Congenital Heart Disease in Children

Heart disease describes a range of conditions that affect your heart. Diseases under the heart disease umbrella include blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you’re born with (congenital heart defects), among others.

Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, also are considered forms of heart disease.

Many forms of heart disease can be prevented or treated with healthy lifestyle choices.

Most Common Heart Disease

Angina

Also known as angina pectoris, angina occurs when an area of heart muscle does not get enough oxygen. The patient experiences chest discomfort, tightness or pain. Angina is not technically a disease, but rather a symptom of coronary artery disease. Lack of oxygen to the heart muscle is usually caused by the narrowing of the coronary arteries because of plaque accumulation (atherosclerosis).

Arrhythmia

Arrhythmia is an irregular heartbeat.

• Tachycardia is when the heart beats too fast
• Bradycardia is when the heart beats too slowly
• Premature contraction is when the heart beats too early
• Fibrillation is when the heart beat is irregular

Arrhythmias are problems with heart-rhythm. They happen when the heart’s electrical impulses that coordinate heartbeats do not work properly, making the heart beat in a way it should not, either too fast, slowly or erratically.

Irregular heartbeats are common, we all experience them. They feel like a fluttering or a racing heart. However, when they veer too far from normal heartbeat or occur because of a damaged or weak heart, they need to be taken more seriously and treated. Irregular heartbeats can become fatal.

Congenital heart disease

This is a general term for some birth defects that affect how the heart works. Congenital means you are born with it. In the UK it is estimated that 1 in every 1,000 babies are born with some kind of congenital heart disease. Examples include:

• Septal defects – there is a hole between the two chambers of the heart. This condition is sometimes called hole in the heart.
• Obstruction defects – the flow of blood through various chambers of the heart is partially or even totally blocked
• Cyanotic heart disease – not enough oxygen is pumped around the body because there is a defect (or some defects) in the heart.

Coronary artery disease

The coronary arteries, which supply the heart with nutrients, oxygen and blood become diseased or damaged, usually because of plaque deposits (cholesterol-containing deposits). Plaque accumulation narrows the coronary arteries and the heart gets less oxygen.

Dilated cardiomyopathy

In this disorder the heart chambers become dilated because the heart muscle has become weak and cannot pump blood properly. The most common reason is not enough oxygen reaching the heart muscle (ischemia) due to coronary artery disease. Usually the left ventricle is affected.

Myocardial infarction

Also known as heart attack, cardiac infarction and coronary thrombosis. Interrupted blood flow (lack of oxygen) damages or destroys part of the heart muscle. This is usually caused by a blood clot that develops in one of the coronary arteries (blood vessels that supply the heart with blood). It can also occur if an artery suddenly narrows (spasm).

Heart failure

Also known as congestive heart failure. The heart does not pump blood around the body efficiently. The left or right side of the body might be affected; sometimes both sides are. Coronary artery disease or hypertension (high blood pressure) can over time leave the heart too stiff or weak to fill and pump properly.

Hypertrophic cardiomyopathy

A genetic disorder in which the wall of the left ventricle becomes thick, making it harder for blood to leave the heart. The heart has to work harder to pump blood. This is the leading cause of sudden death in athletes. A father or mother with hypertrophic cardiomyopathy has a 50% chance of passing the disorder onto their children.

Mitral regurgitation

Also known as mitral valve regurgitation, mitral insufficiency or mitral incompetence occurs when the mitral valve in the heart does not close tightly enough, allowing blood to flow back into the heart when it shouldn’t. Blood cannot move through the heart or the body efficiently. Patients feel tired and out of breath.

Mitral valve prolapse

The valve between the left atrium and left ventricle does not fully close, it prolapses (bulges) upwards, or back into the atrium. In the majority of cases the condition is not life-threatening and no treatment is required. Some patients, especially if the condition is marked by mitral regurgitation, may require treatment.

Pulmonary stenosis

It is hard for the heart to pump blood from the right ventricle into the pulmonary article because the pulmonary valve is too tight; the right ventricle has to do more work to overcome the obstruction. A baby with severe stenosis can become cyanotic (turn blue). Older kids generally have no symptoms. If pressure in the right ventricle is too high treatment is required. Balloon valvuloplasty or open heart surgery may be needed if there is an obstruction.

Cardiovascular disease is the leading cause of death in the United States and often can be attributed to the lifestyle factors that increase the risk of atherosclerosis or narrowing of arteries. Smoking, along with poorly controlled hypertension (high blood pressure), and diabetes, causes inflammation and irritation of the inner lining of the coronary arteries. Over time, cholesterol in the bloodstream can collect in the inflamed areas and begin the formation of a plaque. This plaque can grow and as it does, the diameter of the artery narrows. If the artery narrows by 40% to 50%, blood flow is compromised or decreased enough to potentially cause the symptoms of angina.

In some circumstances, the plaque can rupture or break open, leading to the formation of a blood clot in the coronary artery. This clot can completely occlude or block the artery. This prevents oxygen-rich blood from being delivered to the heart muscle beyond that blockage and that part of the heart begins to die. This is a myocardial infarction or heart attack. If the situation is not recognized and treated quickly, the affected part of the muscle cannot be revived. It dies and is replaced by scar tissue. Long term, this scar tissue decreases the heart’s ability to pump effectively and efficiently and may lead to ischemic cardiomyopathy (ischemic=decreased blood supply + cardio=heart + myo=muscle + pathy=disease).

Heart muscle that lacks adequate blood supply also becomes irritable and may not conduct electrical impulses normally. This can lead to abnormal electrical heart rhythms including ventricular tachycardia and ventricular fibrillation. These are the heart arrhythmias associated with sudden cardiac death.

Symptoms of coronary heart disease

The most common symptoms of coronary heart disease (CHD) are chest pain (angina) and a heart attack.

You can also experience other symptoms, such as heart palpitationsand unusual breathlessness. In some cases, people may not have any symptoms before they are diagnosed.

Heart attacks

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction).

Heart attacks can permanently damage the heart muscle and, if not treated straight away, can be fatal.

Dial 999 for immediate medical assistence if you think you’re having a heart attack.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina, but it’s often more severe.

During a heart attack, you may also experience the following symptoms:

• pain in other parts of the body – it can feel as if the pain is travelling from your chest to your arms, jaw, neck, back and abdomen
• lightheadedness
• sweating
• nausea
• breathlessness

The symptoms of a heart attack can also be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn.

A heart attack can occur at any time, including while you’re resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.

Unlike angina, the symptoms of a heart attack aren’t usually relieved using a nitrate tablet or spray.

In some cases, a heart attack can occur without any symptoms. This is known as a silent myocardial infarction and is more common in people with diabetes.

Heart failure

Heart failure can also occur in people with CHD when the heart becomes too weak to pump blood around the body. This can cause fluid to build up in the lungs, making it increasingly difficult to breathe.

Heart failure can occur suddenly (acute heart failure) or gradually over time (chronic heart failure).

Risk factors for developing heart disease include:

• Age. Aging increases your risk of damaged and narrowed arteries and weakened or thickened heart muscle.
• Sex. Men are generally at greater risk of heart disease. However, women’s risk increases after menopause.
• Family history. A family history of heart disease increases your risk of coronary artery disease, especially if a parent developed it at an early age (before age 55 for a male relative, such as your brother or father, and 65 for a female relative, such as your mother or sister).
• Smoking. Nicotine constricts your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Heart attacks are more common in smokers than in nonsmokers.
• Poor diet. A diet that’s high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.
• High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood flows.
• High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis.
• Diabetes. Diabetes increases your risk of heart disease. Both conditions share similar risk factors, such as obesity and high blood pressure.
• Obesity. Excess weight typically worsens other risk factors.
• Physical inactivity. Lack of exercise also is associated with many forms of heart disease and some of its other risk factors, as well.
• Stress. Unrelieved stress may damage your arteries and worsen other risk factors for heart disease.
• Poor hygiene. Not regularly washing your hands and not establishing other habits that can help prevent viral or bacterial infections can put you at risk of heart infections, especially if you already have an underlying heart condition. Poor dental health also may contribute to heart disease.

Treating heart disease

The goal of treating cardiovascular disease is to maximize the patient’s quantity and quality of life. Prevention is the key to avoid cardiovascular disease and optimize treatment. Once plaque formation has begun, it is possible to limit its progression by maintaining a healthy lifestyle with routine exercise, diet, and by aiming for lifetime control of high blood pressure, high cholesterol, and diabetes.

An aspirin may be used for its antiplatelet activity, making platelets (one type of blood cells that help blood clot) less sticky and decreasing the risk of heart attack.

Medications may be prescribed in patients with heart disease to maximize blood flow to the heart and increase efficiency of the pumping function of the heart.

Beta blocker medications help block the action of adrenaline on the heart, slowing the heart rate. These medications also help the heart beat more efficiently and decrease the oxygen requirements of the heart muscle during work.

Calcium channel blockers also help the heart muscle contract and pump more efficiently.

Nitrates help dilate arteries and increase blood flow to the heart muscle. They may be short-acting (Nitrostat) to treat acute angina symptoms or long-acting preparations (Imdur) may be prescribed for prevention.

Should there be significant stenosis or narrowing of the coronary arteries, angioplasty and/or stenting (described above) may be considered to open the blocked areas. These procedures are performed in conjunction with cardiac catheterization. Depending upon the patient’s anatomy and the extent of the blockage present, coronary artery bypass graft surgery (CABG) may be required.