19: Cardiovascular problems
Think about the following health promotion opportunities in your clinical practice related to cardiovascular problems:
Dental care
Children with a cardiac condition need to pay particular attention to their dental hygiene. Tooth decay and gum disease can cause bacteria to enter the bloodstream which in turn can cause infective endocarditis, an infection of the inner lining of the heart. Although this is a very rare condition, it can prove life threatening. It is important therefore that children with a cardiac condition are registered with a dentist, attend regular check-ups and that the dentist is fully aware of their heart condition. In addition, good oral hygiene should be encouraged and excessive sugary foods and drinks should be avoided. Current NICE guidelines (CG064) do not routinely recommend antibiotic prophylaxis for dental treatment, but families should be advised to check with their Cardiologist or Cardiac Liaison Nurse.
Recreational drugs
Young people, particularly those with a cardiac condition should be made aware of the risks of recreational drugs. Not only could there be concerns regarding function of the heart, injecting drugs also increases the risk of infective endocarditis developing.
Body piercing\tattoos
These also increase the risk of bacteria entering the blood stream, thereby increasing the risk of infective endocarditis. It is strongly recommended that children/young people with a cardiac condition do not undergo tattooing or body piercing.
Pregnancy
Females with a cardiac condition need to be aware of the risks that an unplanned pregnancy could cause to both their own health and that of the baby. Ideally pregnancies should be planned, after consultation with a cardiologist. Children who have a cardiac condition, both male and female, are at increased risk of conceiving a child with a cardiac condition. Parents who already have a child with a cardiac condition are also at increased risk of having a subsequent child with a cardiac condition. Foetal heart anomaly screening is offered to all families who have a history of congenial cardiac disease.
Check-ups
It is really important that children attend all follow-up appointments. The interprofessional team need to be aware of cost\travel issues that some parents may face: often cardiac centres cover a wide area of the country and families have to travel some distance to attend appointments. Parents may be entitled to a number of benefits. Some hospitals have cardiac nurse specialists who are able to advise parents on what benefits they may be entitled to.
General health advice
It is important that children with a cardiac condition receive all their routine vaccinations. As their condition may make them more susceptible to other infections, they may also be advised to have additional vaccinations to protect against illnesses such as influenza and RSV (bronchiolitis).
All children benefit from exercise; however, children with a cardiac condition may have limitations on the amount of exercise they can safely perform. It is important that schools are kept informed of any specific advice from the child’s cardiologist. A varied diet with sufficient protein, fats and fruit and vegetables is also important to ensure the child receives adequate nutrition. Excessive salt and fat can cause damage to the heart and kidneys and should be avoided. A child’s emotional wellbeing should also be considered. Hospitalisation and living with a cardiac diagnosis can make the child feel different from their friends. The interprofessional team can work with parents to ensure that the family can access relevant support.
The weblink below has more detailed advice from Great Ormond Street’s website: