Introduction

Coronary heart disease (CHD) or coronary artery disease is a term to identify the condition which takes place when the arteries or the blood vessel that takes the oxygen to the heart starts to narrow. It is sometimes also referred to as Ischaemic heart disease.¹ Over time this can often lead to serious and fatal  cardiovascular conditions including heart attack, heart failure and even deaths.

CHD is often seen in adults due to various lifestyle factors, and can also occur in children. However the causes and symptoms included are quite different when compared to each other. 

This article focuses on the few differences between CHD in adults vs children. 

Causes and Risk Factors

Causes in adults 

Lifestyle related problems

In Adults, CHD is usually governed by lifestyle choices. These include smoking, excess alcohol consumption, high fat diet, and lack of physical exercise. These factors can cause buildup of plaque inside the arteries, leading to atherosclerosis. Over time, this plaque can harden and narrow the arteries, reducing blood flow to the heart and potentially leading to heart failure.

Age- Related Changes

Aging is related to higher risk for CHD. On aging, the arteries may lose elasticity. Moreover, age-related chronic diseases like diabetes, hypertension, or cholesterol may increase the risk of CHD. 

Genetic predisposition

Individuals with a family history of heart disease are at a significantly higher risk of developing coronary heart disease (CHD) due to genetic predisposition.² 

Causes in Children 

Congenital Heart Defects (CHDs)

Unlike adults, children suffer from congenital heart defects or structural defects in heart that are present from birth.These may be due to defects in heart valves, blood walls, and may or may not require surgeries depending on the complexities.³ 

Acquired conditions

Acquired CHD occurs after birth usually due to viral/bacterial disease, including conditions like Kawasaki Disease, which leads to inflammation in arteries. Rheumatic fever is the most common cause of acquired heart condition in children.⁴ Although these conditions are uncommon, early detection and treatment are of utmost importance.

Genetic Factors

Genetics play a crucial role in causing CHD in children. Genetic disorders are associated with increased risk of congenital disease. Genes involved in carbohydrate metabolism coagulation and immune system also play an important genetic factor in CHD.⁵ 

Symptoms and Presentation

Sometimes CHD is silent, which means you do not have specific symptoms until experiencing a heart attack or other complications. Typically in adults, most CHD symptoms include  chest pain or discomfort often described as angina, shortness of breath, fatigue,light-headedness, and neck pain. Angina is the feeling of pressure or fullness in the chest which might radiate to arms, neck, shoulders, or back.

Atypical symptoms of CHD include less obvious symptoms in women who face more risk in CHD without the common symptoms such as nausea, sweating, extreme dizziness, and stomach pain.⁶ 

In children, congenital heart defects dependent symptoms include rapid heavy breathing, excessive sweating, pale or grey skin or lips, and difficulty in gaining weight.⁷ As children grow, symptoms evolve and more often have palpitations.

Diagnosis

Diagnosing CHD involves a combination of risk assessment tests like patient history, physical examination, and various tests to assess the heart’s function and structure.

Diagnostic approaches for Adults 

These involve non-invasive tests such as an electrocardiogram (ECG) which records electrical activity of the heart, and echocardiography which utilises ultrasound to visualise the heart structure and function. Stress tests are also used to evaluate how the heart works under stress conditions.Advanced diagnostic techniques like coronary angiography are used to visualise blockage; MRI or CT scans can be conducted if a blockage is suspected.⁸ 

Diagnostic approaches for Children

In case of children, pre-birth cardiac defects can be visualised during routine pregnancy ultrasounds, also known as foetal ultrasound. Foetal Echocardiography is a primary diagnostic tool that can provide a detailed image of heart anatomy which is the main focus in visualising structural defects in children. In some cases, MRI or CT scans may be used for more detailed imaging. Cardiac catheterisation, in which a thin tube is inserted into the heart, is needed to provide precise information on blood flow and how the heart works.⁹ 

Treatment Approaches

Early detection is crucial for treatment to be effective. The three main approaches to treating CHD include:

• Lifestyle modification- the first step in preventing further progression include lifestyle changes, such as quitting smoking, adopting a healthy diet, exercising regularly, and stress management. These changes can significantly reduce the risk factors and help in improving overall heart health.
• Medications- medication may be prescribed to manage the symptoms, prevent complications and manage risk factors. These may include statins to reduce high levels of cholesterol, and beta- blockers and ACE inhibitors to reduce heart strain and lower blood pressure.
• Surgical interventions- in more severe cases, interventions like angioplasty and coronary artery bypass grafting are commonly used to open or reroute blocked arteries.¹⁰

Treatment and management in children

For children with congenital heart defects, treatment depends on the severity and specificity of heart defect. Some minor defects may not have long term effect and may not require intervention with timely monitoring. However, severe defects might require surgical correction such as heart surgery or heart transplant, foetal cardiac intervention, and catheter-based interventions. 

• Medications treatment - medication may be prescribed to manage the symptoms and prevent complications such as diuretics to reduce fluid build-up and cardiac strain, or antiarrhythmic drug to regulate heartbeats 
• Long-Term Monitoring: children with congenital heart defects often need long-term follow-up with a paediatric cardiologist to monitor their condition, assess growth and development, and adjust treatment plans as needed.⁹

Prognosis and Long-Term Management

• Long term management in adults:focus on Prevention- 
  • For adults, managing CHD includes preventing further worsening of disease which is essentially done by focusing on mitigation of risk factors. These include improving lifestyle by regular exercise, quitting smoking, and following a healthy diet. 
  • Additionally, routine check-up with a healthcare provider is crucial to monitor cholesterol level, blood pressure, and other risk factors. 
• Long term management in children
  • As children grow, they might face challenges such as the need for additional surgeries or procedures, which involves lifelong care for congenital defects.¹¹

Psychological and Social Impacts

People suffering from CHD aren't just physically challenged but are also affected mentally and emotionally. A systematic study found that there is modest evidence linking work-related stress to incident CHD. Both adults and children with CHD face psychological and emotional challenges. Adults may experience stress, anxiety, or depression due to lifestyle changes or the chronic nature of the disease. Children and their families often deal with developmental challenges, social isolation, and the emotional burden of managing a lifelong condition.¹²

Summary 

Coronary heart disease may similarly affect adults and children alike, however, it is brought on by very different causes, symptoms, and treatments. Whether it be addressing lifestyle factors in adults or the management of congenital defects in children, understanding these differences is paramount to better care.

For both groups, early detection, individualised treatment plans, and ongoing support are vital to managing this complex disease. We can further help people cope with CHD, regardless of age, through awareness and early detection. By raising awareness and understanding  CHD in adults and children, we can help promote better health outcomes and quality of life for all those affected by this condition.