Slower Rate Of Growth Than Expected

Published Date: 02 Nov 2017

There are 3 main categories which heart defects fall into:

Septal defects

Obstruction defects

Cyanotic defects

Septal defects are those in which there is a hole in the middle between the two chambers. This allows deoxygenated blood and oxygenated blood to mix. This can cause symptoms such as fatigue and shortness of breath.

Obstruction defects are those where there is a partial or full blockage of blood through the various chambers and can sometimes cause chest pains and dizziness.

Cyanotic defects are where there is one or more defect within the heart that causes a lack of oxygen to be delivered around the body. The name comes from the bluish tint that it causes (cyan).

Septal defects

The most common septal defect is a ventricular septal defect which affects 200 in ever 100 000 babies born in the UK. The hole occurs between the two lower chambers knows as the ventricles. The left ventricle has a higher pressure because this section of the heart must pump blood around the body as opposed to the right side which pumps blood at a lower pressure due to less distance required to the lungs. Ventricular symptoms depend on the size of the hole. Small holes usually require no treatment and heal by the age of 2 years. Medium sized holes will have noticeable effects such as:

Excessive sweating

Baby appearing tired

Slower rate of growth than expected

Repeated infections of the airway

Rapid breathing

Rapid heart rate

Large holes have the same symptoms but are much more severe. The child may develop cyanosis during sports which is the skin turning a bluish tint. This occurs severely at the fingers, toes and lips.

Atrial septal defects affect the same number as ventricular defects which is 200 in every 100 000. Atrial defects do not show up as easily as ventricular. Usually a symptoms are:

Shortness of breath during physical activity

Poor weight gain

Repeated chest infections

Atrial defects are usually found later on in adult hood when a test is taken for an unrelated problem. If not found until adulthood, complications such as heart failure and pulmonary hypertension can occur.

Treating atrial and ventricular defects are usually done in the same way. Recommended treatment depends on the severity of the defect and any reactions that may occur. Small defects usually require no treatment. Medium and large defects usually require a combination of drugs such as:

Diuretics

Angiotensin- converting enzyme (ACE)

Digoxin

Diuretics remove fluid from the body and allow breathing much easier. Angiotensin-converting enzyme widens the vessels and the walls of the heart. This improves circulation as there is less tension placed upon the heart. A high calorie diet is usually given to improve growth rates.

If none of these drugs work then heart surgery will be required. There are 2 main types of surgery. Open heart and transcatheter are the 2 main types of surgery. In open heart surgery a surgeon will make a cut into the chest and close the septal defect. In trans catheter surgery, a small tube is guided through the body into the heart and special tools are used to close the defect. Trans catheter surgery does not leave behind scar tissue but is usually available in specialized hospitals and a longer waiting time is usually required.

Obstruction defects

Pulmonary stenosis is a defect where the flow of blood to the lungs is blocked by the pulmonary valve and it is much smaller than it should be. Pulmonary stenosis accounts for around 10% of congenital heart defects. It is only noticed in severe cases and causes symptoms such as extreme tiredness and shortness of breath during physical activity.

Aortic stenosis is less common but more severe. It accounts 5% of congenital heart defects. This occurs because the aortic valve is much narrower than it should be. Symptoms include:

Palpitations

Extreme tiredness

Chest pains

Shortness of breath during physical activity, sometimes causing fainting

Symptoms develop overtime and usually get worse. Without treatment, most people with aortic stenosis will move onto heart failure.

Treatment for stenosis involves guiding a balloon to the relevant valve via a catheter and is known as balloon valvuloplasty. For pulmonary stenosis, it is only required for severe cases. In aortic stenosis, treatments is usually delayed until the baby has reached a child stage, even if it has been detected since birth. A recent new development has now allowed for the aortic valve by use of a catheter. The tube is inserted at the groin until it reaches the valve. The replacement valve can then be passed via the catheter. This type of treatment is usually reserved for those too weak to cope with or recover from open heart surgery.

Coarctation of the aorta is another condition where there is a problem with the aorta. This time as opposed to a problem with the valves, the aorta is too narrow, which restricts blood flow to the rest of the body. Symptoms develop within the first few days of birth and include:

Poor feeding

Rapid heart rate

Rapid breathing

Lack of energy

Cyanosis

If left untreated these conditions can occur during childhood and adulthood

High blood pressure

Murmur

Headache

Chest pains

Extreme tiredness

Treatment usually involves medication to stabilize conditions until surgery can be taken place if required. Surgery involves removing the section of the narrowed aorta and reconnecting the two ends. It can be widened with a balloon or metal tube known as a stent. Another common method is to remove vessels from other parts of the body to create a bypass around the narrowed section.

Cyanotic defects

Here are some of the most common cyanotic heart defects:

Tetralogy of Fallot

Transposition of the great arteries

Total anomalous pulmonary venous connection

Tetralogy meaning 4 and Fallot being the doctor who discovered the case has 4 defects; ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy and displaced aorta. This complex set of defects leads to low oxygen rich blood being pumped around the body. Symptoms can develop from birth until around the age of around 2 years. Symptoms include: http://media.tumblr.com/tumblr_ljxz83HzfD1qc2f98.jpg

Low birth weight

Poor feeding

Cyanosis

Poor breathing

Clubbing of fingernails

Delayed physical growth

In order to improve blood flow the child may squat rather than sit. This involves raising the knees to the chest also resting arms and head on the knees. The only option for treatment is open heart surgery due to the number of problems. The surgery usually happens at the age of 3-6 months. http://www.pediatricheartspecialists.com/_uploads/content/TGA_and_normal_-_web.jpg

Transposition of the great arteries affects around 5% of cases. This is when the pulmonary and aortic valves along with their vessels have swapped positions. This results in low oxygen blood being pumped around the body. Symptoms include:

Cyanosis

Rapid heart rate

Rapid breathing

Excessive sweating

Low weight gain

Shortly after birth an injection of prostaglandin is given. This prevents the ductus arteriosus from closing. This allows the blood to mix and gives a greater concentration of oxygen around the body. In some cases a catheter is required to keep a hole there until surgery can take place. This usually occurs when the babyies’ health is stable. The surgeon will perform open heart surgery and switch the arteries around to their correct places.

Total anomalous pulmonary venous connection occurs when the veins from the lungs (pulmonary vein) is connected to the right atrium. Symptoms usually develop within 24-36 hours after birth and include:http://api.ning.com/files/PJs644274Bj3So*-z0UD*Z2Zt7SevR98zvkW96mJjtWCP9giz5dq*Erh16MtVEnAI745iGaQIvSwujN2tEWHrETRtGJ3wnPZMmqCT5Ffikg_/Cardiac_case5_2.jpg

Cyanosis

Rapid breathing

Rapid heartbeat

Difficulty of breathing over time

Poor weight gain

Repeated respiratory infections

Again treatment is open heart surgery. If the pulmonary artery is blocked then surgery will usually commence after birth. If the pulmonary artery is not blocked then the surgery will usually be postponed till a few weeks or months after birth.