Maternal & Pediatrics

Pediatrics: Cardiomyopathy


Why is Cardiomyopathy the Number One Cause for Pediatric Cardiac Arrest & Heart Transplants?

Pediatric heart transplantation (pHTx) represents a small (14%) but very important and particular part in the field of cardiac transplantation.
Approximately 600-700 pediatric heart transplantation procedures are performed worldwide each year, representing about 12% of the total number of heart transplants performed.
The main cause of both of these? Cardiomyopathy
Although there’s not a lot of research behind the real why’s of it, we asked our providers to share some things that are known & information that can hopefully help prevent this pediatric heart issue from continuing to rise!

The Heart and Iron

Our hearts could not function without iron. This mineral is needed to make hemoglobin, which delivers oxygen to the body, and myoglobin in muscles. The most significant muscle in the body is the heart.

Much of what we know about iron in the heart comes from research that centers on people with iron overload at a young age, such as individuals with thalassemia, sickle cell disease, or juvenile hemochromatosis. The most significant research specific to adult onset hemochromatosis and cardiac iron comes from the US National Institutes of Health Hemochromatosis Protocol led by Dr. Susan Leitman and from Professor Dudley Pennell, Director of the National Institutes of Health Research Cardiovascular Biomedical Research Unit at Royal Brompton Hospital, London.

Over Recommended, Unnatural Sources of Iron

70% of pregnant women report using iron-containing prenatal supplements that are often prescribed by their physicians (4), despite the current debate over whether a recommendation of supplemental iron is necessary in iron-replete pregnant women in the US (5–7). Prenatal supplements are products typically intended for use before, during, and after pregnancy, unless otherwise specified on the product label. We compared the forms and amounts of iron used in formulating prenatal supplements with the forms and am

Misleading information on supplement labels is the most common reason for confusion about these ingredients. Consuming these potentially dangerous chemicals is much more serious than once thought.

Synthetic vitamins and minerals are processed in a laboratory, while natural vitamins and minerals are derived from plants. Your body can tell the difference, even if a microscope can’t. Synthetic supplements contain little or no natural ingredients. Some claim to contain 10% natural vitamins, but the rest of the ingredients will have come from a lab. The “ingredients” of synthetic supplements are chemicals that are constructed in a lab. They may look, feel and taste natural, but your body may not—probably does not—absorb synthetic supplements in the same way that your body would absorb natural supplements.

  • Iron overload can occur from certain things that pregnant women take such as medications, and synthetic high dose supplements (ie. iron and folic acid) play a role in baby’s heart development.

Magnesium & Iron Together

Although magnesium and iron are not cofactors, which are nutrients that help other nutrients function, they appear together in foods. Just as you’ll find iron in meats, fish, nuts, leafy greens, grains, cereals, fruits, vegetables and other foods, you will find magnesium in these foods as well. Therefore, a deficiency in one likely predicates the other, unless there is a specific cause for either condition. Strict vegetarians are at particular risk for both deficiencies.

But, what happens if you are magnesium deficient but are supplementing iron?

Excess iron intake reinforces the iron accumulation in liver and spleen of people who are magnesium deficient. The saturation of iron binding capacity can be enormously elevated when we are magnesium deficient and loaded with excess iron. Dietary iron deprivation can also diminish the degree of calcium deposition in the kidney of magnesium deficient people. So, magnesium-deprived people have abnormal iron metabolism losing homeostatic regulation of plasma iron, and magnesium deficient people with dietary iron overload may be hemochromatosis – which can cause serious damage to your body, including to your heart, liver and pancreas.

Magnesium deficiency and iron overload together can have a BIG impact on the heart of both you and your baby.

Viral Infections

Pregnancy comprises a unique immunological condition, to allow fetal development and to protect the host from pathogenic infections. Viral infections during pregnancy can disrupt immunological tolerance and may generate deleterious effects on the fetus.

A range of viral infections in pregnancy are associated with specific placental findings, including lymphoplasmacytic villitis with associated enlargement of villi and intravillous hemosiderin deposition in the setting of maternal cytomegalovirus infection (40), as well as rare reports of intervillositis in the setting of Zika virus (41) and Dengue virus (42), among others.

Viral infections, especially streps, can greatly impact a baby’s heart development.

Genetic Predispositions

Like most common diseases, heart failure develops as a result of complex interactions between genetic and environmental factors. Early studies identified variants in genes in the adrenergic and renin-angiotensin pathways that influence the likelihood of developing heart failure and response to evidence-based therapies. These polymorphisms confer relatively minor increases in risk and manifestation of clinically evident HF in patients who carry these alleles likely requires other genetic and environmental insults.

In contrast, mutations in single genes can cause dilated cardiomyopathy independently and typically are heritable in an autosomal dominant fashion. Diagnosis of familial dilated cardiomyopathy requires a careful family history and confirmatory genetic testing, and can have significant impact on the health of the patient’s family members. Though such testing ideally is undertaken in consultation with a genetics professional, numerous resources are available to guide the cardiologist through the process (Table 22). If you have a genetic predisposition component, it’s okay! There still needs to be a trigger – which we can work together to prevent.

Taking Action

Here’s what you can do to:

  • Be sure to either get your nutrients from whole, mineral-rich, naturally grown foods or take high quality, whole food supplements while pregnant such as folate and avoiding folic acid.
  • If iron is truly needed then making sure it’s the correct form that doesn’t get stuck in the organs/tissues.
  • PAY ATTENTION TO YOUR BODY. It’s intelligent. If you feel sick, see if you have a virus.
Coxsackievirus B (CVB) is the most common cause of viral myocarditis. It targets cardiomyocytes through coxsackie and adenovirus receptor, which is highly expressed in the fetal heart.
But many viruses are commonly associated with myocarditis, including the viruses that cause the common cold (adenovirus); CMV, hepatitis B and C; parvovirus, which causes a mild rash, usually in children (fifth disease); and herpes simplex virus.
Fever, rash, fatigue and general sick symptoms would be what to watch for but would be very hard to prevent as most of that stuff isn’t screened for in pregnancy, just like STDs and such.
Specifically ask for a viral panel that directly correlates with myocarditis (if your doctor doesn’t know what to run, check with other doctors)
You can also specifically ask for CVB to be checked!
If you are pregnant or have concerns for your child, do not hesitate to reach out! We are here to help in any way we can.

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