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| Congenital Heart Disease in Adults | | Every year february 7 to 14 is celebrated as Congenital Heart Disease(CHD) Awareness week. | | Dr Amit Misri
(Sr Consultant Pediatric
Cardiology)
The idea behind it is to
make general popula
tion aware about the incidence and prevalence of CHD, its effect on suffering individuals and their families and community at large. Because of the recent advances in medical and surgical field more and more children with CHDs are reaching adulthood. Therefore it becomes imperative to address myriad of issues relating to such population. What is Congenital Heart Disease? Congenital heart defects (CHDs) are problems with the heart's structure that are present at birth. Common examples include holes in the inside walls of the heart and narrowed or leaky valves. In more severe forms of CHDs, blood vessels or heart chambers may be missing, poorly formed, and/or in the wrong place. How common are congenital heart defects? The reported incidence of CHD is 8-10/1000 live births according to various studies. There is no community based data available in India.
It is estimated that nearly 1.8 Lakh babies are born with heart defects each year in India alone. Of these about 40-50% require early intervention. What causes congenital heart defects? Most causes of CHDs are unknown. Only 15-20% of all CHDs are related to known genetic conditions. Most CHDs are thought to be caused by a combination of genes and other risk factors, such as environmental exposures and maternal conditions. Because the heart is formed so early in pregnancy, the damage may occur before most women know they are pregnant. Environmental exposures that may be related to risk of having a CHD include the mother's diet and certain chemicals and medications. Maternal diabetes is a recognized cause of CHDs. Maternal obesity, smoking, and some infections also may raise the risk of having a baby with a CHD.
What Is GUCH? GUCH or (Grown Up Congenital Heart) patients are those patients who are above 16 years of age and have a congenital heart problem but have survived to reach adulthood. This may be because the type of heart defect may not cause symptoms in early childhood and may manifest only later. Some patients are symptomatic and know that they require surgery but cannot afford it during initial years. Surgical correction and cardiac interventions in critical patients during newborn period have also helped many patients to reach adulthood who otherwise would not have been able to celebrate their first birthday. What symptoms do GUCH patients present with?
These patients may have been asymptomatic in early childhood but now present with complaints of exertional breathlessness, palpitations, appearance of bluishness of nails and lips more so on exertion, sudden loss of consciousness, calf pain on walking, hypertension.
Who should they refer to? Pediatric cardiologist who have knowledge about the congenital heart defects should be doing the initial evaluation and formulating the management plan. Multi disciplinary approach involving adult cardiologist, family physician are required. Symptoms like exertional breathlessness, chest pain often are attributed to coronary artery disease in this age group.
What can be offered to such patients? Treatment is mostly curative that means patient becomes absolutely normal after undergoing a procedure in form of surgery or cardiac intervention. However in certain cases it is palliative in which patient becomes symptomatically better. What are the issues faced by GUCH patients? The most common question that comes in the mind of an adult patient with CHD is can he/she live a normal life. The answer to this lies in the fact what kind of cardiac defect is present and what is the success of the surgical or interventional procedure patient has undergone. Most simple CHDs like small unoperated holes (ASD and VSD) or uncomplicated operated cases of ASD and VSD can live a perfectly normal life and should have a follow up at 5 yearly intervals. Moderately complex operated CHDs like holes with valve problems, operated uncomplicated Tetrology of Fallots can have a near normal life but should avoid competitive sports. Moreover they require checkups at two yearly intervals. Highly Complex CHD like single chambered hearts or cyanotic CHDs should have annual or more frequent checkups and should restrict their activities up to their limitations. What are the complications that can occur in GUCH Patients? These patients are more prone to the development of arrhythmias (irregular heart beats) which can make them symptomatic. Blue or cyanotic patients have a tendency to form clots. This clot can then go to any organ in body and if it goes to brain it can lead to convulsions or stroke. Some patients of CHDs are prescribed blood thinner medications which if not taken properly can result in excessive bleeding. Infection of heart known as infective endocarditis is also a major risk in some forms of heart defects.
Secondary complications causing renal dysfunction, cholilithiasis, and gout are also seen in many patients. Can GUCH patients become pregnant? Patients with simple heart problems can become pregnant and deliver successfully. Moderately complex operated heart defect patients should consult their specialist cardiologist before taking a call. Moreover it should be a combined care by cardiologist and obstetrician at a tertiary level center. Cyanotic patients and patients with severe pulmonary artery hypertension should not become pregnant as it is risky both for the mother and the fetus. Oral contraceptive pills should be avoided as means of contraception as they can cause clot formation . What is the risk of CHD in children of patients having congenital heart disease?
With advances is treatment, patients with CHD often bear kids now. The risk of having a congenital heart defect in such children is very low and is less then 3%.However it is advisable to get a fetal echocardiography done during 16-20 week of gestation to rule out complex congenital heart disease in fetus. Other issues pertaining to GUCH patients? Employment in armed forces , health and life insurance, eligibility for driving licence ,anesthesia for non cardiac surgeries are some of the relevant issues faced by this population. Individualized decisions keeping in mind the nature of disease, success of surgery and present symptoms will all help to make their lives better and productive. As advances in medical field occur, more and more patients with congenital heart disease will reach adulthood. It is thus imperative to identify this patient population, provide them with specialized care and help them live a normal productive life (This Article is Provided by Deptt. of Community Outreach Programme:
In Public Interest By Dr. Amit Misri (Sr Consultant-Medanta Heart Institute), Medanta-The Medicity"Gurgaon For Any Query readers can mail at ([email protected]).
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