Heart attack exposes heart defect

Dear Dr. Roach: We just learned that a 30-yearold woman who was six weeks pregnant with twins had a heart attack during a spin class and is now lying in a coma in the hospital. The woman was then diagnosed with a congenital heart defect.

Other than insurance companies balking at paying for imaging, is there any medical reason for OB-GYNs not to schedule such a test for women with a family history of cardiac problems?

A.S.E. are referring to, but congenital heart disease in adults that leads to heart attacks is quite rare, but not unheard of.

Currently, newborns are screened by pulse oximetry for congenital heart disease, but since this screening recommendation started in 2011, a 30-year-old would not have gotten screened. This screen is very good, but not perfect, at finding congenital heart disease in newborns.

Having an unrecognized congenital heart condition at age 30 would still be very uncommon (90% of congenital heart disease is recognized early), and a general history and physical exam should identify most conditions. There aren’t any guidelines that I could find to screen adults for congenital heart disease.

The reasons why it isn’t recommended include that the condition is rare, but also that a trial of screening the entire population for structural heart disease (congenital and acquired) didn’t find any benefit.

Finally, there is the risk of a false-positive in screening tests (such as an echocardiogram), which might require invasive further testing (such as an angiogram) and has the potential for serious injury, including kidney failure and damage to the arteries.

The issue is different in people with a family history of congenital heart disease because the likelihood is much higher.

In this case, I don’t know if there was a family history, but consideration of screening for family members should occur as soon as one case has been identified.