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Cholesterol and heart diseases affect not only adults but also minors. Acıbadem Health Group Pediatric Cardiology Specialist View Gurur's Full Profile tells the unknown about cholesterol and heart disease in children.
: - Do children have cholesterol? If yes, would it increase the risk of heart disease?
Dr. View Gurur's Full Profile The causes of high cholesterol in children can be divided into two as inherited and caused by nutrition. It is known that high cholesterol, especially cigarette, high blood pressure, diabetes, excess weight and lack of exercise, create fat plaques in the cardiovascular vessels and cause early corner heart disease in adults and as a result death in some of them. In this study, adults, frying, hamburger, etc. It is an important clue that they are present in countries where children are fed more high-saturated fat foods such as. Especially in animal studies, it was observed that the food taken at a young age and thus the fat ratio causes fat plaques in the heart vessels which we call atherosclerosis. So we need to start a balanced diet from childhood. In addition to this, there are also familial disorders of blood fat mechanism with high cholesterol levels. Although severe ones are not common, they should be treated when diagnosed. According to the recommendation of the American Pediatric Association and the American Heart Association, their families (mother, father or their parents) who have an early corner heart disease under the age of 55, have infarction, have angiography in the veins of the heart, and have stenosis or balloon in the veins. which is cerebrovascular disease, ie paralyzed, or dies suddenly under the age of 55; The cholesterol levels of children with a mother's or father's cholesterol 240 MGK / l or higher should be evaluated and a treatment / follow-up method should be applied according to the result. Thus, we can significantly reduce the risk of cardiovascular disease in later life.
: - Which children's cholesterol should be checked?
Dr. View Gurur's Full Profile The children the American Pediatric Association and American Heart Association recommend to look for cholesterol can be listed as follows:
1. In their families (mother, father or their parents) who have an early coronary heart disease under 55 years of age, ie infarction, congestion of the heart vessels with angina, and steno or balloon in the veins
2. Families with cerebrovascular disease under 55 years of age, paralyzed, peri-vascular disease, ie, blockage of hand and foot vessels or sudden death under 55 years
3. The mother's or father's cholesterol is 240 mg / dl or higher. Cholesterol levels of these children should be evaluated and a treatment / follow-up method should be applied according to the results. Thus, we can significantly reduce the risk of cardiovascular disease in later life.
: - What causes subsequent heart disease? How is diagnosis and treatment performed?
Dr. View Gurur's Full Profile We can divide the subsequent heart disease in children. The first is the occlusive diseases of the heart and the second is the heart arrhythmias. While some of the heart's acquired diseases develop later due to other reasons, some of them are accepted under the title of operative, although the patient carries the related gene, but not later than the early ages. heart diseases caused by rheumatic fever, heart tumors and other systemic diseases. Some of them are interrelated and cause and effect relationship are seen together with several heart diseases in one patient. Heart ultrasound, echocardiography, has an important role in the diagnosis of acquired diseases.
In addition to echocardiography, cardiac angiography should be helpful in the diagnosis if the heart and vessels should be demonstrated by computed tomography, MRI or MR angiography.
The most important cardiac muscle disease is hypertrophic cardiomyopathy, which is more familial and genetic diagnosis of some types can still be performed. In this disease, the heart muscle abnormally increases, prevents the pumping of blood from the heart to the body and can cause fatal arrhythmias. While a part of the patient is placed on an anti-arrhythmia device, a part of the patient gets rid of his complaints by shaving the heart muscle during surgery.
Myocarditis, endocarditis, pericarditis and Kawasaki disease are the most common cardiac infections. Myocarditis usually occurs as a result of viruses affecting the heart after upper respiratory tract infection, ie angina, and may go up to heart failure in the first period. Although some patients have been treated with medication for many years, part of it requires heart transplantation. Endocarditis, which is usually caused by an underlying congenital heart disease, can be treated with medication when the microbes in the blood go and settle in the patient's heart. One patient may require surgery. Therefore, people with congenital heart disease or subsequent heart valve disease should take a dose of antibiotics before any intervention, including dental interventions that cause bleeding in the mouth. Kawasaki disease, which is diagnosed after high fever that does not fall in children's age, can cause cardiovascular damage, while a part of the patient is completely cured with treatment, and some of them may require by-pass surgery in younger ages. The diagnosis of cardiac tumors in childhood is usually made by echocardiography performed before or after delivery. 90% of heart tumors are benign and a large portion of the early diagnosis without the need for any treatment spontaneously shrinks and disappears.
Some rheumatic diseases such as lupus, rheumatoid arthritis, neurological diseases such as muscular dystrophy, sickle cell anemia as well as some genetic diseases such as marfan syndrome can be seen in various heart diseases.
The second group of subsequent heart diseases is cardiac arrhythmia, which means that the heart rate is fast, slow or irregular. Some of these are hereditary and may be accompanied by sudden deaths in the family. While some point to an underlying heart disease, there are arrhythmias that can occur without any structural disorders in the heart. The main methods used in the diagnosis of heart irregularities are electrocardiogram and recording of heart beat for 24 hours called Holler. The looper, which we recently started to use in Acıbadem Hospital, also uses a device called a looper to record the arrhythmia to a tape and record it on the phone and send it to our hospital instantly and the doctors on duty are informed. If the cause of arrhythmia cannot be demonstrated by the above diagnostic methods, further investigation can be performed in patients with electrophysiological studies. Through the catheter, that is, entering the heart through the groin and / or veins in the neck, various stimuli are given to the heart, and it is seen how the heart rate disorder occurs. This pathway is used both for diagnosis and treatment. Arrhythmias diagnosed by electrophysiological study are eliminated by a light electric current wherever they originate in the heart. Thus, a part of the patients do not need medication. In some patients, the arrhythmias are benign, meaning that they do not require any additional treatment or are kept under control with medication. A very small number of patients whose families have sudden death or heart rhythm disorders are vitally put on a pacemaker if the heart rate decreases or if the heart rate is too high, the antiarrhythmic device decreases the rate.
: - Does untreated angina cause subsequent heart disease?
Dr. View Gurur's Full Profile Undoubtedly, acute rheumatic fever is one of the most important diseases affecting the heart that we frequently see in our country. Acute rheumatic fever occurs as a result of an upper respiratory tract infection caused by bacteria that we call beta streptococci, that is, untreated angina or late treatment. Heart valves are the most affected area. Irreversible damage to the heart valves may occur. In one part of the patient, heart valve damage may regress with prolonged and regular use of antibiotics and in another part it may progress to valve replacement by surgery. Does every angina cause heart disease? Of course no. Angina or in other words upper respiratory tract infections are caused by viruses and the antibiotics used do not affect these microorganisms. As the use of excessive and inappropriate antibiotics will cause resistant microbes, the first thing to be done during angina is to investigate the cause of throat infection. Routine streptococcal antigen test can also be performed in our hospital for half an hour. If this test is positive, that is, if harmful bacteria have grown in the throat, medication is taken immediately. If the test is negative and your doctor considers it appropriate, then the response of the throat culture to be taken after two days can be expected. There is no need for an antibiotic treatment for viruses that cause throat infection. Only a few of them can cause myocarditis, ie, heart muscle infection, in some people.
: - Can congenital heart diseases be treated without surgery?
Dr. View Gurur's Full Profile In the treatment of congenital heart diseases, great progress has been achieved in the last 50 years. Especially with the widespread use of cardiac catheterization procedures and more reliable interventions, interventions performed with angiocardiography in the treatment of some non-complex congenital heart diseases have replaced the operations. The patent ductus arteriosus (PDA: the hole between the aorta, the main vessel leading to the body and the main vessel to the lung), one of the simpler heart diseases previously treated by surgery, the ventricular septal defect (VSD: the hole in the wall between the ventricles of the heart), atrial septal defect (ASD: the upper cavities of the heart, ie the hole in the wall between the atria) and the patent foram ovale (PFO: prenatal uterus is required for life in the opening between the closed atria) can be closed without a large part of the formation. While VSD studies are continuing at all speed, some of the devices required to cover holes such as PDA, ASD and PFO have been approved and are widely used all over the world, especially in the United States. In addition, the stenosis of some heart vessels and heart valves can be opened by balloon, the narrowing of the vessels can be expanded by stenosis. Most of these procedures are also performed in our hospital. No medicine to close the heart holes. Certain medications are given prior to surgical treatment of cardiac anomalies. In rhythm disorders, drug treatment and abrasion techniques are applied.
: - Does stem cell therapy, which has recently been used in some heart diseases, also be used in childhood heart diseases?
Dr. View Gurur's Full Profile Most of the research done with stem cells is mainly aimed at creating new cardiac muscle cells in the place of the dead heart muscle because blood and therefore oxygen do not go as a result of cardiovascular disease seen in adults. These studies will help us in the treatment of some part of childhood heart diseases when the heart enlarges due to the general disorder in the study of the heart muscle which we call dilated cardiomyopathy and includes some heart diseases in which heart failure occurs. Currently, there is no such treatment or research in children.