Most heart disease in children falls in two categories: congenital heart disease and arrhythmias. Children with congenital heart disease are born with anatomical defects of the heart. Arrhythmias are abnormalities in the heart rhythm that can present at any age. Arrhythmias in children can accompany congenital heart defects, or can be caused by conditions, like electrolyte imbalances. Unlike adults, children can have a wide variety of symptoms of heart disease.
Cyanosis and Heart Failure
There is a group of congenital heart defects that presents with cyanosis. Cyanosis is a bluish tinge in the skin around the lips, around the eyes, and on the fingertips or nail beds, that signifies decreased oxygen content in the blood. Another symptom of heart disease is congestive heart failure. Congestive heart failure is the condition in which the heart cannot deliver enough oxygen to the tissues. Children with congestive heart failure often present with rapid breathing, or tachypnea, and poor feeding. They may also have poor weight gain and growth failure. Older children will have fatigue and enlargement of the liver (hepatomegaly). As the failure worsens, children have cardiomegaly, or enlargement of the heart muscle, which happens as the heart tries to increase the amount of blood it pumps.
Arrhythmias
Children with abnormal heart rate may not notice their arrhythmia, or it may be so infrequent as to not be noticeable. Younger children with arrhythmias cannot report if their heart is skipping beats or if they have chest pain or tightness, the usual symptoms of arrhythmias in adults. They usually present with irritability, poor feeding, and frequent and inconsolable crying. They may have rapid breathing, poor weight gain or failure to thrive, and easy fatigability, particularly when feeding. They may appear pale, or have cyanosis. Older children might complain of chest pain, difficulty breathing, palpitations and dizziness. If the tachycardia is persistent or life-threatening, children may present in shock.
Shock
The symptoms of cardiac shock include loss of consciousness; poor or absent breathing; pale, mottled skin which progresses to cyanosis; and absence of a regular pulse. Congestive heart failure can precede shock, so children can also have enlargement of the heart and the liver. They can have generalized edema or swelling from accumulation of fluids. This can lead to fluid in the lungs, with symptoms of rapid breathing and cough.
