28
Feb

Nice Location to Avoid Crowded Boston

I looked online for an apartment for rent in Arlington MA because I simply couldn’t take another day of trying to commute around the city. I decided to move to Arlington, Massachusetts in order to get away from the crowds in Boston. Granted, Arlington isn’t that far from Boston (it’s only six miles north), but it makes a world of difference from the place I used to live which was smack dab in the city. I just got tired of the noise, the traffic, and the pollution. All that stuff gives you constant headache and it’s not healthy at all.

The best thing about the apartment complex where I now live is the people. Most of them are, like me, trying to escape hectic city life. Continue reading

24
Feb

I Just Picked Up the New Boss

I went down to Logan this morning and waited for the new boss to show up. Of course I knew that it was going to be a relative of the big boss in NYC. This is a big firm, but I thought it was going to be a man. The name that they gave me was Stevie, which is not always a nickname for Steven. It is also a nickname for Stephania. At any rate she was surprisingly attractive and the first thing I did was to show her some Boston luxury apartments for rent. She did not like the first two places that I showed her, but the third one was fine with her. Continue reading

18
Feb

I Am Doing Really Well

I guess that some guys are lucky and others are not. I must have gotten the luck from a couple of poor guys. I was going to school at UMass in Amherst when I met the girl, that was about seven months ago and at first it was not anything at all. We were usually in the library at the same time and we both knew some other people. She wanted help with her computer science studies and that is how it started. However at some point we started to date. Now she has a nice Arlington apartments and when my lease expired I moved in with her. Of course that is not the big thing, which is this job that she helped me to get. I went there expecting it to be a real interview, but in fact it turned out that the guy was shocked that I was actually qualified for the job. I asked him what was going on and he asked me if I really did not know. He opened his office door and pointed towards a portrait in the lobby. “That’s her grandfather” he said. Continue reading

26
Nov

Pediatric Cardiomyopathy

Pediatric Cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy is a chronic heart condition that involves the deterioration of the heart muscle (myocardium). The heart muscle becomes abnormally enlarged, thickened and or stiffened. Eventually the heart is unable to pump effectively and cannot supply the body with enough blood to function. In severe cases, cardiomyopathy can lead to heart failure or sudden death.

There are 5 forms of cardiomyopathy:

  • Dilated cardiomyopathy (DCM)
  • Hypertrophic cardiomyopathy (HCM)
  • Restrictive cardiomyopathy (RCM)
  • Arrhythmogenic right ventricular cardiomyopathy (ARCM)
  • Left ventricular non-compaction cardiomyopathy (LVNC)

Who gets cardiomyopathy?

Cardiomyopathy predominantly affects adults, but in rare instances affects infants and children. According to the North American Pediatric Cardiomyopathy Registry, one out of 100,000 children in the U.S. is diagnosed with cardiomyopathy each year. However, this is a conservative number because it does not include all types of cardiomyopathies. Cardiomyopathy can occur in any child regardless of age, gender, race or economic background.

Causes of cardiomyopathy in children:

There are many causes of cardiomyopathy in children, including some that are not fully understood. Common causes include:

  • Inheriting the condition from one or both parents
  • A viral infection
  • Toxins affecting other organs
  • Using chemotherapy drugs
  • Metabolic, mitochondrial or systemic diseases in parts of the body other than the heart

Despite advances in genetic testing, the exact cause remains unknown in 2/3 diagnosed children.

Symptoms of pediatric cardiomyopathy:

Occasionally, symptoms of pediatric cardiomyopathy can be mistaken as a cold, flu, asthma, or stomachache. Some affected children have no symptoms while others may experience any of the following symptoms:

  • Shortness of breath or rapid breathing
  • Dizziness and fainting
  • Irregular or rapid heartbeat
  • Abdominal bloating or swelling
  • Chest pain
  • Extreme fatigue

Infants may experience poor weight gain, extreme sleepiness, difficulty feeding or excessive sweating.

How is pediatric cardiomyopathy diagnosed?

A pediatric cardiologist confirms the diagnosis through an echocardiogram (echo) and electrocardiogram (EKG, or ECG). In some cases, other medical tests are necessary. Genetic testing may be recommended to verify the cause of the disease.

Since pediatric cardiomyopathy is rare, it is recommended to locate a children’s medical center with a wide range of experience in managing children with cardiomyopathy. Early diagnosis and treatment of the disease is essential to preventing complications and progression to heart failure.

Treatment options for cardiomyopathy:

There is no cure for cardiomyopathy, but the disease is treatable. Symptoms and complications can be well-controlled by medications, surgery, and implantable devices. The type of cardiomyopathy and its severity determines the treatment plan.

  • Medication is usually the first treatment option to improve the functioning of the heart.
  • An implantable cardioverter defibrillator (ICD) may be needed to regulate heartbeat in children with irregular heart rhythms (arrhythmia).
  • A surgical procedure called a myectomy may relieve some symptoms in children with HCM.
  • A heart transplant may be necessary if medical management is ineffective in controlling symptoms and preventing heart failure.

Genetic considerations:

Cardiomyopathy is often genetic, so it is important to assess a family’s inheritance risk and discuss family screening. A pediatric cardiologist and a pediatric geneticist should work together to form a screening plan and discuss genetic testing options.

How does the diagnosis impact a child’s lifestyle?

Although cardiomyopathy is a chronic condition, many children with cardiomyopathy lead a relatively normal life with few limitations. A diagnosis will likely involve more visits to the cardiologist and taking daily medications. Other adjustments may include restriction from competitive and contact sports, diet changes, and school accommodations.

About sudden cardiac arrest:

Often underdiagnosed, cardiomyopathy is the leading cause of sudden deaths in children under the age of 18. Because the disease can be present without symptoms, families should be aware of any family members who have heart disease or who died unexpectedly before age 50.

Warning signs of sudden cardiac arrest:

Recognizing the warning signs of sudden cardiac arrest is also important. If your child experiences any of the following, he or she should see a pediatric cardiologist for an extensive cardiac evaluation:

  • Chest pain or discomfort when being physically active
  • Unexplained fainting or near fainting
  • Excessive fatigue associated with exercise
  • Unusually fast heartbeat
Last Updated 9/26/2016
26
Nov

Parenting with a Congenital Heart Defect: Why Prioritizing Your Own Health is Important

Parenting with a Congenital Heart Defect: Why Prioritizing Your Own Health is Important

If you are a parent who lives with a congenital heart defect (CHD), it can be challenging to balance the day-to-day demands of being a mom or dad while living with and caring for your own health.

Who to Put First?

It may be difficult some days to figure out who to put first – your children or yourself. When it is hard to find the energy to even get out of bed, it is important to take care of your own physical and emotional needs first. As a parent, this may not sound “right,” but the best gift you can give your child is to also care for yourself.

A CHD can be unpredictable, as can your child’s needs. Plan ahead.

  • Ask for help. When a CHD overrules parenthood, call friends, family members or a sitter to help. Parenting changes with older children, but you still need to be okay with reaching out to others.
  • Find time to relax. Whether visiting with friends, seeing a movie, meditating, or just reading, it is essential to make relaxation a priority.
  • Lower your expectations. Your parenting style may be different from your sister’s or your friend’s, but that does not mean you are not a good parent. Lowering your expectations will help make meeting the challenges of parenting with a CHD seem easier.

Planning for the Future

Every person with a CHD should have a living will. It not only notifies your family members about your wishes, but it also guides them in decision making if you are unable to speak for yourself.

Once you have a living will, be sure to:

  • Store it in a safe place in your home and tell your family members where it is located. This is not a document to keep in the bank safety deposit box. It should be located in a secure but easily accessible spot in your home.
  • Talk to your family about the instructions included in your living will. Family members are more accepting of a loved one’s wishes if they are aware of what those are ahead of time.
  • Bring it to the hospital if you are admitted. Living wills are now required by hospitals so be sure to bring it with you if you are being admitted to the hospital

Additional information regarding congenital heart defects and lifelong cardiac care is available at the Congenital Heart Public Health Consortium (CHPHC) website, www.chphc.org. The CHPHC is housed at the American Academy of Pediatrics through a grant from the Centers for Disease Control and Prevention in an effort to utilize public health principles to affect change for those whose lives are impacted by a CHD. Organizational members of the Consortium represent the voice of providers, patients, families, clinicians and researchers.

Last Updated 11/7/2016
26
Nov

Irregular Heartbeat (Arrhythmia)

Irregular Heartbeat (Arrhythmia)

My child’s heart seems to beat very fast. Does she have an irregular heartbeat?

Your child’s heart rate normally will vary to some degree. Fever, crying, exercise, or other vigorous activity makes any heart beat faster. And the younger the child, the faster the normal heart rate will be. As your child gets older, her heart rate will slow down. A resting heart rate of 130 to 150 beats per minute is normal for a newborn infant, but it is too fast for a six-year-old child at rest. In a very athletic teenager, a resting heart rate of 50 to 60 beats per minute may be normal.

The heart’s regular rhythm or beat is maintained by a small electrical circuit that runs through nerves in the walls of the heart. When the circuit is working properly, the heartbeat is quite regular; but when there’s a problem in the circuit, an irregular heartbeat, or arrhythmia, can occur. Some children are born with abnormalities in this heart circuitry, but arrhythmias also can be caused by infections or chemical imbalances in the blood. Even in healthy children, there can be other variations in the rhythm of the heartbeat, including changes that occur just as a result of breathing. Such a fluctuation is called sinus arrhythmia, and requires no special evaluation or treatment because it is normal.

So-called premature heartbeats are another form of irregular rhythm that requires no treatment. If these occur in your child, she might say that her heart “skipped a beat” or did a “flip-flop.” Usually these symptoms do not indicate the presence of significant heart disease.

If your pediatrician says that your child has a true arrhythmia, it could mean that her heart beats faster than normal (tachycardia), very fast (flutter), fast and with no regularity (fibrillation), slower than normal (bradycardia), or that it has isolated early beats (premature beats). While true arrhythmias are not very common, when they do occur they can be serious. On rare occasions they can cause fainting or even heart failure. Fortunately, they can be treated successfully so it’s important to detect arrhythmias as early as possible.

Signs and symptoms

If your child has a true arrhythmia, your pediatrician probably will discover it during a routine visit. But should you notice any of the following warning signs between pediatric visits, notify your doctor immediately.

  • Your infant suddenly becomes pale and listless; her body feels limp.
  • Your child complains of her “heart beating fast,” when she’s not exercising.
  • She tells you she feels uncomfortable, weak, or dizzy.
  • She blacks out or faints.

Diagnosis

It’s unlikely that your child will ever experience any of these symptoms, but if she does, your pediatrician will perform additional tests and perhaps consult with a pediatric cardiologist. In the process the doctors may do an electrocardiogram (ECG), to better distinguish a normal sinus arrhythmia from a true arrhythmia. An ECG is a tape recording of the electrical impulses that make the heart beat, and it will allow the doctor to observe any irregularities more closely.

Sometimes your child’s unusual heartbeats may occur at unpredictable times, often not when the ECG is being taken. In that case the cardiologist may suggest that your child carry a small portable tape recorder that continuously records her heartbeat over a one- to two-day period. During this time you’ll be asked to keep a log of your child’s activities and symptoms. Correlating the ECG with your observations will permit a diagnosis to be made. For example, if your child feels her heart “flutter” and becomes dizzy at 2:15 P.M. and the ECG shows her heart suddenly beating faster at the same time, the diagnosis of tachycardia will probably be established.

Occasionally irregular heartbeats will occur only during exercise. If that’s the case with your child, the cardiologist may have your youngster ride a stationary bicycle or run on a treadmill while her heartbeat is being recorded. When your child is old enough to participate in sports, ask your pediatrician if any special tests or restrictions are necessary.

Last Updated 11/21/2015
26
Nov

High Blood Pressure in Children

High Blood Pressure in Children

Can children get high blood pressure?

We usually think of high blood pressure, or hypertension, as a problem that affects adults. But, in fact, this condition can be present at any age, even in infancy. About 5 of every 100 children have higher than normal blood pressure, although fewer than 1 in 100 has medically significant hypertension.

How blood pressure is measured?

The term blood pressure actually refers to two separate measurements:

  • Systolic blood pressure is the highest pressure reached in the arteries as the heart pumps blood out for circulation through the body.
  • Diastolic blood pressure is the much lower pressure that occurs in the arteries when the heart relaxes to take blood in between beats.

If either or both of these measurements are above the range found in healthy people of the same age and sex, it’s called hypertension.

Causes

In many cases, hypertension seems to develop with age. As a result, your child may show no signs of high blood pressure as an infant, but may develop the condition as she grows.

Children who are overweight are much more prone to have hypertension (as well as other health problems). By age 7, more than 50% of hypertension is due to obesity and this rises to 85-95% by adolescent years. Thus, good eating habits (without overeating and without emphasizing high-fat foods) and plenty of physical activity are important throughout the early years of childhood (and for the rest of her life).

When hypertension becomes severe in children, it’s often a symptom of another serious problem, such as kidney disease or abnormalities of the heart or of the nervous or endocrine (gland) system.

Early detection is key

Fortunately, high blood pressure can be controlled through dietary changes, medication, or a combination of the two.

However, if hypertension is allowed to continue or become worse over many years, the prolonged extra pressure can lead to heart failure or stroke in adulthood. Also, long-term hypertension causes changes in blood vessel walls that may result in damage to the kidneys, eyes, and other organs. For these reasons it’s important for children with hypertension to have their blood pressure checked regularly by their pediatrician, and for you to follow the doctor’s treatment advice carefully.

Signs and symptoms

In most routine physical examinations, your child’s blood pressure will be measured. This is how hypertension is usually discovered. Most often this condition causes no noticeable discomfort, but any of the following may indicate high blood pressure:

  • Headache
  • Dizziness
  • Shortness of breath
  • Visual disturbances
  • Fatigue

Diagnosis

If your child is found to have high blood pressure, your pediatrician will order tests to see if there is an underlying medical problem causing it. These tests include studies of the urine and blood. Sometimes special X-rays are used to examine the blood supply to the kidneys. If no medical problem can be found, your child will be diagnosed with essential hypertension. (In medical terms, the word essential refers only to the fact that no cause could be found.)

Managing your child’s high blood pressure

What will the doctor tell you to do? If obesity is the cause, the first step will be to have your child lose weight. This will need to be very closely monitored by your pediatrician. Not only will weight loss lower blood pressure, it can provide many other health benefits as well.

The next step toward reducing our child’s blood pressure is to limit the salt in her diet. Giving up the use of table salt and restricting salty foods can reverse mild hypertension and will help lower more serious blood pressure levels. You’ll also have to be cautious when shopping for packaged foods; most canned and processed foods contain a great deal of salt, so check labels carefully to make sure the items have little or no salt added.

Your pediatrician also may suggest that your child get more exercise. Physical activity seems to help regulate blood pressure and thus can reduce mild hypertension.

Medication

Once your pediatrician knows your child has high blood pressure, he’ll want to check it frequently to make sure the hypertension is not becoming more severe. Depending on how high the blood pressure is, the pediatrician may refer the child to a child hypertension specialist, usually a pediatric nephrologist (kidney specialist) or pediatric cardiologist (heart specialist). If it does become worse, it may be treated with medication as well as diet and exercise.

Many types of medications are available, which work through different parts of the body. When your child’s blood pressure is brought under control with diet or medication it is important to continue the treatment according to your doctor’s recommendations, including changes in diet, or the hypertension will return.

Prevention

It’s very important to detect hypertension early. Uncontrolled long-standing hypertension can have damaging ef­fects on several other organs in the body such as the heart, kidneys, and brain.

It is now recommended that all children have their blood pressure checked beginning at age three, sooner for those at high risk. These include infants who were preterm, or of low birth weight, who had a difficult or prolonged hospital stay. It also includes children who have congenital heart disease, who are receiving medications that might increase blood pressure, or who have any other condition that might lead to high blood pressure.

Because overweight children are more likely to develop hypertension (as well as other health problems), watch your child’s caloric intake and make sure she gets plenty of exercise. Even relatively small decreases in weight or small increases in physical activity may prevent hypertension in overweight children.

Last Updated 11/21/2015

26
Nov

Heart Murmur

Heart Murmur

What is a heart murmur?

Technically, a heart murmur is simply a noise heard between the beats of the heart. When a doctor listens to the heart, she hears a sound something like lub-dub, lub-dub, lub-dub. Most often, the period between the lub and the dub and between the dub and the lub is silent. If there is any sound during this period, it is called a murmur. Although the word is unsettling, murmurs are extremely common, and usually normal (that is, the sounds are causes by a healthy heart pumping blood normally).

“Innocent” murmurs

In preschool and school-age children, heart murmurs are almost always not a concern; the children require no special care, and the sound eventually disappears. These children have “normal” or so-called functional or innocent heart murmurs.

If your child has such a murmur, it probably will be discovered between the ages of one and five during a routine examination. The doctor then will listen carefully to determine if this is a “normal” heart murmur or one that might indicate a problem. Usually, just by listening to its sound, the pediatrician will be able to tell if a murmur is innocent (normal). If necessary, she will consult a pediatric cardiologist to be certain, but additional tests are usually not necessary.

On rare occasions, a pediatrician will hear a murmur that sounds abnormal enough to indicate that something might be wrong with the heart. If the doctor suspects this, your child will be referred to a pediatric cardiologist to enable a precise diagnosis to be made.

Heart murmurs and infants

When do heart murmurs become a concern? When they occur very early at birth or during the first six months of life. These murmurs are not functional or innocent, and most likely they will require the attention of a pediatric cardiologist immediately. They may be due to abnormal connections between the pumping chambers (septal defects) or the major blood vessels coming from the heart (e.g., transposition of vessels). Your infant will be observed for changes in skin color (turning blue), as well as breathing or feeding difficulties. He also may undergo additional tests, such as a chest X-ray, electrocardiogram (ECG), and an echocardiogram. This echocardiogram creates a picture of the inside of the heart by using sound waves. If all of these tests prove normal, then it is safe to conclude that the baby has an innocent murmur, but the cardiologist and pediatrician may want to see him again to be absolutely certain. The cardiologist and pediatrician together will make a decision as to next steps depending on the results of these tests.

When a specific condition called patent ductus arteriosus (PDA) occurs, it is often detected shortly after birth, most commonly in premature babies. It is a potentially serious condition in which blood circulates abnormally between two of the major arteries near the heart, due to the failure of a blood vessel (the ductus arteriosis) between these arteries to properly close. In most cases, the only symptom of PDA is a heart murmur until the ductus closes on its own shortly after birth, which often happens in otherwise healthy, full-term newborns. Sometimes, especially in premature babies, it may not close on its own, or it may be large and permit too much blood to pass through the lungs, which can place extra strain on the heart, forcing it to work harder and causing a rise in blood pressure in the arteries of the lungs. If this is the case, a medication or, rarely, surgery may be needed to help close the PDA.

Treatment

Innocent heart murmurs  are normal and therefore require no treatment. Children with these innocent heart murmers do not need repeated evaluation or long-term follow-up care from cardiologist, nor do they require restrictions on sports or other physical activities.

Innocent heart murmurs generally disappear by midadolescence. Cardiologists don’t know why they go away, any more than we know why they appear in the first place. In the meantime, don’t be discouraged if the murmur is softer on one visit to the pediatrician and loud again on the next. This may simply mean that your child’s heart is beating at a slightly different rate each time. Most likely the murmur will go away eventually.

Patent ductus arteriosus is a selfcorrecting problem in some cases, or medications can be used to close a PDA. But if the ductus arteriosus remains open, it may need to be corrected surgically or with a catheter.

If other, more serious, heart conditions are diagnosed from birth or shortly thereafter, and the evaluation reveals more serious defects, the pediatric cardiologist and pediatrician will consult a pediatric cardiac surgeon at a regional Pediatric Cardiac Center where complete pediatric cardiac diagnostic and intervention capabilities exist.

Last Updated 11/21/2015
26
Nov

Genetics and Congenital Heart Defects

Genetics and Congenital Heart Defects

A congenital heart defect (CHD) is the most common type of birth defect. It is estimated that 2 to 3 million people in the United States have a CHD.

Over the last few decades, treatments for CHDs have improved—meaning more children born with a CHD are growing up to have children of their own.

If you have a CHD, you might wonder what the risk is for your child to also have a CHD. You might also wonder whether pregnancy will affect your health. These are very important questions to discuss with your congenital cardiologist and perhaps other specialists, such as a maternal-fetal-medicine specialist and a geneticist or genetic counselor.

What causes a congenital heart defect?

CHDs are caused by genetics, the environment, or a combination of both. Some known genetic causes include:

  • Chromosome abnormalities: Extra or missing chromosomes.
  • Gene mutation: A change to the DNA sequence or order that makes up a gene.

About genetic testing:

There are two types of tests used with genetic testing: chromosomal and DNA. Recent advances in these tests have made it more possible to find the genetic cause of CHDs for many patients. Sometimes, however, a genetic change cannot be identified, but the cause can still be genetic.

How to reduce your baby’s risk of a congenital heart defect:

If you have a CHD, your baby has a higher risk of being born with a CHD. In fact, there is about a 5% chance your child will have a CHD, too. A geneticist or genetic counselor can help you determine if genetic testing might be helpful for you prior to becoming pregnant. See Preconception Counseling for Women with a Congenital Heart Defect for more information.

You might be asking yourself:

  • What can I do to lower my baby’s chance of being born with a CHD?
  • How might I be able to improve my baby’s outcome if he or she has a CHD? 

These are important questions to ask your medical care team, but some research suggests taking folate prior to conception and during pregnancy may decrease the risk of a CHD.

How a congenital heart defect is diagnosed in an unborn baby:

A CHD can be diagnosed very early in pregnancy (around 18 to 20 weeks) via an ultrasound of the baby’s heart, called a fetal echocardiogram.

If you have a CHD caused by a genetic change, your maternal-fetal-medicine specialist can perform either an amniocentesis or chorionic villus sampling to determine whether your unborn baby has the same genetic change. Both of these tests are done by inserting a needle into the womb to get a small tissue sample for testing

Additional information regarding congenital heart defects and lifelong cardiac care is available at the Congenital Heart Public Health Consortium (CHPHC) website, www.chphc.org. The CHPHC is housed at the American Academy of Pediatrics through a grant from the Centers for Disease Control and Prevention in an effort to utilize public health principles to affect change for those whose lives are impacted by a CHD. Organizational members of the Consortium represent the voice of providers, patients, families, clinicians and researchers.

Last Updated 11/7/2016
26
Nov

Common Heart Defects

Common Heart Defects

Congenital heart defects are structural problems arising from abnormal formation of the heart or major blood vessels. At least 1% of all live-born infants have a heart defect. The cause of a heart defect is most often unknown. Some defects may be small and may cause your child few problems; others are life-threatening.

Types of Congenital Heart Defects

There are 18 types of congenital heart defects recognized and many additional anatomic variations. The more common heart defects are listed below:

  • Atrial Septal Defect (ASD)
  • Atrioventricular Canal Defect
  • Coarctation of the Aorta (CoA)
  • Hypoplastic Left Heart Syndrome (HLHS)
  • Pulmonary Atresia
  • Pulmonary Stenosis (PS)
  • Tetralogy of Fallot
  • Total Anomalous Pulmonary Venous Connection (TAPVC)
  • Transposition of the Great Arteries
  • Tricuspid Atresia
  • Truncus Arteriosus
  • Ventricular Septal Defect

Outlook for Children Born with a Heart Defect

Even if your baby is born with a heart defect, it is very likely nowadays that he or she can live a normal adult life and overcome the problem. The many advances in the diagnosis and treatment have made it possible to correct defects via surgery and heart catheterization. Even the most difficult cases have hope now.

The diagnosis and treatment for other heart defects will continue to improve with new advancements and research. Talk with your child’s pediatric heart surgeon if you have specific questions about your child’s condition, treatment options, and expected outcomes.

Last Updated 11/21/2015