Musical Hearts

This week’s guest columnist is Taylor Phillippi, MD, a Family Medicine resident at Ochsner University Hospital & Clinics.

February was American Heart Month, promoting cardiovascular health. This was easy for me; my husband was born with Ebstein’s Anomaly, a defect of his tricuspid valve requiring four surgeries in his 31 years. Congenital Heart Defects (CHD) are the most common birth defect. About half are discovered with prenatal ultrasound, leaving half to be detected after birth.

The first clue is often a murmur, which are extra heart sounds heard through a stethoscope, a “whoosh” between the “lub-dups” of heartbeats. When parents learn their baby has a murmur, they sometimes panic, fearful that their child will be sickly. However, the vast majority are benign and do not require extensive work-ups. In fact, most kids have murmurs at some point in their lives, and they go away.

How do we discern benign murmurs from ones heralding CHD? Benign murmurs come-and-go between exams, are soft, sometimes “musical” (sounding like a tone) and limited to one area of the chest. Harsh, or “blowing” murmurs, are the sound of blood that doesn’t below squirting through holes between heart chambers. Even most of these close on their own. However, any abnormal murmurs require an Echocardiogram (ultrasound of the heart) to be sure they’re okay.

Babies also now get other tests to look for CHDs, like blood pressures and oxygen levels in their arms and legs. Differences in circulation between limbs can indicate certain defects. However, not all defects make murmurs or show up with these tests. Sometimes, they show themselves in the first weeks of life, when baby suddenly begins to breathe hard and feed poorly. These babies need to be checked right away. Although it could be benign, there’s a chance it could also be a congenital heart defect.

Every week we see children with chest pain. Some kids even say “my heart hurts”, freaking out their parents. Is this a heart attack like Uncle Ernie? Kids say that because they’ve learned their heart is in their chests and it hurts, so they make the association. Fortunately, most pediatric chest pain isn’t cardiac; it’s usually rib cage “growing pains,” called Costochondritis. Ant-inflammatory pain medicine like Ibuprofen makes it better.

One of the beauties of pediatrics is that children rarely get heart attacks. Their hearts are young strong organs ready for a lifetime of work. Also, kids don’t abuse their hearts like adults. They haven’t spent decades eating fatty foods and loafing around, weakening hearts and clogging the arteries that feed them. The few children who have heart problems are born with defects, as discussed.

Rarely, children also get heart infections called Viral Myocarditis. These usually start quietly, with mild runny nose and coughing, maybe a low-grade fever. Instead of the usual three-day recovery like a cold, these kids start to slowly get more tired and eat less. When their eating drops off dramatically and they begin to breathe hard, parents realize it’s not just a cold. We’ll admit these kids to the hospital for monitoring and medication to boost their cardiac function. Most recover, but a few have lasting function deficits, and occasionally need heart transplants.

Unfortunately, a recent virus called COVID-19 has made Myocarditis a little less rare. While most kids just get colds from COVID-19, some get Myocarditis. They spend days in the Intensive Care Unit (ICU) and occasionally die. Fortunately, there’s a vaccine for that! Next COVID-19 season, or surge, get your kids vaccinated. There’s parents out there who wish they had.