course is possible at any age of the child.
The peculiarity of this cardiomyopathy type is a significant reduction in heart muscle tissue elasticity and progressive course of the disease. Reduced myocardial contractility leads to slow worsening of cardiac insufficiency symptoms.
At a very small child there observed growth retardation, lethargy and progressive weakness, cyanosis of face and extremities when crying or other physical exertion. Older children prefer calm games, there is lack of desire to play mobile games, increasing dyspnea at physical exertion and cyanosis of extremities. Teenagers may complain of a feeling of lack of air, pain in heart and heart palpations, increasing weakness and constant fatigue.
Most common type of the disease. Maybe the final stage of other cardiac diseases, such as children’s myocarditis. There is marked enlargement of cardiac chambers. Progressive course of the disease.
At young children, characteristic signs are poor weight gain, difficulties with feeding (baby poorly sucks, often interrupts due to lack of air). At older ages, signs of congestive cardiac insufficiency predominate: weakness and constant fatigue, not corresponding to load, swelling of legs and abdomen (ascites), dyspnea (especially at night) and cough.
It is for this cardiomyopathy variant occurrence of thromboembolic complications is typical. Appeared on heart sac walls clot can detach and clog any vessel in child’s body. Consequently, blood stroke or renal or pulmonary infarction may occur.
One variant of this cardiomyopathy type in children – is ischemic. Lack of blood supply in the myocardium (ischemia) occurs as a result of prolonged and severe metabolic disorders, irreversible changes of the vascular network.
This form of cardiomyopathy is not an independent disease, but one of the systemic disease’s manifestations. For example, dystrophic changes of myocardium observed at diabetes, obesity, hyperthyroidism, pheochromocytoma, malignant neoplasms, systemic collagenosis. Symptoms of heart sac lesions are non-specific, to the foreground come symptoms of an underlying disease.
General Principles of Diagnostics
During the preventive medical examination, there may be revealed cardiac enlargement and expressed metabolic abnormalities on ECG (this is the main feature of myocardial dystrophy).
In order to establish final diagnosis special investigation is required:
- echocardiography to study contractility, structure and functional state of cardiac chambers;
- Doppler sonography to examine large vessels state;
- needle biopsy of heart sac, scintigraphy, positron emission tomography to estimate myocardial dystrophy degree.
Doctor Draws Attention
- Conservative treatment is the use of drugs that enhance metabolic processes (vitamins, anabolic steroids).
- With early treatment disease may reverse.
- In case of cardiac insufficiency, therapy is aimed at the elimination of edema and facilitation of heart work (glycosides, diuretics).
- In case of significant changes of heart sac, heart transplantation surgery is indicated.
Cardiomyopathy in infants and children treatment can only be performed with early diagnosis and proper careful therapy.