When little hearts don't beat correctly

Because there are often no symptoms in the early stages, it is difficult to detect, and because some causes are not known, it can be difficult to prevent. However, risk factors to look out for include viral infections, rubella, genetic disorders, or drug abuse by the mother during pregnancy. 

Heart disease in children can be divided into two categories: congenital heart disease and acquired heart disease. Of these two, congenital heart |disease is by far the more common. It is estimated that between 8 and 10 newborns out of every 1,000 births has a heart defect. In some cases, the symptoms may not appear until the child is already past his or her fifth birthday.

However, the first symptoms will usually be observed before the child reaches 2 years of age. Just as heart disease is divided into two categories, |so congenital heart disease can also be further grouped into cyanotic and non-cyanotic conditions.

In cyanotic congenital heart disease, the heart and blood vessels are subject to an abnormality that causes “blue” and “red” blood to mix and restrict the flow of oxygen through the body. The most noticeable symptoms are the skin and mouth turning bluish or purplish. However, the baby will also become very easily fatigued and will cry constantly, especially when being breastfed. If the condition remains untreated, it can lead to developmental problems due to the lack of oxygen in the blood.

In non-cyanotic congenital heart disease, there is no change in skin colour. The usual causes are a congenital defect in the development of either the heart or the blood vessels and there may be a hole in the heart valves. |In babies, the symptoms include a need to take regular breaks to breathe during breastfeeding, while older infants and children will experience |fatigue and laboured breathing during physical activity. 

Other congenital heart diseases include::

l Atrial Septal Defect (ASD): With this condition, blood passes through a hole in the upper left heart chamber to the upper right heart chamber. It can be detected on examination as a heart murmur. 

l Ventricular Septal Defect (VSD): In this condition, the red blood from the lower left heart chamber leaks into the lower right heart chamber and into the lungs. As a result, the left side of the heart is forced to work extra hard to pump an excessive amount of blood and this can lead to heart |failure.

l Pulmonary Valve Stenosis: This condition is when the lower right |heart valve is not able to open fully due to abnormal development. To |compensate for this, the heart has to work extra hard and is at increased risk of failure die to the heavy workload.

Less common heart conditions include:

l Single Ventricle: This condition occurs when the two lower chambers of the heart function as a single chamber. As a result, the flow of blood is |not separated and the venous blood and arterial blood mixes together. |This causes the baby to turn blue due to a lack of oxygen in the blood flowing through the body.

l Transposition of the Great Arteries (TGA): With this condition, the |pulmonary artery and vein are switched, causing oxygen-rich blood to be sent back to the lung, and blood that has already been used to be re-sent around the body. This condition also causes the baby to turn blue.

The first step to diagnosing congenital heart conditions typically involves a review of the medical history of the individual and their family. If risk factors are identified, then this may lead to a clinical examination including ultrasound, coronary angiogram or magnetic resonance imaging (MRI).

Diagnosis tends to be easier in adults as they can describe their symptoms. However, it is difficult to know when babies are experiencing genuine symptoms as they can sometimes just be seeking attention. As a result, it is extra important to watch for the following warning signs in babies and young infants.

l Bluish skin

l Frequent fatigue

l Hyperventilation or abnormal breathing

l Restricted growth

l Breaks between breastfeeding. A healthy baby will breastfeed for 15 to 20 minutes without needing to take a break, but babies with congenital heart conditions will need to take regular breaks to breathe, resulting in the feeding being extended to up to an hour. 

In many cases, treatment with medication or surgery can lead to a |complete cure. Even in cases where a full cure is not possible, the treatment will provide the children with a better quality of life. 

While surgery can be performed on children of all ages, it is generally avoided in newborns unless a medical implication necessitates immediate action. Advances in medical technology have made this a far less risky |operation than in the past. In most cases, however, the doctor will wait until the baby has grown and gained weight before performing the surgery.

After surgery, patients will typically be monitored for up to two weeks, depending on the particular procedure performed and the patient’s |condition. If there are no complications, the patient should recover fully |in just 2 to 3 months.

 

DR NATTIPAT JUTHACHAROENWONG is a Paediatric Cardiologist at Samitivej International Children’s Hospital, Srinakarin Campus. Call (02) 378 9082-83.