Save heart of new born baby…

Regular health check-ups play major role in Congenital Heart Disease care

The World Health Organisation states that approximately three lakh newborns die within four weeks of their birth every year, worldwide, due to congenital anomalies (the condition that exists in a child before birth). The most common and severe congenital anomalies are the heart defects which top the list, followed by neural tube defects and Down’s syndrome.

While many children succumb to the heart defects they are born with, the advancements in medical technologies help them survive after treatment. In this case, regular check-ups are mandatory. Even if a patient underwent a surgery as an infant, follow-up care is necessary.

Symptoms
Some of the regular symptoms, indicating the abnormality in functioning of the heart, include abnormal heart rhythms (arrhythmia), bluish tint of the skin (cyanosis), chest pain, shortness of breath, tiring quickly on exertion, dizziness or fainting, swelling of body tissues or organs (oedema). In these cases, the patient should approach a doctor for treatment without any delay.

How it develops
Heart defects mostly develop during the first half of the gestation period. The baby’s heart starts beating in the first month. It’s a vaguely heart-shaped structure. In later stages, it divides into two sides and the large blood vessels through which blood travels to the heart and out of it also are formed. The defect in the heart happens at this time.

Causes
As the defect develops before the baby is born, the mother’s health plays a major role in it. If a mother contracts German measles (rubella) while pregnant, this could affect the heart development of the baby. Likewise, diabetes and some medications consumed by the would-be-mother can also cause some defects. Some of the diseases could also be passed on from generation to generations (genetic factors).

It is noted that 50 per cent of the children with Down’s syndrome (caused due to an extra 21st chromosome) are born with heart defects. A missing piece (deletion) of genetic material on chromosome 22 also causes heart defects. These are usually detected through genetic testing during fetal development.

Even if the person undergoes treatment as a child, some issues may resurface during adulthood. They resurface due to the various reasons. The treatment a patient received in their childhood would be good enough during childhood but as the body grows, the heart would need further care in adulthood.

Another reason can be that the problems which were not serious in childhood would have worsened and need treatment now. Follow-up forms an important part of care to cure congenital heart disease. This is required even in cases where the patient underwent surgery as a child. This is because there are chances of the patient developing complications like endocarditis or abnormal heart rhythms.

Complications in adulthood
The complications might not arise for the next few years. But, as the severity of the defects, which varies with every case, some of the complications can be seen.

These include:
Abnormal heart rhythms (arrhythmia): This is seen when electrical impulses in the heart, responsible for coordinating your heartbeats, don’t function properly. In some cases, patient suffers sudden cardiac death.

Heart infections (endocarditis): This condition is an infection in the inner lining of the endocardium, a thin membrane present inside four chambers and four valves of the heart. This generally occurs when bacteria from other parts of body enter the bloodstream and then lodge in the heart.

They can trigger stroke if left untreated. In case a prosthetic heart valve or prosthetic material was used to repair the heart, or if the defect wasn't repaired completely, antibiotics are usually given during any other surgical procedures as a preventive measure.

Heart failure: Heart failure happens when the patient’s heart can't pump enough blood required for the body. This happens over time when certain conditions like coronary artery disease or high blood pressure weakens the heart or makes it too stiff. This hampers the heart’s usual function.

Medications can reduce the chances of developing heart failure. Some lifestyle changes like exercising, consuming less salt, losing excess weight and managing stress well can also help.

Pulmonary hypertension: This is high blood pressure in the arteries in the lungs. In some cases, congenital heart defects increase the blood flow to the lungs, thereby, increasing pressure. With increasing pressure, the heart's lower right chamber (right ventricle) has to work harder to pump blood through the lungs. This eventually weakens the heart muscle and it could fail. This has to be recognised early, and treated appropriately before the lung artery can get damaged permanently.

Heart valve problems: An abnormal valve can cause problems in adulthood. In some cases children who undergo valve repair in childhood may have to go through another surgery. In some surgical or catheter-based treatments, the patients may require repeat procedures again

Diagnosis
If a heart murmur is detected, the patient would have undergo some tests which include electrocardiogram (ECG), Chest X-ray, Echocardiogram, Exercise stress test, Cardiac computerised tomography (CT) or magnetic resonance imaging (MRI), Cardiac catheterisation.

Treatment
Depending on the kind of heart disease, the kind of treatment recommended may vary. A patient might have to go in for regular check-ups. They can be put on medications which help in stopping blood clots from forming or to help control heartbeats.

Some patients may require devices like pacemaker to control heart rate or to correct irregular heartbeats. In other cases, catheterisation techniques are used to control the defects. The heart can be repaired without opening the chest or heart surgically.

If catheter procedures can’t repair the defect, open-heart surgery may be performed. Heart transplant is done in cases where the disease has progressed beyond repair and resulted in intractable heart failure.

By: Dr Joseph Xavier
The writer is a Consultant Adult and Paediatric Cardiac Surgeon, Fortis Hospital.