Facts About Congenital Cardiac Defects

What is a congenital heart defect?

Congenital Heart Defect (CHD) is a defect in the structure of the heart and vessels of a newborn. One in every 125 babies born (8-10 per 1000 live born) has congenital heart defects, which, incidentally, is also the most common birth defect. Many of these children have curable conditions and with good long-term prognosis.

These are primarily seen in newborns, infants, and children, but in our country, it is not uncommon to see grown-ups diagnosed for the first time with an uncorrected congenital heart defect. Late presentation of congenital cardiac defects is primarily because of a lack of health awareness and health facilities.

Nearly 30% of these defects are critical, requiring intervention in early infancy, only making congenital heart defects a common cause of infant mortality in India and contributing to about 10% of the infant mortality rate.

How to suspect that your child may be suffering from a heart defect?

1. Have you noticed that your baby is blue?

   Blueness is an important indicator of heart disease. Blue babies always have a severe form of heart disease.

   The earlier the blueness appears, the more serious the heart defect. Some of the blue babies are prone to episodes of "Cyanotic spells" characterised by an increase in the rate and depth of breathing with an increase in blueness. This may go on to limpness, convulsion, or unconsciousness. If there is a history suggestive of a 'cyanotic spell', the child needs early intervention.

2. Does your child get repeated chest infections?

   Frequent chest infections may be the only feature of heart disease in a child. Upper respiratory infections like the common cold, mild cough, or hoarseness are not related to heart disease.

   Chest infections usually manifest with fever, fast breathing, and the indrawing of the chest and usually require antibiotics for recovery. More than one episode of lower respiratory tract infection in a year may be the only clue to the existence of congenital heart disease in a child.

3. Does your child have feeding problems?

   The inability to take mother feed at a single stretch, especially when associated with sweating, is an early manifestation of congenital heart disease.

   Feeding difficulty is considered to be present if the baby cannot suck from the breast at a stretch for five minutes and becomes breathless during feeds. There may be complaints of excessive sweating during feeds and stopping after taking a small feed (suck-rest-suck cycle). The baby takes small interrupted feeds. It is not uncommon to shift to bottle feed as the mother becomes very apprehensive. Feeding pattern and weight gain become better on bottle feed as lesser exertion is needed to suck on a bottle.

4. Poor weight gain

   Infants with congenital heart disease have poor feeding patterns and unsatisfactory weight gain. With cardiac defects, their metabolic rate is high, requiring more calories, but due to feeding problems, their intake is poor, leading to poor weight gain. In addition, frequent chest infection leads to further weight compromise.

5. Have you noticed that your child is not able to keep pace with his peer group while playing? This may indicate that a diseased heart cannot cope with the demands during exertion and competitive sports.

6. Grown-up children complain of fast heartbeat (Palpitations), decreased exercise tolerance, early fatigability, and sometimes episode of fainting (syncope). High blood pressure may be a manifestation of narrowing of the aorta (coarctation of the aorta).

What should parents do?

If you notice any of the above symptoms, consult a paediatrician. The treating paediatrician refers the baby to a pediatric cardiologist if there is suspicion of a heart problem. Detailed cardiac evaluation is a must in deciding the timing of intervention. Once you know that your baby has heart disease, don't lose hope. Most heart diseases can be treated.

Do you know that people with congenital heart defects are living longer?

As medical care and treatments have advanced, infants with heart defects live longer and healthier lives. Many now are living into adulthood. It is important for children and adults living with a congenital heart defect to see a heart doctor regularly throughout their lives.

Do you know that some congenital heart defects can be prevented?

The exact cause of most congenital heart defects is unknown. Some babies have heart defects due to changes in chromosomes or genes; they also might be caused by a mix of genes and other risk factors. The Centers for Disease Control and Prevention's National Birth Defects Prevention Study has found that women who are obese, have diabetes, or smoke during pregnancy increase their chances of having a baby born with a heart defect. A woman can take a few important steps before and during pregnancy to help prevent congenital heart defects, like a healthy diet, controlling diagnosed diabetes, quitting smoking, and taking folic acid daily. These actions can reduce the risk of having a baby with a congenital heart defect.

Do you know that some heart defects can be found before birth?

Some congenital heart defects can be found before birth by fetal echocardiography. Knowing if a baby has a heart defect before birth can help families plan for the future.

Treatment facilities in India

Over the last three decades, there has been great advancement in facilities for congenital heart defects in India. Many centers have come up with treatment facilities for children with congenital heart defects. Even newborns with critical congenital defects are being treated successfully at these centers with good results.

It is necessary to make people aware of the problem, its treatment facilities, and good outcome if treated on time.