CONGENITAL HEART DISEASE

CONGENITAL HEART DISEASE

Congenital heart disease is a general term for a range of birth defects that affect the normal workings of the heart.The term "congenital" means the condition is present at birth . Congenital heart disease is one of the most common types of birth defect, affecting up to 9 in every 1,000 babies born in the UK.

CAUSES OF CONGENITAL HEART DISEASE

Congenital heart disease is caused when something disrupts the normal development of the heart. It occurs when something affect the heart’s development during about the fifth week of pregnancy. This is when the heart is developing from a simple tube like structure into a shape more like a fully formed heart. In most cases, no obvious cause of congenital heart disease is identified. However some things are known to increase the rate of the condition.  

                                   

1.     Genetic conditions (Down syndrome)

                                           

                                                                                                

Several genetic health conditions that a baby inherits from one or both parents can cause congenital heart disease. It's also recognised that certain types of congenital heart disease run in families.

Down's syndrome is the most widely-known genetic condition that can cause congenital heart disease. Children with Down's syndrome are born with a range of disabilities as the result of a genetic abnormality. About half of all children with Down's syndrome have congenital heart disease. In 90% of cases, this is a type of septal defect . Other genetic conditions associated with congenital heart disease include:

• Turner syndrome  A genetic disorder that only affects females and it's estimated that 25% of children with Turner syndrome will be born with congenital heart disease, which is usually a type of valve or artery narrowing problem.
• Noonan syndrome - A genetic disorder that can cause a wide range of potential symptoms and around 80% of children with Noonan syndrome will be born with congenital heart disease, and in about half of all cases, this will be pulmonary stenosis.

2.     Women with diabetes.

Women with diabetes are five times more likely to give birth to a baby with congenital heart disease than women who don't have diabetes. It's estimated that 3-6% of women with diabetes who become pregnant will give birth to a baby with a heart defect. The side where it is occur most commonly, transposition of the great arteries.

·         This increased risk only applies to type 1 diabetes and type 2 diabetes. It doesn't apply to gestational diabetes, which can develop during pregnancy and usually disappears once the baby is born.

       3. Rubella       

·         Rubella (German measles) is an infectious condition caused by a virus. It isn't usually a serious infection for adults or children, but it can have a devastating effect on an unborn baby if a mother develops a rubella infection during the first 8 to 10 weeks of pregnancy.

A rubella infection can cause multiple birth defects, including congenital heart disease. All women of childbearing age should be vaccinated against rubella. The vaccine is now given as part of the routine childhood vaccination schedule. Contact your GP for advice if you're not sure whether you've been vaccinated against rubella.

SYMPTOMS OF CONGENITAL HEART DISEASE

Congenital heart disease can have a range of symptoms, because the condition refers to several different types of heart defect . General signs of congenital heart disease can include:

• excessive sweating
• extreme tiredness and fatigue
• poor feeding
• rapid heartbeat
• rapid breathing
• shortness of breath
• chest pain
• a blue tinge to the skin (cyanosis)
• clubbed fingernails

In more severe cases, these problems may develop shortly after birth. However, symptoms sometimes don't develop until the teenage years or early adulthood.

TYPES OF CONGINETAL HEART DISEASE 


There are many types of congenital heart disease and they sometimes occur in combination. Some of the more common defects include :

 

SEPTAL DEFECTS  -  where there’s a hole between two of the heart chambers 

COARCTATION OF AORTA   – where the main large artery of the body called the aorta , is narrower than normal 

PULMONARY VALVE STENOSIS  – where the pulmonary valve which controls the flow of blood out of the lower right chamber of the heart to the lungs , is narrower than normal 

TRANSPOSITION OF GREAT ARTERIES  – where the pulmonary and aortic valves and the arteries they are connected to have swapped positions .

EBSTEINS ANOMALLY  – where the valve on the right side of the heart ,which separates the right atrium and right ventricles , doesn’t develop properly

PATENT DUCTUS ATRIOSEOUS  – where this connection doesn’t close after birth as it’s supposed to . 

VENTRICULAR SEPTAL DEFECTS – extra blood flows throught the hole from the left to the right ventricle due  to the pressure difference between them . 

HYPOPLASTIC LEFT HEART SYNDROME  – where the left of the heart doesn’t develop properly and is too small 

 
DIAGNOSIS  : Doctors may find some problems before a baby is born. Other problems may be found in infants, kids, or adults. The doctor listens to your heartbeat to check your health. If she hears an unusual sound or heart murmur, she might order more tests, such as :

Echocardiogram : A type of ultrasound that takes pictures of your heart. There are different kinds, so ask your doctor what you can expect.

Cardiac catheterization : A doctor guides a very thin, flexible tube (called a catheter) through a blood vessel in your arm or leg to reach your heart. She puts dye through the catheter and then uses X-ray videos to see inside your heart.

Chest X-ray : These can reveal signs of heart failure.

Electrocardiogram (ECG or EKG) : This measures the heart’s electrical activity.

MRI : You get a scan that lets doctors see the heart’s structure .

  COMPLICATIONS 

Children and adults with congenital heart disease can also develop a range of further problems, such as :

• problems with growth and development
• repeated respiratory tract infections (RTIs)– infections of the sinuses, throat, airways or lungs
• heart infection (endocarditis)
• pulmonary hypertension – raised blood pressure within the blood vessels that supply the lungs (pulmonary arteries)
• heart failure– where the heart is unable to efficiently pump enough blood around the body

TREATMENT : Treatment for congenital heart disease depends on the specific defect you or your child has.

Mild heart defects don't usually need to be treated, although it's likely that you'll have regular check-ups to monitor your health.

   
  More severe heart defects usually require surgery and long-term monitoring of the heart throughout adult life by a congenital heart disease specialist.

     
  In some cases, medications may be used to relieve symptoms or stabilise the condition before and, or after surgery. 

      These may include diuretics to remove fluid from the body and make breathing easier, and digoxin to slow down the heartbeat and increase the strength at which the heart   pumps.
                                                                                           

                                                                                                     
PREVENTATION  :  As so little is known about the causes of congenital heart disease, there's no guaranteed way of avoiding having a baby with the condition. However, if you're pregnant, the following advice can help reduce the risk :

• Ensure you are vaccinated against rubella and flu.
• Avoid drinking alcohol or taking drugs.
• Take 400 micrograms of folic acid supplement a day during the first trimester (first 12 weeks) of your pregnancy – this lowers your risk of giving birth to a child with congenital heart disease, as well as several other types of birth defect.
• Check with your GP or pharmacist before you take any medication during pregnancy, including herbal remedies and medication that's available over the counter.
• Avoid contact with people who are known to have an infection.
• If you have diabetes, make sure it's controlled.

Avoid exposure to organic solvents, such as those used in dry cleaning, paint thinners and nail polish remover.

CONCLUSION 

 Congenital heart disease patients with or without invansive therapeutic interventions are at increased risk of development and other psychiatric disorders , which seem to develop earlier than in patients with diabetes mellitus or asthma . The medical literature tells us that the most effective ways to reduce the risk of heart disease , cancer , stroke , diabetes , Alzheimer's and many more problems are through healthy diet and exercise . Our body are evolved to move , yet we now use the energy in oil instead of muscle to do our work .