Congenital Heart Disease versus Coronary Artery Disease
The term “heart disease” in children is a bit of a misnomer. Adult coronary heart disease is typically acquired atherosclerotic or degenerative valve disease that develops over time and is often abbreviated CHD. In contrast, congenital heart disease or congenital heart defects are anatomic malformations that occur during cardiac development in the embryo. The abbreviation is the same, CHD, which further blurs this important distinction. For the remainder of this chapter, the abbreviation CHD will be used to represent congenital heart disease or congenital heart defects by convention, although congenital heart “conditions” may be more appropriate.
Based on the 2010 Centers for Disease Control and Prevention (CDC) statistics, there are just over 2 million US infants, children, adolescents, and young adults living with congenital heart defects. CHD are the most common type of birth defect, affecting approximately 40,000 (1%) of births per year in the United States. There is a wide range of types of heart defects, and the spectrum of severity as well as unique combinations of lesions makes for a diverse patient population. It is important to note that children can develop acquired heart disease as well, yet it is less common and has a different composition than that typically seen in older adults. Acquired conditions in children include inflammatory or infectious heart disease, such as rheumatic heart disease, endocarditis, and Kawasaki's disease. Genetic cardiomyopathies and channelopathies with delayed phenotypic expression can also occur. Last, certain severe familial hyperlipidemias may also lead to coronary artery disease in the young, but this is rare.
With the advancements in the field of CHD, survival is the expectation, and babies born with CHD today are living longer and healthier lives than in any past era. Therefore, it is essential that health care providers caring for pediatric patients with heart disease promote healthy and active lifestyles and maximize potential from early ages. The underlying pathophysiology in adult-onset heart disease is different from that of CHD in children. The goals of a structured, supervised exercise and secondary prevention program therefore are very different between the two and require specialized considerations. Also, the smaller numbers and highly specialized care required for these young patients leave a gap in regional resources and expertise and create challenges when configuring a pediatric cardiac rehabilitation program.
Physical Activity in All Youth
Physical inactivity in all youth is a major health concern in the United States, not just for those afflicted by a cardiac condition. Currently, most American children and adolescents without disease do not meet the physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day.1 It is also known that participation in physical activity declines as young people age, which is an alarming trend.2 Unfortunately, children with CHD when compared with unaffected peers often ...