Rus Articles Journal

Whether children`s heart of

Should be reminded that heart is one of the most important human organs. It works without respite, providing receipt with blood of oxygen and nutrients to other bodies and fabrics. It is possible to tell without exaggeration that in his “hands“ - destiny of all organism.

Unfortunately, cases of the birth of children with congenital pathologies of development of vitals and systems in recent years became frequent. It is possible to blame for it ecology, an unhealthy way of life of parents, to accuse doctors of negligence, but the fact remains: diseases it is warm - vascular system in structure of children`s incidence are high on the list. Besides in recent years the ratio, clinical symptomatology and an outcome of heart troubles at children considerably changed. At present generation into the forefront not rheumatic diseases of heart virusno - the bacterial nature act, it is tended to increase in frequency of congenital heart diseases, violations of a rhythm and conductivity, and also arterial hyper - and the hypotensions (raised and the lowered arterial pressure).

Ultrasonic research of a fruit allows to diagnose vnutriutrobno about 90% of various forms of heart diseases.

the First inspection after the birth kids pass

in walls of maternity hospital: by means of a stethoscope the skilled children`s doctor can listen to tones and noise not only in heart, but also on the head of the baby (before closing of a big fontanel). If necessary the doctor - neonatolog appoints additional inspection for an exception of congenital pathology.

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at the age of 1 month to all children conducts ultrasonic examination of abdominal organs, a brain, heart, coxofemoral joints, obligatory electrocardiographic examination for definition of a condition of conductivity of a cardiac muscle and identification of risk group is conducted. The following planned inspection of heart is necessary to kids in a year. Further surveys repeat with connection of additional experts. Thus, the chance that pathology of heart of the child will be passed by doctors, is practically absent. However parents should not lose vigilance.

the Problem consists that parents pass dangerous symptoms, neglect surveys of the child at doctors, and meanwhile the illness progresses.

Some especially vigilant mummies in vain sound alarm, without knowing physiological features of the nursery is warm - vascular system, and pass a great lot of inspections with children, spending for it a lot of time and money. Unfortunately, such “campaigns“ do not do well to the child, and vain disorders adversely affect work of heart of parents.

Therefore to parents should know some features of work of children`s heart and to have an idea of some “calls“. Also the knowledge of prevention of development of heart diseases is important.

Physiological and anatomic features warmly - vascular system at children

Laying of heart at the child begins

on the second week of pre-natal development from two independent warm rudiments which then merge in one tube located in a neck. Since the end of the second month of pregnancy the placentary blood circulation remaining until the child`s birth (to this age the germ eats a gistotrofny way) is established. Warmly - the vascular system of a fruit is distinguished by functioning of the following three educations: oval opening, arterial and venous channels. They are necessary for dumping of excess blood and the help in work of heart in the conditions of lack of breath and low pressure. In the right auricle blood streams completely do not mix up as blood from the lower hollow vein goes through an oval window to the left auricle, and then to the left ventricle whereas blood from the top hollow vein directs through the right auricle in the right ventricle.

At the child`s birth lungs finish and filled with blood, fetalny blood ways (arantsiyev and arterial channels, an oval window and the remains of umbilical vessels) are closed. At newborns extra uterine blood circulation is established, small and big circles of blood circulation begin to function. Blood pressure from - for receipts of its large number increases in the left auricle, and the valve of an oval window is mechanically closed. Closing of an arterial channel happens under the influence of nervous, muscular and torsion factors.

meanwhile, heart of the newborn has a number of the anatomist - physiological features. At newborns heart rather big also makes 0,8% of body weight (about 22 g) whereas adults have 0,4%. The right and left ventricles are approximately equal, thickness of their walls makes 5 mm. With age there is an increase of mass of heart: by eight months weight doubles, by three years - trebles, by six years increases by 11 times. Anatomic heart of the newborn is located above, than at children of advanced age that is partially caused by higher standing of a diaphragm. Pulse at children of all age more frequent, than at adults. It is explained by faster contractility of a cardiac muscle in connection with smaller influence of the wandering nerve and more intensive metabolism. Normal rate of pulse of the newborn of 120 - 140 beats per minute, when feeding or crying increases to 160 - 200 blows. Then pulse rate at children gradually decreases with age. Shout, concern, temperature increase of a body always cause pulse increase in children. Respiratory arrhythmia is characteristic of pulse of children: on a breath it becomes frequent, on an exhalation - thins.

the Increased needs of fabrics of the growing organism for blood are satisfied with relative increase in minute volume of heart. Arterial pressure at children of subjects is lower, than the child is younger. At the newborn child systolic pressure averages about 70 mm of mercury., by a year it increases to 90 mm of mercury. Growth of pressure happens further most intensively in the first 2 - 3 years of life and in the pubertatny period. Increase of pressure goes parallel to growth of speed of distribution of a pulse wave on vessels of muscular type with age and is connected with increase of their tone.

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In heart of the child well developed a network of small arteries which provide good blood supply of a cardiac muscle. The main vessels have rather big sizes. Till 10 - 12 years at children the pulmonary artery is wider than an aorta, then their gleams become identical, and after puberty the return relationship is established. System of capillaries at children it is relative and absolute more widely, than at adults that causes difficulties in maintenance of a temperature homeostasis.

Summarizing everything told about the anatomist - physiological features it is warm - vascular system at children, one may say, that rather big mass of heart, rather wider openings of heart and gleams of vessels are the factors facilitating blood circulation at children. The small systolic volume of blood and high frequency are characteristic of children of early age the serdtsebiyeny, and minute volume of blood per unit mass of a body is rather big. Rather bigger amount of blood and feature of a power exchange at children force heart to perform work, rather big, than work of heart of the adult. Reserve opportunities of heart at early age are limited from - for bigger a rigidnost of a cardiac muscle, a short diastola and high heart rate. Lack of negative impact on a cardiac muscle of children`s heart of chronic and sharp infections, various intoxications is its advantage.

And from our window …

the Oval window call the opening in a mezhpredserdny partition with existence of the valve connecting the right and left auricles during pre-natal development and normal closed after the birth.

But it can be closed by

and not at once, and in several months or even years. The open oval window continuing to function after two years of life of the child characterizes the mezhpredserdny message without blood dumping. It is small anomaly of development of heart.

At 50% of children till one year the oval window continues to function, its anatomic closing has to come to the end by year, in certain cases two years of life.

Arterialny Canal begins to be closed by

in a few minutes after appearance of the kid on light and is finally closed by second week of life at a third of all children and by second month practically at all healthy kids. During this time dumping of blood from an aorta in a pulmonary artery and vice versa can be carried out. This tranzitorny blood circulation - a necessary stage of adaptation of the newborn to conditions of extra uterine existence.

At a raspravleniye of lungs of the newborn air and increase in a pulmonary blood-groove pressure increases in the left auricle and promotes closing of an oval window.

If the window is not closed by

.

the Open oval window which is not preventing work of heart is found in 50% of children at the age of 5 years and in 10-25% of adults. Only sometimes such pathology demands surgical intervention. Presence of an open oval window at the baby - not a reason for nervousness.

However in addition needs to survey and observe the child. At newborns the open oval window can sometimes accompany a respiratory distress - a syndrome, but more often anomaly does not give any noticeable manifestations. Closing of an opening in heart does not happen also at congenital defect owing to stretching of walls of auricles. At a soyedinitelnotkanny dysplasia, an alcoholic embriopatiya, prematurity of physiological closing of an oval window also does not occur.

When the doctor listens a stethoscope or a phonendoscope (in medicine it is called - an auskultation) to a thorax of the child, the open oval window often is the reason of existence of noise in heart.

Noise of heart

One of frequent signs of damage of heart are noise of heart. Warm noise are registered at more than a half of all born children today. There is an opinion that all children in some period of growth have a noise in heart, but its reasons are various. And though in most cases noise does not demonstrate existence of organic pathology of heart, it is necessary to treat him with great attention. Such children are subjected to additional inspections and observed at the cardiologist.

Noise are subdivided by

on systolic and diastolic. By origin they can be organic and functional. The first are characteristic of anomaly in development of heart, the reasons of emergence of functional noise can be various. Traditionally it is considered that systolic noise is more characteristic of its functional nature. Diastolic noise at children in most cases have organic genesis (reason) and arise at insufficiency of valves of an aorta and pulmonary artery; stenosis of the left and right atrioventricular openings; pathological dumping of blood into a diastola: defect of an aortolegochny partition, an open aortal channel etc.

Differ with

noise and on the loudness, duration, a timbre, a zone of the maximum localization and area of primary carrying out.

For descriptive reasons data on characteristics and the reasons of functional noise at children and teenagers can be displayed in the table:

to of to to to to to to to to to to to < / table>

But to the few parents knows that noise can accompany the small structural deviations in development of heart which do not have significant effect on its work or to reflect the considerable violations of a blood-groove connected with congenital heart disease.

it became clear to

With introduction to broad practice of ultrasonic research of heart (echocardiography) that any anatomic reason, that is they almost all “organic“ is surely necessary for emergence of noise. Therefore now it is considered more correct to divide noise on “innocent“ and “pathological“.

to Parents needs to be known: functional noise can occur also at almost healthy children during various age periods.

of the Reason of noise

the Most frequent reason of functional noise in heart are abnormally located chords of the left ventricle of heart. In a different way they can be called false chords. The false chord is fibrous or voloknisto - muscular tyazh which settles down in the left ventricle of heart, connecting among themselves its opposite walls (or the muscles called by papillary). Intensity of noise in heart depends on quantity and an arrangement of false chords. It is known that at children`s age of a false chord occur much more often than at adults. Partly this results from the fact that at children the left ventricle of heart has the ellipse form whereas at adults it on a configuration approaches a sphere. For this reason the ventricle extending with age can gradually push aside a falshchkhorda which will be attached to a surface of a cardiac muscle and as if self-destructs (but there is it not always). The false chord is anomaly, but at the same time is rather harmless. Abnormally located chord creates “noise“ effect, without breaking at the same time a blood-groove in heart. Nevertheless, there are data that false chords can be one of the reasons of emergence of violations of a rhythm of heart.

Falshkhord`s

not the only reason of noise in heart. The prolapse (progibaniye) of mitralny and aortal valves, an open oval opening (or “window“) and so on can be the cause of noise. The reasons, actually, a set …

Some of anomalies are the states demanding medical supervision and specialized medical care, others as if become obsolete over time. For example, there are purely functional noise which can accompany the course of the expressed anemia (anemia) and rickets, to be listened against high fever, heavy infectious process or during active growth of the child, and also in some other cases.

When needs to be examined?

It is very frequent at the first inspection of the newborn, make to the child the diagnosis “noise in heart“ without interpretation of its nature. For most of parents such diagnosis already sounds as a sentence. But you should not panic at once. Any noise in heart demands specification of the reason of its emergence, so, the child needs to be surveyed and observed at the cardiologist. Do not wait when it “passes itself“ (it can not occur). Now by the main method of studying of work of heart is ultrasonic - an echocardiography (an echo - KG).

Elektrokardiogramm`s (electrocardiogram)

will help to reveal violations of work of heart in due time. Ekhokardiogramma will add research, having found the reason of violations.

When the child with “functional“ noise in heart within many months (and even years) continues to be observed by the children`s cardiologist or the cardiorheumatologist, but at the same time to it ultrasonic research of heart is not conducted, the situation can be compared unless to sitting on a time bomb. Without carrying out this usual research on present times it is impossible to be sure that at the child behind a mask of “functional“ noise the serious pathologist does not disappeariya it is warm - vascular system. It is unlikely there will be such doctor who will risk to exclude with absolute confidence heart disease without carrying out special research. At the same time for the skilled diagnostician - the instrumentalist it is possible to specify (to confirm or disprove) the presumable diagnosis in only a few minutes.

What parents need to remember?

In order that the child had a healthy heart, it is necessary to watch carefully its daily routine, food, the general state of health and to competently distribute loadings. Psycho - emotional including. The raised loadings are not necessary to heart, but the child has to train the heart, that is lead active lifestyle: to spend sufficient time on the street, to regularly go on nature, play sports. In food it is necessary to pay attention to full-fledged proteins (meat, fish, cottage cheese, eggs), heart the same muscle as all others, and it it is necessary to feed. Fresh fruit and vegetables, and also dried fruits, broths rich with potassium and magnesium from them are useful. Be attentive and do not start the centers of a chronic infection at the child: even the notorious caries which is not cured in time is capable to reduce immunity and to start the mechanism which indirectly “will halloo“ at work of heart. Therefore regularly you drive the child on planned surveys not only to the cardiologist and the neurologist, but also on reception to other narrow experts to whom you will be channelized by the local pediatrician.

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Noise Approximate age the Temporary characteristic
Noise of a peripheral stenosis of a pulmonary artery Newborn Systolic noise of exile Bifurcation of a pulmonary artery
the Vibrating Steel`s noise of 3-8 years Systolic noise of exile Does not know the Origin
Carotid noise of 3-8 years Systolic noise of exile Carotids
Venous noise - “noise of a top“ of 3-8 years Continuous the Jugular and top hollow vein
Noise of a pulmonary blood-groove of 6-18 years Systolic noise of exile the Valve of a pulmonary artery