Heart Guidelines
- Due to the increased incidence of heart problems in children with Down syndrome there must be a high level of clinical suspicion of congenital heart disease (CHD) for all newborns with the syndrome.
- Early detection is essential as delay in treatment can result in irreversible pulmonary vascular disease (PVD). Heart disease should be actively excluded in all infants with Down syndrome at or before their 6 week check.
- A high index of suspicion regarding heart disease should be maintained throughout life, even where initial screening has been negative particularly in those where cardiac echo was not performed and for certain conditions which present in early adulthood.
- Specialist cardiology review is vital in those with suspected cardiac anomalies.
- Down syndrome is associated with an increased incidence of periodontal (gum) disease.
Most patients with a heart defect, whether repaired or not, will require antibiotic cover during any dental treatment to prevent any bacteria entering the blood stream from where they can reach the heart causing bacterial endocarditis (infection of the heart lining), which can be very serious. Good dental care and antibiotic prophylaxis is important and should be encouraged. - Early detection of sleep apnoea in those with heart disease is essential and may help prevent complications such as pulmonary vascular disease (PVD).
It is recommended that:
Clinical examination, electrocardiogram (ECG) and chest X-ray be performed at birth and at 6 weeks of age
OR
Clinical examination, ECG and cardiac ECHO be performed by staff with appropriate ECHO experience under the supervision of a paediatric cardiologist. Clinical examination alone is not sufficient. It is hoped that in the future that advances in Telemedicine in Ireland may allow transmission of ECHO images between paediatricians in peripheral hospitals and the National Heart Centre.
Parents should receive written instruction regarding prevention of infective endocarditis, where appropriate.
Good Dental Health should be encouraged and regular dental assessments.
There is an increased incidence of mitral valve prolapse and of aortic regurgitation in adults with Down syndrome thus an ECHO cardiogram should be performed in early adult life.