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Cardiac Conditions in Teens

Teenagers frequently experience chest pain. Rarely, though, is the symptom related to the heart. Nevertheless, such complaints should be brought to the attention of your pediatrician, who will diagnose the problem through process of elimination.

“Usually, just asking the patient questions points us to the source of the pain,” says Dr. Reginald L. Washington, a pediatric cardiologist from Denver. Among the red flags he looks for are chest pain upon physical exertion and chest pain accompanied by dizziness. “Those situations would warrant further evaluation,” he says, “but most of the time the cause turns out to be anxiety, too much caffeine, asthma, muscle strain or costochondritis.” The latter condition, an inflammation of the chest wall, is treated with rest, over-the counter anti-inflammatory medications and heat.

High Blood Pressure (Hypertension) and High Blood Cholesterol (Hypercholesteremia)

Doctors once believed that virtually all high blood pressure in youngsters was a complication of another medical condition, such as kidney disease. We now know that even infants can develop primary hypertension, also referred to as essential hypertension. Abnormally elevated levels of the fatlike substance cholesterol in the circulation are also sometimes seen in teenagers. Either problem can pave the way for a future heart attack, cerebral stroke, renal failure, or blindness, among other conditions.

Symptoms that Suggest Primary Hypertension or Hypercholesteremia Include:

  • Dizziness and/or headache from high blood pressure
  • High cholesterol does not cause symptoms in teenagers

How Hypertension and Hypercholesteremia are Diagnosed

Diagnostic measures include physical examination and thorough medical history, plus one or more of the following procedures: (1) multiple blood pressure readings (2) cholesterol blood test.

In teenagers, an abnormally high blood-pressure measurement calls for a second reading, then several additional readings over the course of other office visits before a definitive diagnosis is made. The first number represents the systolic pressure: the peak pressure within the blood vessels when the heart contracts. The second number expresses the diastolic blood pressure reached when the heart relaxes between beats. If the blood pressure remains elevated, more extensive laboratory tests would be  ordered, along with an electrocardiogram (EKG).

Memo to Mom and Dad: Stress can contribute to hypertension. As parents of a teenager, have you had your blood pressure taken lately?

How Hypertension and Hypercholesteremia are Treated

Improved diet and exercise: Both hypertension and hypercholesteremia are uncommon among teenagers. Often, studying the family tree reveals a genetic thread entwined throughout its branches. About half of all youngsters diagnosed with hypertension and two-thirds of those with high cholesterol have a hereditary predisposition to the disorder. “The rest of the cases are due to poor dietary practices and a lack of physical activity,” says Dr. Washington. “In general, those are the easiest to treat. If they learn to eat healthily and engage in aerobic exercise, almost all of them can get their blood pressure and cholesterol down into a normal range.” Even if your youngster’s blood pressure and cholesterol level are normal, we advise following the sensible eating plan. Getting into the habit of choosing foods that are low in saturated fat, cholesterol and salt may help prevent cardiovascular disease later in life.

Drug therapy: Adolescents who fall into the high-risk categories for hypertension or hypercholesteremia may require medication in addition to modifying their diet and lifestyle. Agents typically used to bring down the concentration of cholesterol in the blood include cholestyramine, clofibrate and statins.

To lower blood pressure, a pediatrician might prescribe a diuretic in combination with an agent from one of four families: beta-blockers, angiotensinconverting-enzyme inhibitors or ACE inhibitors; calcium-channel blockers; and alpha-beta blockers. Diuretics, also known as “water pills,” act on the kidneys to flush excess water and sodium (salt) from the body. The other medications reduce blood pressure through various mechanisms.

Helping Teenagers to Help Themselves

Youngsters with or without hypertension or hypercholesteremia should be encouraged to:

  • Maintain a healthy weight.
  • Engage in aerobic exercise for at least thirty minutes per day.
  • Abstain from using tobacco or alcohol.
  • Learn techniques for relieving stress, be it exercise, deep breathing or meditation.
  • Consult the pediatrician if considering taking birth-control pills. Although neither condition is common in healthy teens, oral contraceptives can worsen both high blood pressure and high blood cholesterol.

Mitral Valve Prolapse (MVP)

Four flap like valves regulate the flow of blood through the heart’s four chambers. The mitral valve is situated in the left side of the heart, the side that receives freshly oxygenated blood from the lung, then pumps it out to the circulation. Under normal circumstances, the valve opens to let blood pass from the upper left chamber (the left atrium) into the lower left chamber (the left ventricle). Approximately one in eight otherwise healthy adolescents and young adults are found to have mitral valve prolapse. For reasons that remain unclear, one or both flippers billows out (prolapses) into the upper chamber instead of snapping shut. This can produce a clicking sound, audible through the pediatrician's stethoscope. Occasionally, blood may leak backward into the atrium, causing a murmur.  “The sounds usually come and go,” says Dr. Washington. Some youngsters with mitral valve prolapse have both a click and a murmur, while others have no abnormal heart noises at all.

Symptoms that Suggest Mitral Valve Prolapse May Include:

  • Abnormal heart murmur
  • Fluttering sensation in the chest, as if the heart were racing or skipping a beat
  • Shortness of breath
  • Headache
  • Sharp, fleeting chest pain

Nineteen out of twenty people with mitral valve prolapse do not exhibit any symptoms; the condition is discovered during a routine physical.

How Mitral Valve Prolapse is Diagnosed

Physical examination and thorough medical history, plus one or more of the following procedures:

  • Stethoscopic exam
  • echocardiogram
  • chest X ray

How Mitral Valve Prolapse is Treated

“The vast majority of people with mitral valve prolapse can go about their lives without having to worry about the condition or restrict athletic activities,” explains Dr. Washington. Under certain circumstances, however, a leaky mitral valve can become infected. To reduce the risk of endocarditis, rare though it may be, the current recommendation is for antibiotics to be taken just prior to dental appointments and surgical procedures.

Helping Teenagers to Help Themselves

Reducing caffeine consumption can help alleviate heart palpitations. Remember that caffeine is present not only in coffee but in soda, chocolate and tea.

Heart Murmur: Language of the Heart

“A heart murmur,” explains Dr. Washington, “is merely the sound of the heart vibrating slightly or valves opening and closing as blood flows through it. There are probably fifty different types, each with its own distinctive sound. Most of them,” he emphasizes, “are perfectly normal.” As many as four in five young people have these “innocent” murmurs now and then. Unless the murmur occurs during a doctor’s visit, it generally goes undetected. An abnormal murmur, which a pediatrician can identify with a stethoscope, indicates a heart condition that may require further diagnostic testing, possibly by a pediatric cardiologist. Possible causes include infections of the heart (endocarditis, myocarditis), faulty valves and cardiac defects that had been present since birth. Normal heart murmurs don’t call for limits on activities. With abnormal murmurs, says Dr. Washington, “the underlying cause will determine whether restrictions are necessary.”

Last Updated
Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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