What is an acquired heart disease?

As a pediatric cardiologist, much of my work focuses on children with congenital heart disease, structural abnormalities of the heart. While less common, children can develop heart problems after birth, sometimes called acquired heart disease. Most of these diseases can be detected by a patient’s history, blood tests, electrocardiogram, and echocardiogram, which can evaluate cardiac structures and function.

Kawasaki disease

Kawasaki disease typically presents with fever, rash, red eyes, and, if untreated, can lead to dilation or aneurysm of the coronary arteries. The disease is more likely to be severe in infants. Its cause is not known, but detection and treatment with gamma globulin can prevent the cardiac abnormalities.

Viral myocarditis

Another acquired heart disease, viral myocarditis, occurs when the heart becomes inflamed following a viral infection. This can occur at any age but is more common in older children and adolescents. Symptoms include fever, chest pain and rapid heartbeat. Patients with severe myocarditis have inflammation of the heart muscle and decreased cardiac function. This can be detected by cardiac ultrasound, known as an echocardiogram, and cardiac MRI.

One form of myocarditis sometimes occurs after COVID infection, called multisystem inflammatory syndrome, or MIS-C. Some cases of myocarditis require hospitalization and intensive medical treatment, but fortunately, most patients don’t need treatment and have an excellent recovery.

Rheumatic fever

Rheumatic fever (RF) used to be the most common type of heart disease in children, with prevalence in the U.S. peaking in the early 1900s. It typically occurs a few weeks after a strep throat infection, most commonly in children above age 4. Symptoms include fever, rash and rapid heartbeat. RF can affect the heart valves, causing leaking of the mitral and aortic valves. Most rheumatic fever can be prevented by treating strep throat with antibiotics. If your child develops a sore throat, I recommend bringing them to their pediatrician or nurse practitioner for evaluation. If they have an active strep infection, antibiotic treatment will prevent most cases of RF.

What concerns me even more than any of these acquired heart conditions is the dramatic increase in risk factors for future heart attacks. Since I became a doctor 40 years ago, health issues once considered rare in children have become common – hypertension, high cholesterol, high triglycerides, type 2 diabetes and obesity. These are now everyday findings in my clinic and throughout the pediatric population. These are highly correlated with lifestyle. I encourage parents to focus on the whole family eating fruits, vegetables, healthy protein such as nuts, seeds, fish, whole grain foods, minimal refined carbohydrates and exercising every day.

Dr. David Thoele is a pediatric cardiologist and co-director of the Narrative Medicine Program at Advocate Children’s Hospital.

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