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 Children's Health

March 2012
Murmurs in Little Hearts
Dr Anil Sivadas
 
Of all the children born in the country, it is estimated that one in every 125 of them suffer from some form of congenital heart disease. Congenital heart defects are mostly genetic and are at times associated with other problems in the body.

These defects are rarely due to known causes and in most patients there is no obvious reason why the child is showing up with the problem.

Uncommon causes attributable to CHD
  • Exposure of the mother to certain drugs, viruses or X-rays during pregnancy
  • Consanguinity - parents who are blood relatives

Congenital Heart Defects can be broadly categorised into two types: Acyanotic and Cyanotic.

Acyanotic Heart Diseases
The conditions for this type of congenital heart disease are:
  • Atrial Septal Defects
  • Ventricular Septal Defects
  • Patent Ductus Arteriosus
The symptoms and signs include:
  • Failure to thrive
  • Recurrent infections in the lower respiratory tract
  • Fatigability or excessive sweating which may be signs of heart failure
At times the conditions are discovered when the child is being treated for some other illness. The chest gives off a murmuring sound on the stethoscope, which alerts the doctor to the possibility of a heart disease. Usually babies born with Down’s Syndrome have a higher incidence of heart defects.

Cyanotic Heart Diseases
The most common conditions of this type of heart defects are:
  • Tetralogy of Fallot: There is a large defect in the heart with obstruction of blood flow to the lungs.
  • Transposition of the great arteries, which cause the children to be born with blue tinged fingers, toes or lips. If these children are not treated in time, they do not live
    beyond a month.
Treatment
  • It depends on the type of cardiac disorder and the effect of the defect on various parameters like growth and on the changes that happen to the lungs.
  • Early intervention is required for serious disorders like transposition of arteries where surgery is mandatory in the first month of life.
  • Some anomalies can be treated without surgery by interventional cardiologists.
Diagnosis
  • Clinical examination by paediatricians and paediatric cardiologists
  • Baseline investigations consisting of chest X-ray and ECG
  • Gold standard and the investigation of choice is 2D colour Doppler echocardiography
  • Additional investigations such as 3D echocardiography, 64-slice CT angiogram, cardiac MRI, angiography and cardiac catheterization
Dr Anil Sivadas is Sr Consultant Paediatric Cardiology Apollo Health City, Hyderabad


    
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