Holes in the Heart – Causes, Sympoms. Diagnosis and Treatment
This is the regular term for Congenital Heart Disease (CHD). These are defects in the heart that children are born with although they may manifest at different times in a child’s life.
The heart is the pumping organ in the body which sends blood to all body parts
The heart basically has 4 chambers: 2 upper called left atrium and right atrium;2 lower called left ventricle and right ventricle and the upper chambers are separated from the lower chambers by valves and 4 big pipes: 2 which take blood away from the heart to the lungs and to other parts of the body and 2 which bring blood back to the heart from the lungs and the rest of the body..
The human heart chambers and valves.
The pipe from the left chamber supplies the body while the pipe from the right supplies the lungs. These pipes have valves to regulate the amount of blood flow and the valves open to let blood out and close to keep blood out at different times. It is this opening and closing that gives the heart beat.
Holes can occur between the 2 upper chambers; between the 2 lower chambers; between the 2 pipes that take blood away from the heart. These holes can lead to increased blood flow into certain chambers causing enlargement and increased blood flow to the lungs causing congestion of the lungs. There can also be narrowing of the valves or the pipes so that blood flow is reduced. The obstruction causes the heart chambers to be thick because they are overworked.
The origin of the pipes can also be exchanged i.e. the pipe from the left will lead to the lungs and the pipe from the right leading to the body. Sometimes, the valves may not form at all; some pipes may not form at all or some chambers may not form at all. A single child may have a combination of several types of holes.
There are 2 major types. Those which make the baby blue; and those which do not make the baby blue.
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Causes of holes in the heart:
In most cases of holes in the heart, the cause is usually unknown and most doctors will tell you that “at times it just happens”. Several conditions could cause holes in the heart and these include: family history of holes in the heart especially where close family members marry each other, some infections in the mother especially in early pregnancy, taking un-prescribed or illicit drugs in pregnancy, exposure to radiation (Xrays) in pregnancy, diabetes mellitus, advanced maternal age, developmental conditions like Down syndrome, prematurity (usually PDA).
Symptoms.
These include fast breathing, difficult breathing and chest in-drawing while breathing, feeding difficulties (especially while feeding at the breast) the children tend to get tired and need to rest after few minutes of sucking at the breast. This is called suck-rest-suck cycle and they sweat a lot on the forehead while sucking. These children have frequent chest infections (medically known as pneumonias). These features are due to the increased fluid in the lungs (congested lungs)
They may have poor growth because they use so much energy for breathing, suck very little at the breast and have frequent chest infections. Blue babies have bluish discolouration of the lips, tongue and hands and feet, squat frequently due to reduced blood flow to the lungs which causes low oxygen level in the blood.
Not all of these symptoms occur in every child with a hole in the heart.
These symptoms occur usually after the first month of life especially for the holes which do not make babies blue. However, some of them occur from the very minute the child is born especially the ones which make babies blue. Some children may not manifest any symptoms until school age and early adolescence.
The doctor may be the first to notice the signs during a routine visit or during examination for another illness. The doctor may hear sounds from the child’s chest when listening with a stethoscope: these sounds are known as murmurs and they are evidence of blood flowing through a hole, through a narrow valve or through a narrow pipe.
Making a diagnosis of holes in the heart
The doctors may request some tests which include: a chest Xray which will show the enlarged heart and congested lungs; an ECG which will show how the heart beats or evidence of enlarged or thick chambers; an Echo which is a heart scan and will show the holes, abnormal positions of pipes, obstructed valves and pipes and enlarged and thickened chambers.
Treatment
Children with holes in the heart are treated by special children doctors called Paediatric Cardiologists. Although, any doctor can suspect a diagnosis of holes in the heart and refer a child to a specialist for further care. Treatment can be through open or closed heart surgery.
Open Heart Surgery is for very complex or very large holes.
Closed Heart Surgery is reserved for very small holes and simple holes.
Tubes are placed in the vessels of the legs and umbrella like plugs are passed through stem into the heart and used to block the holes. Sometimes simple holes may be closed with open heart surgery in very small babies due to difficulty of passing plugs through their small leg vessels.
Drugs are given by doctors to reduce congestion of the lungs and improve symptoms till child can have the surgery. For children with obstructed valves drugs can also be given to improve blood flow through the narrowed valves.
Drugs never close holes in the heart!
The doctor may also advise feeding with cup and spoon to improve feeding difficulty and also encourage high calorie feeds to help with growth. Other recommendations may include keeping
It is important to get treatment on time to avoid complications. Complications include increased pressure in the lungs due to prolonged congestion, infection of the heart, brain infections due to poor oxygen in the blood and abnormal direction of blood flow. Increased pressure in the lungs is like a point of no return. Once pressures increase to a particular level in the lungs, heart surgery can no longer be performed so it is important to get the hole closed before this complication sets in.
Prevention
Early age at conception in parents; especially the mother, although holes in the heart still occur in children of very young mothers, screening for infections in the mother if there is a history of her child having a hole in the heart and getting treatment where available, avoid taking un-prescribed or illicit drugs in pregnancy (including herbal medications, many of which the contents are unknown, avoid exposure to radiation (Xrays) in pregnancy, proper treatment of predisposing conditions like diabetes mellitus.