Heart failure is common in the elderly. But doctors often don’t think about it in young, healthy kids -- a fact of life Dr. Paul Kantor and some colleagues are hoping to change.
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A group of concerned pediatric cardiologists are trying their best to
ensure that other children don't die the way Dan Miller did. Miller, who lived
in Delaware, Ont., was 17 in early 2003 when he fell ill with what looked to
his parents like a bad case of the flu. When he started throwing up every 45
minutes, Tim and Theresa Miller thought he had gastroenteritis. But when he
wasn't getting better, his parents took him to a hospital.
Though the teenager had an unusually high heart rate, doctors too
thought he had a stomach bug. He was given intravenous fluids and sent home. It
was the wrong diagnosis and the wrong treatment. Two days later he was back in
the emergency department and then admitted to hospital. The high school senior
had heart failure, brought on by myocarditis — an infection in his heart
muscle.
His parents watched helplessness as their formerly healthy son died of
heart failure, which, had it been spotted earlier, may have been treatable. He
became noticeably ill on Saturday and was dead by Thursday. "You never
want to live through that, that's for sure," Theresa Miller says of the
loss of her son and his final days.
Heart failure is common in the elderly. But doctors often don't think
about it in young, healthy kids — a fact of life Dr. Paul Kantor and some
colleagues are hoping to change. Kantor, who is the head of pediatric
cardiology at Stollery Children's Hospital in Edmonton, chaired a working group
that has drawn up guidelines to help doctors spot a condition that is too often
mistaken for a stomach infection, hepatitis or even asthma.
The guidelines are being presented Tuesday at the Canadian
Cardiovascular Congress, a scientific conference jointly hosted by the Canadian
Cardiovascular Society and the Heart and Stroke Foundation. "(It's) truly
a devastating thing to find out that your child has a heart condition at all.
And when you find out the extreme severity of it, it's even worse," said
Kantor, whose specialty is pediatric heart failure. "But I think there's a
special degree of helplessness that strikes parents who feel that they've done
what they could do to access the medical system, but unfortunately the medical
system was not able to recognize the true nature of the problem and deal with
it effectively."
There aren't good figures on how many children suffer heart failure in
Canada. Kantor says data from the U.S. suggests that about 3,000 children a
year in North America are hospitalized with heart failure and survive to be
discharged. Those — plus the children who don't make it — are the most severe
cases. Many others have milder cases of heart failure and go unnoticed, Kantor said.
Heart failure in children can be caused by genetic abnormalities, or the
result of an infection like influenza where something goes wrong.
Sometimes a respiratory virus moves out of the lungs to infect the heart
muscle. Sometimes the body's immune response to the initial infection leads to
excess inflammation, which weakens the heart muscle to the point where it
cannot pump blood properly. "They may be breathless, they may have
grunting type of breathing. Often in teenagers they vomit and have serious
abdominal pain and are misinterpreted to have gastroenteritis," Kantor
said. Caught early enough, heart failure is reversible with the right
treatment. But if it becomes advanced, only about 50 per cent of children will
still be alive five years later, Kantor said. And those that survive may need a
heart transplant.
The aim of the guidelines is to prompt emergency room physicians and
family doctors to put heart failure on the list of possible diagnoses when they
are faced with sick children who have vague symptoms. "If the heart rate
is very fast and there's no good explanation as to why that is and the blood
pressure is low, an ECG can be done. Blood tests can also be done to indicate
whether there is damage to heart muscle," Kantor said, suggesting that at
that point a pediatric cardiologist should be consulted if possible. "A
specialist who considers this would not have much difficulty deciding that a
child has myocarditis."
In addition to giving doctors the tools needed to spot heart failure,
the guidelines tell physicians how to treat it. Rather than giving fluids, as
was done with Dan Miller, diuretics should be used to drain excess fluid from
the body that is making the heart's job even tougher. Severe cases may need to
be put on machines that take over for the heart, to give it time to recover. Theresa
Miller is lending her voice to the effort to bring the new guidelines to the
attention of the medical community, saying she wished someone had thought to
explore the state of her son's heart when he first went to hospital. "We're
so appreciative of the work that's been done around these guidelines and just
hope they get out there to every Canadian ER," she said. "When you go
through this, that's all you're left with, is that hope that, well, whatever we
could do so someone else wouldn't go down this road."
Source: Canada.com
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