It is a condition characterised by sudden, sharp chest pain that lasts only a minute or two and are not related to activity. When the pain is present, it hurts to cough or breathe deeply. This pain may occur several times a day, but more usually once or twice a week.
The underlying cause is not known. It is speculated that this could be triggered by the irritation of nerve fibres between the ribs.
Good dental hygiene is essential for all children and adults, and we would recommend regular dental check-ups. Regular dental check-ups are crucial.
The use of antibiotics before a dental procedure is not routinely recommended unless they meet the following criteria:
Kindly consult your doctor regarding your condition if you are unsure if your child requires antibiotics prior to dental procedures.
Exercise is important even for those with heart disease. It improves heart function and overall 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 lowering blood pressure.
There are different types of exercise. In static exercise, the muscles contract, but there is little joint movement (e.g. weightlifting). In dynamic exercise, the muscles contract and move the joints (e.g. running). Each place 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 up sport as their co-curricular activity (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 2.4k run as they often perform less well at endurance-type activities.
As always, parents or patients must seek the advice of their own doctor when deciding how much exercise and to what level is safe, particularly as there are no published guidelines for activity levels in children.
Most children with heart disease can receive all the normal vaccinations at the appropriate time.
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 you:
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, 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 recommended 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. However, it is 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. However, some 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.
Not all children with heart disease require medication. Those who do may need it for fluid reduction, to aid heart pumping, for rhythm control, or for blood thinning.
The majority of these medicines have been used for many years and are very safe, but like all drugs, side effects may occur - 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.
Most women with heart disease are able to undergo a normal pregnancy and delivery.
The exceptions are those with severe cyanosis, when there is usually insufficient oxygen in the blood supply to the placenta to sustain the baby. Most of these pregnancies spontaneously abort.
Women with pulmonary hypertension (high lung artery pressure) are not usually advised to get pregnant as there is a serious danger to their lives.
As with any medical problem, it is essential that medical advice is sought - preferably before the event so that the pregnancy can be monitored and if treatment is necessary, it can be undertaken early.
If a woman herself has a heart problem, then there is an increased risk that her child will have a heart problem too. The risk is around 6%. If a man has a heart problem, then the risk is 2%. If the couple have had a previously affected child, then the risk is about 2%. These figures represent average risks; the actual risks vary considerably depending on the specific heart condition. There is also some evidence that taking vitamins for 3 months before conception and the first 3 months of the pregnancy can reduce the chance of heart disease occurring in the baby.
