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Heart Conditions


Pediatric cardiomyopathy is a rare heart condition that affects infants and children. Specifically, cardiomyopathy means disease of the heart muscle (myocardium). Several different types of cardiomyopathy exist and the specific symptoms vary from case to case. In some cases, no symptoms may be present (asymptomatic); in many cases, cardiomyopathy is a progressive condition that may result in an impaired ability of the heart to pump blood; fatigue; heart block; irregular heartbeats (tachycardia); and, potentially, heart failure and sudden cardiac death.

Cardiomyopathy may be termed ischemic or nonischemic. Ischemic cardiomyopathy refers to cases that occur due to a lack of blood flow and oxygen (ischemia) to the heart. Such cases often result from hardening of the arteries (coronary artery disease). Nonischemic cardiomyopathy refers to cases that occur due to structural damage or malfunction of the heart muscle. Nearly all cases of pediatric cardiomyopathy are nonischemic. This report deals with nonischemic pediatric cardiomyopathy.

Cardiomyopathy may also be termed primary or secondary. Primary cardiomyopathy refers to cases where cardiomyopathy occurs by itself or for unknown reasons (idiopathic). Secondary cardiomyopathy refers to cases where the disease occurs secondary to a known cause such as heart muscle inflammation (myocarditis) caused by viral or bacterial infections; exposure to certain toxins such as heavy metals or excessive alcohol use; or certain disorders that affect the heart and/or additional organs systems.

According to the Pediatric Cardiomyopathy Registry, approximately 79 percent of pediatric cardiomyopathy cases occur for unknown reasons (idiopathic).

Nonischemic cardiomyopathy may be further divided into four subtypes based upon the specific changes within the heart. These subtypes are: dilated, hypertrophic, restrictive and arrhythmogenic right ventricular dysplasia.

Cardiomyopathy is a disease of the heart muscle. It affects people of all ages and is mostly inherited. It is not curable but can usually be treated successfully, with most of those affected going on to lead a long and full life.

There are several different types of cardiomyopathy three main types of cardiomyopathy – hypertrophic, dilated and arrhythmogenic right ventricular.


Early diagnosis


Increased awareness of the condition in recent years and recognition of subtle symptoms has helped early diagnosis and therefore early management. Without doubt, this can change the outcome of the condition and help to prevent complications. With the knowledge that the disease can be inherited, family screening has also contributed a great deal to early diagnosis. With knowledge of an existing or potential problem, lifestyle modifications and medication can be applied on time. Young people can be given appropriate advice when undergoing preventative screening and this is much better than treating an already severe condition.

Understanding the Condition

Understanding about the mechanisms and progression of heart dysfunction has significantly increased in the last few years. Studies have shown a number of mechanisms are activated when the heart function starts to go down and doctors are now trying to use these mechanisms in a beneficial way for the patient. In the context of a weak heart, the body’s reaction triggers compensatory mechanisms that can be helpful short term but damaging in the long term. Although it was previously thought that a weak heart needs medication that will make it beat more strongly, contemporary cardiology has been able to apply treatment that interferes with the more basic mechanisms.

An example of this is medication that prevents the heart condition from deteriorating further by keeping the heart rate and function mildly suppressed and under reasonable control. This is because studies have shown that the more you activate the failing heart, the worse it becomes in the long run. Whereas the more you protect the heart from its own compensatory reaction, the safer it is for the heart in the long term. So the philosophy in the management of heart dysfunction has changed over the years and is focusing on the prognosis and prevention of complications alongside the immediate reduction of symptoms

Congenital Heart Disease

Congenital heart disease is a category of heart disease that includes abnormalities in cardiovascular structures that occur before birth. These defects occur while the fetus is developing in the uterus and may affect approximately 1 in 100 children.

Congenital heart defects may produce symptoms at birth, during childhood, or not until adulthood. Other congenital defects may cause no symptoms.

What Causes Congenital Heart Disease?

The cause of congenital heart disease is unknown. However, there are some factors that are associated with an increased chance of having congenital heart disease. These risk factors include:

  • Genetic or chromosomal abnormalities in the child, such as Down syndrome
  • Taking certain medications or alcohol or drug abuse during pregnancy
  • Maternal viral infection, such as rubella (German measles) in the first trimester of pregnancy
  • The risk of having a child with congenital heart disease may double if a parent or a sibling has a congenital heart defect

What Types of Congenital Heart Problems Are There?

The most common congenital heart problems include:

  • Heart valve defects. These can result in a narrowing or stenosis of the valves, or a complete closure that impedes or obstructs forward blood flow. Other valve defects include leaky valves that don’t close properly, thereby allowing blood to leak backwards.
  • Defects in the walls between the atria and ventricles of the heart (atrial and ventricular septal defects).
  • Holes or passageways between the heart’s different chambers may allow abnormal mixing of oxygenated and unoxygenated blood between the right and left sides of the heart.
  • Heart muscle abnormalities that can lead to heart failure

There are several different types of CHD’s.

Atrial Septal Defect

A congenital defect in the interatrial septum of the heart.

Atrioventricular Septal Defect

A heart defect, where there are holes between the right and left chambers of the heart, and the valves, which control the way blood flows in the chambers, may not be formed correctly.

Coarctation of the Aorta (“Coarctation of the Aorta.”)

The aorta is the largest organ of the body, and its function is to move oxygen-rich blood to the entire body to provide it with oxygen. Coarctation occurs in any part of the aorta, but it usually occurs in the ductus arteriosus artery.

Depending on how much the aorta is narrowed, symptoms of this will be shown once someone enters adulthood.

Dextro-Transposition of the Great Arteries (d-TGA)

d-TGA is a birth defect where the two main arteries of the heart, the pulmonary and aorta artery, are switched in position.

Hypoplastic Left Heart Syndrome

A malformation of the heart in which the left side is underdeveloped, resulting in insufficient blood flow.

Pulmonary Atresia

This occurs when the valve that controls the blood flow from the heart to the lungs does not form at all.

Tetralogy of Fallot

It is characterized by pulmonary stenosis, an opening in the interventricular septum, malposition of the aorta over both ventricles, and hypertrophy over the right ventricle.

Tricuspid Atresia

Tricuspid is the valve that controls blood flow from the right atrium, the upper right chamber of the heart, to the right ventricle, the lower right chamber of the heart.

Total Anomalous Pulmonary Venous Return (TAPVR)

Oxygen-rich blood does not return to the left atrium from the lungs. Instead, oxygen-rich blood returns to the right side of the heart, where there are oxygen-poor cells. The oxygen-rich and oxygen-poor cells combine, so the baby gets less oxygen than it actually needs

Most babies usually have a hole between their right and left atrium to survive with this defect

Truncus Arteriosus

This defect occurs when the blood vessel coming out of the babies’ heart does not separate during its development. As a result, there is still a connection between the aorta and the pulmonary artery.

There are different types of Truncus, but the most common one is a hole between the bottom two chambers of the heart ventricles (ventricular septal defect).

Ventricular Septal Defect

This occurs during pregnancy, and it happens when the wall between the left and right ventricles does not develop, leaving a hole in the heart.

In this process, the blood flows from the left ventricle to the ventricular septal defect then to the right ventricle. This extra step forces the heart and the lungs to work harder, and this can result in higher blood pressure, irregular heart rhythms, or stroke.


What Are the Symptoms of Congenital Heart Disease in Adults?

Congentital heart disease may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all. In adults, if symptoms are present, they may include:

  • Shortness of breath
  • Limited ability to exercise

Congenital Heart Defects in Children

There are several congenital heart defects that are detected and treated early in infancy. Most of them are abnormal connections among the veins, as well as other arteries of the heart (aortic and pulmonary). These abnormal connections can allow unoxygenated blood to flow to the body instead of to the lungs, or allow oxygenated blood to flow to the lungs instead of to the body. They may also cause heart failure. Some examples of congenital heart disease in infants and children include:

  • Patent ductus arteriosus (when blood bypasses the lungs, preventing oxygen from circulating throughout the body)
  • Tetralogy of Fallot (four different heart defects that occur together)
  • Transposition of the great vessels (blood from the left side of the heart and right side of the heart intermix because the large artery connections are incorrect)
  • Coarctation of the aorta (a pinched aorta)
  • Heart valve problems

What Are the Symptoms of Congenital Heart Disease in Infants and Children?

The symptoms of congenital heart disease in infants and children include:

  • Cyanosis (a bluish tint to the skin, fingernails, and lips)
  • Fast breathing and poor feeding
  • Poor weight gain
  • Recurrent lung infections
  • Inability to exercise

How Are Congenital Heart Defects in Children Treated?

Some congenital heart defects will require surgery or an interventional procedure to repair the problem.

Children with congenital heart disease may also need treatment with medication to improve heart function.

Children and adults with congenital heart disease should be treated by a cardiologist who specializes in congenital heart disease. Some types of disease may require a team approach as the child grows into an adult.

Atrial Fibrillation

Atrial fibrillation (say “A-tree-uhl fih-bruh-LAY-shun”) is an irregular heart rhythm (arrhythmia) that starts in the upper parts (atria) of the heart. Atrial fibrillation is the most common type of persistent irregular heartbeat (arrhythmia).

Normally, the heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with the heart’s electrical system causes the atria to quiver, or fibrillate. The quivering upsets the normal rhythm between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm.

Atrial fibrillation is dangerous because it greatly increases the risk of stroke. If the heart doesn’t beat strongly, blood can collect, or pool, in the atria. Pooled blood is more likely to form clots. If the heart pumps a clot into the bloodstream, the clot can travel to the brain and block blood flow, causing a stroke. Atrial fibrillation can also lead to heart failure.


What causes atrial fibrillation?

Conditions that damage or strain the heart commonly cause atrial fibrillation.

These include:

  • High blood pressure
  • Coronary artery disease (CAD)
  • Heart attack
  • Heart valve disease, especially diseases of the mitral valve

What are the symptoms?

Symptoms may include:

  • Feeling dizzy or lightheaded
  • Feeling out of breath
  • Feeling weak and tired
  • A feeling that the heart is fluttering, racing, or pounding (palpitations)
  • A feeling that the heart is beating unevenly
  • Chest pain (angina)

Third-Degree Atrioventricular Block

When DJ was 17 months old a horrible virus caused a Third-Degree Atrioventricular Block.

What is a Third-Degree Atrioventricular Block?

It’s a medical condition where the SA node (the hearts natural pacemaker; sets the heart rate) cannot do its job of sending impulses to propagate the ventricles (start the pump of blood throughout the body). The body does have a backup plan for if the SA node fails, the AV node is considered the secondary pacemaker. The AV node is only 40-60 beats per minute and the SA node is 60-100 beats per minute, which is a great decrease of blood pressure.

Anything less than 60 beats per minute causes bradycardia which will become a serious problem if the heart doesn’t pump enough oxygen rich blood to the body. A Third-Degree Atrioventricular block is when the AV is also blocked, and its classified as a complete heart block in many cases, where bradycardia is a common symptom.


What are the treatments?

In some less severe cases the heart block can go away on its own if the factor causing it are treated, such as changing medications or taking medications to increase heart rate (short term solution). The cure is a permanent pacemaker, which is what DJ got surgery for after the virus in his heart caused the third-degree atrioventricular block when he was 17 months old. The pacing may not be successful if the underlying diseases causing the heart block don’t receive treatment. Unfortunately, what caused DJs heart block was an underlying virus that was never seen before, or since. The virus was dormmate for 16 years after his surgery, until it woke up and destroyed his heart in a matter of weeks by causing cardiomyopathy (hard for the heart to deliver blood to the body) which lead to his passing.

How to tell if you have one (symptoms):

  • Light headedness
  • Dizziness
  • Fainting
  • Fatigue
  • Chest Pain
  • Bradycardia (slow heartbeat)
  • Shortness of breath

Seek medical attention if experiencing any of these symptoms, especially if having past heart problems or family history of third-degree atrioventricular block.

What causes a third-degree atrioventricular block?

A third-degree AV block can be caused by damage to the heart from surgery, damage to the heart muscle from a heart attack, heart disease that results in muscle damage, heart valve disease, some medications, rheumatic fever (results if strep throat is not treated properly) and sarcoidosis (growth of tiny collections of inflammatory cells in different parts of the body). Some babies are born with a heart block and it may also be genetic factors. In DJs case it was a virus he contracted at 17 months old.

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Nutrition for Pediatric Cardiomyopathy

The goal is to decrease chances of obesity and clogged arteries with the healthiest options out there. Diligently eating healthy is the most important preventative to cardiomyopathy, which includes eating less salt, less fats, and more nutrients.


  • Low saturated fats and low trans fats: lean meat (chicken, turkey, fish)
  • You should also be drinking low fat milk and dairy products to maintain blood pressure levels.
  • Replace salty seasonings with lemon, pepper, garlic, onions, or other spices (ginger, cinnamon, parsley, oregano, so much more)
  • Eat vegetables, about 6-8 a day.
  • For children (and anyone who needs a more abundant diet with more calories), it’s important that they get a great amount of protein and fatty acids to support growth and energy, but of course still being cautious of too much (foods from animals like eggs, milk, meat for high protein intake, carbs from grain like pasta or bread and carbs from vegetables like corn or potatoes)
  • To prevent inflammation, eat fatty fish and vegetable oils like soybean, canola, etc. that are high in alpha-linolenic acid.
  • Meat and seafood is not only good for protein, fatty acids, and nutrients, but is also high in selenium which is a common link to many diseases including cardiomyopathy, even though this mineral is greatly overlooked.

Patients with cardiomyopathy are at a greater risk of obesity and clogged arteries. Preventative measures such as eating healthy and avoiding carbs is not as straightforward at a first glance, especially when there are fats we still need to be consuming and stereotypically healthy foods that can actually be harmful.

One of the most important food choices should be reducing salt intake to avoid high blood pressure. Salt is pretty much everywhere, especially in large quantities in processed or canned foods, so make sure to watch out for packaged foods with more than 350 mg of sodium. Frozen or fresh foods are some of the healthiest options without extra salt from processing. For carbs and fats, we still need them! Just in moderation and from healthy sources.

Nutrition for Congenital Heart Disease

The main priority for their nutrition is to improve their growth rate and get more calories in a healthy way to make sure they are getting the proper nutrients they need without having to eat more, which can decrease their energy.

  • Eat simple foods to add calories/protein including vegetable/coconut oil, peanut butter, nuts, butter/milk/dairy products that can easily be incorporated in many foods like putting on toast or adding to oatmeal, creamy sauces and dressings, bacon, ribs, chicken, etc.
  • Enforce a strict schedule for when to eat. Patients should eat frequently with healthy/nutritious snacks throughout the day to sustain energy, and should eat at around every 2-3 hours.

Children can get tired easily when feeding, and they may also have malabsorption from reduced blood flow which may limit the amount of nutrients and calories their body is profiting from even with a good diet.

Patients should be consuming foods with a lot of calories because their energy depletes faster from having to take more breaths and need calories to keep up with their energy. Maximize calorie intake whenever possible, for example, by adding cheese or butter to bread or making sure they drink a lot of milk/dairy. Calorie intake is also important to aid in growth, since CHD patients make growth failures. Infants need 24-30 calories per ounce of body weight.

Some children cannot simply just ‘eat more’ to increase body weight or gain more energy because the eating can be fatiguing and expends more energy for them.

They can also take glucose polymer supplements to aid in their intake to gain energy. Glucose is very important to maintain energy that all parts of their body needs. Food pumps can also be used if they are still calorie deficient and malnourished. Because they do not need to expend more energy to eat, they are getting the right nutrients and calories from the food without having to waste any energy. Bad blood flow is harmful to CHD patients because the heart will have to work harder to pump blood, which can exhaust its energy. Still remember to maintain a good and healthy diet to avoid other heart diseases like atherosclerosis or coronary heart disease.

Nutrition for Atrial Fibrillation

Patients with atrial fibrillation should keep up with a strict, healthy diet that may sound intimidating at first but, in reality, entails a wide range of natural foods and a colorful palette. The best diet is the meditarrean diet which is a plant based diet with a lot of vegetables, fruits, and whole grains.


  • Unsaturated fats like olive oil and avocado oil for natural source of protein and carbs.
  • Omega 3 is important for reducing heart risks. Eat salmon, avocado, walnuts, cauliflower, and much more.
  • Protein is vital to prevent AFib risks. Eat more lean meats and healthy proteins, have 10-20 extra grams of protein per day. The amount you have in total varies depending on weight. Try this calculator if you want an exact amount.
  • Fruits are important but still can have a lot of sugar, choose less sugary ones like peaches, berries, watermelon, etc.
  • Adding on to eating a lot of vegetables, eat an array of color (think of adding as much variety as possible) ex: carrots, peppers, cucumbers, turnips, tomatoes, and dark purples or reds which are very healthy.

Avoid caffeine (coffee, tea, energy, etc.) and red meats. Red meats have high levels of saturated fats and may contribute to atrial fibrillation. Aim to lower cholesterol levels by avoiding red meats and processed foods. Excess tyramine raises blood pressure and can cause pain from increased AFib symptoms. To prevent high levels of tyramine, avoid blue cheese, swiss cheese, sausage, pepperoni, salami, salty sauces like soy sauce, fava beans, dried fruits and citrus fruits (to reduce biogenic amines/BA). Also reduce foods with trans fats, which are found in the majority of common processed foods/junk foods.

Carbs are known to be main contributors to heart disease but we still need carbs to survive. Eating less carbs causes inflammation and oxidative stress (symptoms of stress: pain, fatigue, etc. from an imbalance of oxygen levels and antioxidants in the body). Healthy sources of carbs include whole grains, fruits low in sugar, and vegetables

Nutrition for Tetralogy of Fallot

Although Tetralogy of Fallot can only be cured with heart surgery, these food tips can be beneficial to maintain oxygen levels which are obstructed from TOF.


  • Intake a proper amount of water (based on water being necessary to replenish oxygen levels)
  • Foods to increase oxygen levels consist of: red meat like beef, fish, beans, and leafy vegetables like kale, broccoli, or celery.
  • Foods that are rich in iron are also very beneficial to increasing oxygen levels and maintain energy for tetralogy of fallot patients.
  • Add more B12 by eating fish, beef, dairy products, eggs, and maybe even B12 supplements.
  • Add more Vitamin A by eating orange colored fruits and vegetables like potatoes, carrots, cantaloupe, pumpkin, mangos, etc.
  • Other foods for oxygen: lemons, sweet fruits like watermelon or pineapple, grains, and dates/ currents.
  • Foods that release nitric oxide consist of dark purple vegetables like beets or pomegranates, nuts, fruits high in Vitamin C like oranges, garlic, and spices like turmeric or cayenne pepper.

Some patients may experience hypoxia where their skin turns blue due to an oxygen deficit, they may need diuretics, less salt in their diet, and intake a proper amount of water to replenish oxygen levels.

Blood circulation is important to make sure that oxygen in the blood is being distributed efficiently throughout the body and, most importantly, to the heart. Foods that support blood circulation are meant to release nitric oxide and allow blood vessels to expand which makes it easier for blood to flow through and improve circulations.

Along with blood circulation, oxygen levels must be stable to maintain energy for Tetralogy of Fallot patients with foods that are rich in iron.

Lacking vitamins like B-12 or Vitamin A can also weaken oxygen levels. Hemoglobin is responsible for maintaining oxygen in your red blood cells. Vitamin A also helps to produce red blood cells that carry oxygen in your blood.

Family Cooking

Tetralogy of Fallot patients are at risk of having irregular heartbeats. A heart healthy diet will prevent more complications such as clogged arteries or lack of nutrients to put less stress on the heart. Although it isn’t necessary to completely shift your diet, make sure to eat a proper amount of vegetables, whole grains, fruit, low fat/low salt foods, and good sources of protein. Overall, a heart healthy diet is vital to keep the heart strong and to function at its full potential for patients that have experienced complications with a weak heart either from not receiving a proper amount of oxygen or having irregular heartbeats.

Nutrition for Kawasaki Disease

Statistically, KD is most common in Asian descents which might be because they consume more soy. Soy contains high levels of isoflavones which interferes with the body’s ability to properly adhere to inflammatory response. It is important to regulate cholesterol levels with a heart healthy diet.


  • Foods to decrease inflammation include foods with omega 3s like salmon, tuna, grapes, blueberries, and possibly incorporate traits of a Mediterranean diet for the best results.
  • Foods that are high in thiamine include black beans, pork, acorn squash, bread/wheat products, freshwater fish like salmon or trout, and beef.
  • Foods high in Vitamin D include cod, mushrooms, fortified milk, and fortified orange juice (fortified means that there are extra nutrients and minerals added to the product).
  • Breastfeeding over infant formula has also shown to decrease the chances of diseases, including Kawasaki Disease. Lactoferrin, lysozyme, and other enzymes/proteins found in breast milk act as a defense against diseases for infants, although it is not a 100% preventative for Kawasaki Disease.

Soy contains high levels of isoflavones which interferes with the body’s ability to properly adhere to inflammatory response. Despite the obvious sources of soy coming from soy milk or soy nuts, other foods to avoid that are high in soy consist of tofu, edamame, bean sprouts, miso soup, soy sauce, and teriyaki sauce just to name a few.

Patients with Kawasaki Disease experience inflamed blood vessels and can seriously damage organs in the long run. In addition, a high intake of sugar has been a common contributing factor to worsen the symptoms of Kawasaki Disease so a healthy diet will be very beneficial for patients.

Thiamine deficiency, lack of B1 Vitamin, is another factor that is very dangerous and serves somewhat as a cascading effect that leads to other complications and abnormalities. A Vitamin D deficiency has also shown to be linked to Kawasaki Disease because it also disrupts the inflammation process in your body which puts patients at a greater risk for inflamed blood vessels.

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