Enlarged Heart in Children

Julie Kirk
Contributor: Jodee Redmond
Doctor checking baby's heart using stethoscope

An enlarged heart in can be a symptom of several types of medical conditions. All of them require prompt medical treatment. Learn the conditions and symptoms that cause an enlarged heart in infants and children.

Possible Causes of Enlarged Heart in Children

There are a number of conditions which feature symptoms that include an enlarged heart in a child, such as the following:

Pericarditis

When pericardium (the sac surrounding the heart) is irritated, it causes swelling. Symptoms of this condition include:

  • Sharp pain in the center or left side of the chest
  • Fever
  • Dry cough
  • Swelling in the abdomen or lower extremities
  • Shortness of breath when lying down
  • Fatigue or weakness

Pericarditis can be acute (lasting a few weeks) or chronic (symptoms persist for six months or longer). This condition is treated with a combination of bed rest and medications to reduce swelling. When the pericarditis is caused by fluid around the heart, a procedure to drain the area may be performed.

Myocarditis

Myocarditis affects the walls of the heart muscle, causing inflammation. Possible causes of myocarditis include:

  • Chemicals
  • Infections
  • Medications
  • Radiation

When children develop myocarditis, the condition is usually caused by a viral infection. Influenza has been linked to myocarditis, but other Rubella, Rubeola and HIV can also cause the disorder.

A child with myocarditis may complain of flu-like symptoms, such as fever and fatigue. They may have cold hands and feet, with pale skin in these parts of the body. The child's urine input may decrease due to poor kidney function.

Some children with myocarditis have a cough while others complain of chest pain while exercising. They may feel nauseous or experience pain in the abdomen. This condition can also lead to congestive heart failure and the face, hands and feet may swell as a result.

The inflammation associated with myocarditis will resolve itself with time, and doctors don't offer specific treatment for this symptom. Children with myocarditis are usually admitted to the intensive care unit of the hospital so that their condition may be monitored closely. Medications to help the heart pump more effectively or to keep the blood pressure in a normal range may be given.

Bed rest is an important part of the treatment process for myocarditis. The child may need to have his or her activities restricted for weeks or months during the recovery process. Resumption of normal activities is a gradual process.

Endocarditis

Endocarditis is a bacterial infection affecting the heart valves. The bacteria may enter the body when the child is undergoing dental procedures or a minor surgical procedure. Symptoms of endocarditis include:

  • Chills
  • Fatigue
  • Fever
  • Muscle aches
  • Sore joints
  • Shortness of breath
  • Swelling of the abdomen and lower extremities
  • Night sweats

When endocarditis is diagnosed, it is treated aggressively with antibiotics. The medications are given by intravenous for between four and six weeks. In cases where the infection has damaged the heart valve, surgery may be necessary.

Pediatric heart surgery

Congenital Heart Defects

A congenital heart defect is a problem with the heart structure that was there at birth. At times congenital heart defects aren't diagnosed until later childhood because there have been no noticeable symptoms or problems until then. These symptoms include:

  • Getting tired easily during exercise
  • Quickly becoming short of breath during exercise
  • Fainting associated with exercise or activity
  • Swelling of hands, feet and ankles

The congenital heart defects that could cause these symptoms include a hole in the heart, valves in the heart that leak or don't open properly or the heart does not pump or squeeze as it should.

Enlarged Hearts in Babies

The most common cause for enlarged hearts in babies is due to congenital heart defects. Specific examples of these heart defects include:

  • Ventricular septal defect which is a hole in the wall between the ventricles (lower chambers of the heart).
  • Atrial septal defect which is a hole in the wall between the atrium (upper chambers of the heart).
  • Tetralogy of Fallot (TOF) which is actually four congenital heart defects that interfere with the normal blood flow to the heart.
  • Ebstein's anomaly which is a problem with a valve between the right atria and the right ventricle of the heart.
  • Patent ductus arteriosus which is a hole in the aorta (the main artery that carries the blood from the heart to the body).
  • Coarctation of the aorta which is a narrowing of the aorta.

Discovering an Enlarged Heart

A pediatrician may detect a heart murmur during a routine examination which he will then follow-up with further testing such as an echocardiogram. Other more obvious symptoms that a baby may indicate a heart issue include:

  • Difficulty breathing
  • Poor appetite
  • Failure to thrive
  • Excessive sweating
  • Swelling
  • Pale skin

Diagnosing an Enlarged Heart

The doctor will order a chest x-ray to get an idea of the size of the child's heart. The child may need to be seen by a pediatric cardiologist who will take a detailed medical history and order an electrocardiogram (ECG). An ultrasound examination of the heart gives the doctor detailed information about the size of the heart, its chambers and valves.

Enlarged heart in children is not a common symptom. When it is detected, the treatment will depend on the underlying condition. Any time a child complains of chest pain, he or she should be seen by a doctor to determine the reason for the discomfort.

Heart attacks in children are rare occurrences, but they do occur. Chest pain is a symptom that warrants a trip to the closest emergency room to determine the cause. In most cases, the discomfort is caused by stress or strained muscles. This symptom may also be caused by one of the health conditions listed above, and all of them can cause enlarged heart in children.

Survival Rates for Babies With an Enlarged Heart

Most babies born with an enlarged heart due to congenital heart defects are living longer and reaching adulthood. But the survival rate of babies born with congenital heart defects highly depends on when it is diagnosed, how it's treated and how severe the defect is. According to the Centers for Disease Control and Prevention:

  • About 95% of babies born with non-critical congenital heart defects will survive to 18 years of age.
  • About 69% of babies born with critical congenital heart defects will survive to 18 years of age.

Treatment and Care

The earlier the diagnosis and medical treatment, the better the prognosis for the child or baby. Some degree of ongoing medical care and monitoring will most likely be necessary but it is reassuring to know that most children will go on to live healthy, productive lives.

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Enlarged Heart in Children