Congenital heart disease (CHD) is heart abnormality present at birth or before birth. CHD can range from minor valve abnormalities to significantly malformed or underdeveloped heart problems. Approximately 8 in 1000 infants has some form of CHD making CHD one of the most common forms of birth defects. However, not all children with CHD have critical or serious heart disease needing surgery or intervention. Another major category of heart disease is acquired heart disease – this is commonly coronary artery disease in adults or acquired infections that can cause heart problems.
One of the fastest growing populations is adults with congenital heart disease, or heart problems adults have since birth. Many adults have had surgeries or procedures as children and believe they are “cured”. Thanks to advances in medical and surgical care, it is now believed that the number of adults living with congenital heart disease is equal to, if not greater than, the number of children living with congenital heart disease. Fewer than 10% of adults with congenital heart disease in the United States who need specialty care are receiving recommended care from a specialty adult congenital heart disease specialty center.
A murmur is simply a sound or noise a nurse, doctor or advanced practice provider (nurse practitioner or physician assistant) hears during a checkup or physical examination. Some heart murmurs are caused by heart abnormalities, such as holes or abnormal valves. However, many heart murmurs are “innocent,” “functional” or benign. In fact, approximately 50% of all children with normal hearts can have an innocent murmur heard intermittently. Innocent murmurs are caused by blood flow through the normal heart. Therefore, many heart murmurs are normal and benign. If your primary care provider wants the murmur evaluated further referral to a cardiologist can help sort out if the sound is normal or needs more testing or work up.
Congenital heart disease can be diagnosed by a wide range of examinations and testing. A cardiologist can often diagnose a congenital heart problem by taking a patient and family history, doing a physical examination and common testing such as an electrocardiogram (ECG or EKG). If heart disease is suspected a heart ultrasound (echocardiogram) can diagnose congenital heart disease. Sometimes cardiac magnetic resonance imaging (MRI) or computerized tomography (CT scanning) can be used in more complex cases. Occasionally invasive testing using cardiac catheterization (small tubes put into the blood vessels/heart) can be used to diagnose more complex heart disease. Today, pediatric cardiac catheterization is used commonly to treat congenital heart problems with catheter balloons, stents and implantable devices to close holes. Catheter implanted heart valves are commonly performed in special situations. Often significant congenital heart disease can be diagnosed during pregnancy or prenatally. If routine screening OB fetal ultrasound testing is suspicious for heart disease fetal echocardiography (ultrasound testing on the fetus heart) can be performed by a pediatric cardiologist with expertise in fetal heart imaging.
Yes! Flu vaccination is very important. A yearly flu vaccination can prevent serious complication from influenza (flu) infection. The vaccine changes every year so a yearly vaccination is recommended. Certain patients should not receive a flu vaccination, for example those patients with egg allergy, flu vaccine allergy or immune compromised patients (for example transplant recipients).
Passing out or fainting or syncope is relatively common. Common causes are standing upright or positional changes such as going from sitting to standing. Common fainting – known as vasodepressor or vasovagal syncope – results from an imbalance of heart rate, blood pressure and blood flow to the head causing brief loss of consciousness. Typical scenarios for common fainting are: standing in line, standing in church, standing up in the shower and after using the toilet. Rarely a serious heart problem causes fainting. Fainting during sports or intense exercise is a different story and may be caused by a heart problem. Fainting during sports or intense exercise should be evaluated by a cardiologist. To prevent common fainting episodes increased fluids, extra salt in the diet and avoiding caffeine usually help.
The American Heart Association (AHA) recommends patient history, detailed family history and physical examination for yearly sports physical examination and sports participation screening. Universal screening or testing with EKG or echocardiography is not recommended by the AHA. Universal screening or testing can be a controversial topic. EKG testing or limited echocardiogram screening may not detect all of the rare problems that cause sudden death in young athletes. In the United States, the current AHA recommendations are detailed patient history, detailed family history and physical examination for yearly sports physical examination and sports participation screening. If concerns arise from this screening, evaluation by a cardiologist may be needed.
Within the past year universal screening for critical congenital heart disease has been recommended and endorsed by the American Heart Association and the American Academy of Pediatrics. The congenital heart disease screening test is a “pulse oximetry” test at 24 hours of life before newborn babies are discharged from the nursery. The pulse oximetry test is a non-invasive test with a band aid like probe wrapped around the baby’s hand and foot to measure oxygen levels. An abnormal pulse oximetry screen may indicate heart or lung disease needing more extensive medical evaluation. Pulse oximetry testing will not detect all forms of congenital heart disease; however pulse oximetry screening can aid the pediatrician or family doctor in conjunction with usual newborn physical examination before nursery discharge.
Pediatric hospitals are more commonly opening specialty intensive care units (ICU) that specialize in the care of infants, children and adults with heart problems. Cardiac ICUs are staffed by intensive care physicians, cardiologists, nurse practitioners, respiratory therapists and nurses with special expertise in the care of neonatal, pediatric and adult congenital heart problems. The cardiac ICU is often a different ICU than the pediatric ICU (PICU) or neonatal ICU (NICU). Patients in the cardiac ICU can range from newborns with newly diagnosed heart disease to adults with congenital heart disease.
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