What is Ischemic Cardiomyopathy in Children?
Ischemic cardiomyopathy is caused by a lack of blood supply to the heart muscle. The left ventricle of the heart pumps oxygen-rich blood all over the body, making it the strongest part of the heart. If this area of the heart muscle has reduced blood supply, it becomes too weak to push out the blood. This may cause the left ventricle to enlarge, or dilate, as blood backs up, which is called dilated cardiomyopathy.
Symptoms
Individuals with ischemic cardiomyopathy may develop some symptoms related to having too much fluid in the body. These individuals may also develop symptoms caused by abnormal heart rhythms.
When there is too much fluid in the body, individuals may experience:
- Shortness of breath
- Swelling of the legs and feet (edema)
- Feeling over-tired and not able to exercise or do normal activities
- Rapid weight gain, cough and congestion
When individuals have abnormal heart rhythms (called arrhythmias), they may experience:
- Pain or pressure in chest with activity or rest (angina)
- Fluttering in the chest (palpitations)
- Dizziness, light headedness, and fainting
Causes
In children, a lack of blood supply to the heart can be present at birth caused by defects in the blood vessels of the heart. Certain diseases may also cause issues with the heart blood vessels, such as Kawasaki disease.
In adults, coronary artery disease reduces the amount of blood supply to the heart and can lead to a heart attack. Adults with a family history of heart disease, high blood pressure, smoking, diabetes, high cholesterol, and obesity are at increased risk for heart issues.
Diagnosis
Ischemic cardiomyopathy is diagnosed based on medical history, physical exam and other tests. The doctor may order the following tests:
- Blood tests
- Electrocardiogram (ECG)
- Imaging tests, such as chest X-ray, CT scan, MRI and radionuclide studies
- Echocardiogram
- Exercise stress test
- Cardiac catheterization
You may also need a heart muscle biopsy. During the biopsy, small tissue samples are taken from the heart and examined under a microscope to find the cause of the cardiomyopathy.
Genetic Testing and Family Screening
Children with a family history of high blood pressure, diabetes, high cholesterol and obesity may be at increased risk of developing ischemic cardiomyopathy. If close relatives, like parents, have had a heart attack before age 55, early lab tests for risk factors such as hypertension, diabetes and elevated cholesterol may be ordered.Management & Treatment
Treatment is aimed at improving heart function and reducing symptoms. The most common treatments include medication, surgery and lifestyle changes.
Medication
Medications are used to treat symptoms, reverse heart damage and prevent further damage to the heart muscle. Medications such as beta-blockers and ACE inhibitors are used in most cases. Other medications may be given to manage symptoms or to prevent abnormal heart rhythms.
Surgery
Some patients may need to have a device placed during surgery to help improve the blood supply to the heart. These devices can include an implantable cardioverter-defibrillator (ICD) or a pacemaker.
If cardiac function continues to worsen, a mechanical device may be needed to help the heart pump and supply blood to the body. The device used for young children is called the Berlin heart device. For older children and adults there are multiple devices that could be surgically placed to provide cardiac support. In severe cases, a heart transplant may be considered.
Lifestyle Changes
Doctors also recommend lifestyle changes to ease symptoms, decrease hospitalizations and improve quality of life. Changes involving a heart-healthy diet and exercise are recommended.
