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Abstract

In this monograph, measures are discussed that should be undertaken during childhood to prevent heart disease.Known causes of congenital heart disease include maternal rubella, ingestion of thalidomide during pregnancy, chromosomal anomalies and somatic syndrome complexes. Appropriate preventive measures are immunization with live-attenuated rubella vaccine and avoidance of unnecessary medications during pregnancy. Analysis of chromosomes and genetic counseling in families with an infant with Down's syndrome may be a preventive measure. Prenatal diagnosis of hereditary defects associated with CHD seems to be a promising area of prevention. The outlined etiologic factors account for less than 6% of CHD. Multifactorial inheritance (genetic-environmental interaction) may be responsible for the majority of the CHD. Appropriate genetic counseling and quoting the risk of recurrence is all that one usually can do.Acute rheumatic fever (ARF) is causally related to streptococcal throat infection. Prevention of first attacks of ARF by prompt identification and adequate treatment of streptococcal pharyngitis and prevention of recurrences of ARF with monthly doses of long-acting penicillin seem appropriate. Orodental or other surgical procedures produce transitory bacteremia and these bacteria may lodge on the diseased or deformed heart valves or endocardium and cause endocarditis. Antibiotics are recommended for preventing endocarditis in any patient with a congenital or acquired heart defect 1–2 hours prior to and for 2 days following any potentially bacteremia-producing procedure.The etiology of atherosclerosis is not clearly established. In longitudinal epidemiologic studies, the concept of “risk factors” was developed, which indicates any personal characteristic(s) that is associated with a higher than average incidence of atherosclerosis. Risk factor modification for the adult population to reduce the incidence of atherosclerosis appears to be generally accepted. Despite lack of concrete evidence for effectiveness of risk factor modification in the pediatric age group, many groups of workers recommend such a modification. These include a lowfat and low-cholesterol diet for all children (beyond infancy), screening for hyperlipidemia and prompt treatment if detected, routine blood pressure recording in the pediatrician's office, lowering of dietary salt intake, discouraging cigarette smoking, prevention (or early treatment) of obesity, encouraging moderate exercise and monitoring carbohydrate tolerance of progeny of diabetic patients. Identification of children at risk by a family history of premature onset of an atherosclerotic event may be more practical because of a higher yield. These and the progeny of persons with hypertension, diabetes mellitus and hyperlipidemia should be screened for hyperlipidemia, hypertension (and treated appropriately if present) and counseled as to proper nutrition, exercise and avoidance of smoking. Health education of children and the population at large with regard to current knowledge of risk factors of coronary heart disease and possible methods of prevention is necessary if programs for prevention of atherosclerosis are to be effective.When dealing with children with functional (innocent) heart murmurs and mild organic heart disease, the pediatrician and the pediatric cardiologist should ensure by appropriate counseling that “cardiac nondisease” is not produced. Finally, the miscellaneous group includes prevention of irreversible damage to cardiovascular structures or complications in patients with congenital or acquired heart disease by timely and appropriate medical and/or surgical intervention.