What is congenital heart disease (CHD)?
- Congenital heart disease is often viewed as a group of gross structural or functional abnormalities of the heart that are present at birth.
- Millions of children born with congenital heart disease in our country. But most of the parents are not aware of these problem.
- Their proper observation and knowledge can lead to timely visit to a Paediatric Cardiologist which can save the life of their baby.
- Hence we should know the key symptoms and signs of congenital heart diseases for easy diagnosis.
What are the CHD?
- Acyanotic > Pink (normal color of skin)
- Cyanotic > Blue
- Atrial septal defect (ASD)
- Ventricular septal defect(VSD)
- Patent ductus arteriosus(PDA)
- Pulmonary stenosis (PS)
- Aortic stenosis (AS)
- Coarctation of aorta(COA)
- Tetralogy of Fallot (TOF)
- Transposition of great arteries(TGA)
- Single ventricle
- Tricuspid atresia
Total anomalous of pulmonary venous return (TAPVR)
- Functional heart disease
- Arrhythmia, congenital heart block
How to diagnose CHD?
- Maternal history
- History of the child
- Family history of CHD
- Maternal infection during pregnancy
- e.g viral infection (Rubella infection)
- Medications (e.g. anticonvulsant , ACEI,), alcohol, cigarette smocking.
- Diabetic mother, hypertension
- Maternal connective tissue disease ( SLE)
- CHD 1 % in general population, 15% if mother has CHD.
Gestational & natal History
- Low birth weight/IUGR indicate intrauterine infection (Rubella syndrome).
- High birth weight > infant of diabetic mother (IDM)
- Hereditery diseases :
- Marfan’s syndrome
- Noonan’s syndrome
- Holt-Oram syndrome
- Long QT syndrome
- Congenital heart disease
- Rheumatic fever
- Sudden unexpected death
- Diabetes Malietus, atherosclerosic, HTN, dyslipidemia, and so on.
Symptoms of the baby?
- Typical feeding pattern (suck and sleep cycle : small feed followed by sleeping) >Poor feeding (poor feeding is the result of fatigue and dyspnoea.)
- Poor sleep, irritability.
- Excessive sweating and respiratory distress/chest in drawing during feeding and playing/at rest.
- Frequent lower respiratory tract infection(e.g pneumonia) for which baby takes antibiotics and may need frequent hospital admission.
- Poor weight gain and development.
- Cyanosis, cyanotic spells and squatting.
- Exsercise intolerance
- Chest pain
- Joint symptom
- With large holes/shunt in heart, the lungs are receiving increased blood under higher than normal pressure.
- This can result in pulmonary hypertension (high blood pressure in the pulmonary artery). If this pressure becomes too high, the heart may be unable to function properly.
- Chest X-Ray
- Holter monitoring
- Echocardiography (2D, 3D and color doppler)
- Cath study
- CT scan (cardiac)
- MRI (cardiac)
- Medical management
- Device closure of shunts/PDA stenting/Balloon aortic valvuloplasty/Baloon pulmonary valvuloplasty/coarctoplasty/Balloon atrial septostomy (BAS).
- Pacemaker implantation.
Challenges of CHD diagnosis & treatment :
- Late diagnosis
- Late presentation due to lack of awareness about CHD in grass root level.
- Lack of access to basic medical care
- Ist presentation in hospital because of complications of CHD
- Ignorance about CHD leads to:
- Non-diagnosis : heart disease is very unlikely in children.
- Misdiagnosis as Pneumonia, Asthma, TB.
- Inappropriate counseling : CHD is not curable disease.
- Scarcity of Fund, Expertise, Equipments ( pulse oximetry, ECG and Echocardiography machine ), Surgical back up (post operative management, paediatric ICU), Organized hospital / medical center. Lack of Follow up for surgery in proper time
How to deal with …
Need urgent action :
- Public awareness about CHD for early presentation & diagnosis.
- Educate all health workers & general practitioner on
– Early detection by typical history & cilinical examination (cyanosis, murmur).
-Early referral to Pediatric Cardiologist
Review, Investigations ( X-ray, ECG, Echo)
Plan for treatment (nonsurgical / surgical) , Counseling.
- Training & team work among Obstetricians, Pediatricians, Pediatric Cardiologist, Cardiac Surgeons & all other health care professional.
- Require more resources allocation and judicious use of available resources.
- Need good quality data.
- Prevention of CHD.
- Rubella immunization 3 months before pregnancy.
- Avoid teratogens during pregnancy.
- Control of DM, HTN during pregnancy.
- Folic Acid fortified food to pregnant mother.
- Avoid consanguinous marriage.
- & elderly pregnancy.
- Children with CHD are not burden.
- Timely treatment can give them a beautiful life.
- They are our bright future.
- This is the time to take strong step to deal with CHD properly.