Heart defects

Zdorovye - - КАРДИОЛОГИЯ - Batog Igor Petrovich Head doctor

1. What is heart disease?

Cardiac defects are congenital or acquired changes in the structure of the heart (valves, partitions, walls, outflow vessels), disturbing the movement of blood inside the heart and leading to heart failure. There are two large groups of heart defects: congenital and acquired.

Congenital malformation of the heart is detected in about 1% of newborns, characterized by a variety of abnormalities in the development of the heart and blood vessels.

Prerequisites for the development of congenital heart disease:

- disorders of fetal development under the influence of pathogenic factors in the first months of pregnancy (radiation, viral infections, vitamin deficiency, uncontrolled use of medicines, including some vitamins);

- smoking parents;

- alcohol-addicte parents.

The most common and severe congenital malformations can be divided into two main groups. The first group is affected by heart defects due to the presence of roundabouts (shunts). They include: non-irradiation of the arterial duct - a vessel through which the blood passes through the fetus not working lungs; defect of the interstitial septum (preservation of the opening between the two atria; defect of interventricular septum (gap between left and right ventricle).

Another group of defects is associated with the presence of obstacles to the blood flow, leading to an increase in the load on the heart. For example, coarctation (narrowing) of the aorta or narrowing of the exhaust valves (aortic or pulmonary valve stenosis).

The acquired heart defect does not occur immediately after birth, but with time. It manifests itself in the form of wrong functioning of the valve apparatus of the heart (narrowing of the walls or insufficiency of the valves of the heart). The most common cause of the heart disease contracted is rheumatism, rarer sepsis, atherosclerosis, trauma or syphilis.

2. What are the symptoms of this disease?

Symptoms of congenital heart disease

Frequently occurring symptoms of congenital heart disease are the following ones:

- Severe breathing can be often noticed when the child is active, for example, during eating or crying. - Poor weight gain is likely to be figured out when baby's energy is spent on blood transfusions, there is little to eat and grow. A child may get tired during consuming some foo, and this process can last longer than expected.

- Sudden weight gain or puffiness and swelling of the skin are often seen around the eyes, on the arms and legs, and such condition is more noticeable when the baby has just woken up. Weight gain or swelling may occur due to fluid retention caused by poor blood circulation.

- Tension, especially on the head. It can be noted that the child has damp hair and cold, moist skin. - Fatigue and fussiness are reflecte when the child may be too tired to play, and prefers to sleep most of the time.

- Less wet sleeve than expected. After the first week, most newborn babies need 6 diapers for 24 hours. You can also note that the urine of the baby is too dark and has a distinct smell.

Breaking the blood flow caused by heart disease can mean that the child receives less oxygen. This is

more common in children with cyanotic heart disease ("blue vices"). These defects are abnormal openings between the heart chambers, which allow the blood, unabsorbed by oxygen, from the right heart of the heart to blend with blood that is enriched in oxygen in the left heart of the heart.

The child may have a cyanosis of the skin, lips and nails, that condition intensifies when the baby eats or cries. If the heart disease is worse, the heartbeat may get more slowly than expected, and a child looses weight while learning to stand and walk.

Defects that do not cause cyanosis ("white defects") are not related to the amount of oxygen or blood entering the tissues of the body.

Usually, after correcting the defect, the symptoms disappear. In due time, corrected congenital heart disease with less probability can affect the growth and development of the child in the future. Symptoms of acquired heart disease

- Laboured breathing.

- Expression of weakness.

- Changes in the color of the skin - permanent pallor or, conversely, rosacea.

- Sensation of palpitation.

- Pain in the area of heart is possible under the conditions of physical stress.

- Headaches, dizziness, fainting (loss of consciousness).

3. What should be the correct diagnosis of the disease?

Detection of congenital heart defects can be performed both during pregnancy and after the birth of a child. The majority of the congenital heart defects are detected during the first month after the birth of the child.

In order to diagnose heart disease, the doctor will ask questions about the symptoms that your child has, appetite, and conduct a physical examination. You may need an echocardiogram and a cardiac catheterization (angiogram).

A fetal echocardiogram, which can be done already in the 16th week of pregnancy, is the best method of examination prior to the birth of a child and should be conducted if:

- In the family history there are cases of heart disease.

- During pregnancy, a woman has been exposed to certain chemicals or has taken medications that may increase the risk of developing a child (fetus) with a heart defect.

- An ultrasound examination of the fetus revealed problems with the heart (may show problems with the structures of the heart, but some types of heart disease can not show).

A child can be checked for the presence of congenital heart defects if his mother:

- suffered from rubella during pregnancy.

- Suffered from diabetes mellitus or phenylketonuria.

- Had congenital malformation of the heart. Depending on the symptoms and the type of defect, you may need other examinations:

- Roentgenography of the chest to determine the size of the heart and its blood vessels.

- Electrocardiogram (ECG) to detect an irregular rhythm (arrhythmia) that can be caused by congenital heart disease.

- Blood test to reveal anemia, polycythemia, or level of certain chemicals in the blood.

- A dose-loaded exercise test (load ECG) that can be performed when a child goes to school to determine which pressure he or she is able to take.

- Oximetry to determine whether the heart transports unhealthy oxygen (with severe respiratory insufficiency or cyanosis of the skin, lips and nails). The amount of oxygen in the blood can also be determined by measuring the gas composition of the blood or percutaneous monitors (in newborns).

- Magnetic resonance imaging (MRI) of the heart and

large blood vessels to determine abnormalities of the structures of the heart and / or blood vessels. Carrying out this survey, the child can be given medication to relax and fall asleep for the time of trial.

- Multispiral Computed Tomography (MSCT) is a method of layer scanning of heart structures based on the registration of an X-ray beam passed through tissues using several series of ultrasensitive detectors. An MSCT of the heart provides the possibility of a 3-dimensional heart reconstruction and is used to detect defects in the valves.

In families where there are cases of congenital heart disease, genetic testing can be performed.

4. What are the methods of treatment?

1. Treatment of Acquired Heart Disease Conservative (medication) treatment of acquired heart disease is prescribed only for the purpose to stabilize the heart rhythm, prevent heart failure (a condition where the heart is unable to provide normal blood flow in all organs), complications and relapses (repetitions) of the underlying disease causing heart disease.

The patients are highly recommended to be engaged in those types of work activities, which are not connected with physical overloads. Refusal of smoking and alcohol, performance of therapeutic physical training, sanatorium treatment at cardiological resorts - one of many ways to treat heart defects

The gold standard of treatment for acquired heart defects is cardiovascular intervention, which can be performed by replacing the heart valve to artificial (endoprosthetics) or without prosthetics.

In the first case, in order to avoid thrombosis, it is necessary to take anticoagulants for a lifelong time, and in the second case, there is a risk of blistering again (for example, repeated stenosis of the mitral valve) and the need for re-operation on the heart.

Valve defect correction:

Valvotome (dissection of the merged arms of the heart valves);

valvuloplasty (restoration of the valve's work by dissecting the valve walls and subsequent cross-linking of the new valves).

2. Treatment of congenital heart defects

Treatment of a child with congenital heart disease depends on its type. It is very important to know the age of the child, his size and the general state of his health.

Treatment helps most children live a normal life. The child may need:

- Medicines to alleviate symptoms. Some medications can control irregular heartbeat. Others strengthen the heart until the defect is fixed. A child may need some medications after surgery, as well. - Catheterization of the heart in order to determine the details of the defect or, sometimes, to correct it. With the catheterization of the heart, the doctor conducts a thin flexible tube, which is called a catheter, through the blood vessel (usually in the groin area) to the heart. This allows the doctor to see how blood flows through the heart and its arteries. - Operative intervention for the treatment of a structural defect. If a baby (for example, from a newborn to 3 months) a life-threatening defect, then surgery may be needed immediately. In case of some disorders, the best time for an operation is a period of up to two years. For others the period stads from 2 to 4 years. In some cases, surgical intervention may be performed at an older age. The operation may be postponed if there is a likelihood that the defect itself can be cured.

5. How to protect yourself?

1. Acquired vices:

It is possible to significantly reduce the risk of acquiring a deficiency by prevention and urgent treatment of streptococcal infections (for example, angina), after all, on their soil rheumatism develops.

If a rheumatic attack has already occurred, one should not neglect bicillin prophylaxis, which is prescribed by the attending physician.

People in the risk group of infectious endocarditis (for example, those who have undergone a rheumatic attack in the past or have a mitral valve prolapse) require prophylactic administration of certain antibiotics prior to various manipulations, such as tooth extraction, tonsils, adenoids and other operations. Such prevention requires a serious relationship, because it is much easier to prevent heart disease than to cure it. Especially one needs to take into considertaion that it does not matter how improved the operation technique is, a healthy heart works much better than the one belonging to a person who has undergone operation.

2. Congenital malformations:

Congenital heart defects in general can not be prevented. But before and during pregnancy it is possible to reduce the risk of heart defects for a child.

A woman who has a congenital heart defect must find out if pregnancy can lead to a health risk. It is necessary to pass a number of tests for the presence of infectious pathology (toxoplasmosis, rubella and others, so-called TORCH-infections).

Some heart defects can be detected before the baby is born, and treatment can be started early.

Urgent! Treatment for heart defects has every likelihood to succeed if people are able to come to a doctor in time.

Chernihiv Regional Cardiology Center

14005, m. Chernigov, vul. Vyacheslav Chornovil (Voikov), b.24

Phones: registration number +38 (0462) 72-74-77 reception office +38 (0462) 72-37-25 reception head doctor: +38 (0462) 71-37-39

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