Congenital Heart Defects

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The Normal Heart and How it Works?

The normal heart is a pump made of muscle tissue. It’s about the size of your fist. The heart has four chambers. The two upper ones are the atria, and the lower two are the ventricles. (See diagram.) Four heart valves open and close to keep the blood flowing in one direction as it’s pumped through the heart.

The four heart valves are:

• The tricuspid valve, located between the right atrium and the right ventricle
• The pulmonary (pulmonic) valve, between the right ventricle and the pulmonary artery
• The mitral valve, between the left atria and the left ventricle
• The aortic valve, between the left ventricle and the aorta

Each valve has a set of “flaps” (also called leaflets or cusps). The mitral valve normally has two flaps; the others have three.

Dark bluish (oxygen-poor) blood returns to the heart after circulating through the body. It flows to the heart through veins and enters the right atrium. This chamber empties blood through the tricuspid valve into the right ventricle. The right ventricle pumps blood under low pressure through the pulmonary valve into the pulmonary artery. From there the blood goes to the lungs, where it gets fresh oxygen. Oxygen-rich blood is bright red. Now the blood returns to the left atrium. From there it passes through the mitral valve and enters the left ventricle.

The left ventricle pumps the red, oxygen-rich blood through the aortic valve and into a large artery called the aorta. The aorta takes blood from the heart to the rest of the body. The blood pressure in the left ventricle is the same as in the arm. While passing through the body, oxygen in the blood is distributed to the tissues. The cycle repeats as the blood flows back to the right atrium.

Congenital Heart Defects

Congenital heart defects (CHD) in adults aren’t common. You’ll get the best care at a center where medical professionals are skilled in caring for patients with problems similar to yours. These medical people include board-certified pediatric and adult cardiologists, cardiothoracic surgeons and intensive-care experts, as well as a skilled support team. Often these centers have doctors skilled in special radiology procedures for people with congenital heart disease. As more and more people need this specialized care, centers for adults with congenital heart disease are being formed. You may want to find one

Keeping Your Heart Healthy

Since you have heart disease, all the “healthy-heart recommendations” apply even more to you than to other people. No matter what type of heart disease you have, your overall level of physical fitness will determine how well your heart can compensate. Also, you’re probably at risk of developing heart disease, such as coronary artery disease or high blood pressure, just like other people your age. That’s why you should eat a balanced diet, maintain a reasonable body weight and stay at least moderately active physically (within any limits your cardiologist gives you). You also may need to have your cholesterol level checked by your physician, especially if your family has a history of heart disease.

Complying with the medical regimen your cardiologist gives you is your responsibility. Keep your follow-up appointments, take your medicines as prescribed, have necessary tests done when required, and follow any physical activity restrictions. If you feel that some of the treatments or follow up may be making you worse or are unnecessary, talk with your cardiologist.

Be sure to get regular medical care from your primary care physician. Even though you have a cardiologist, you still need a primary care doctor.

You also need regular dental care. This will minimize the chance of an infection that could affect your heart. For patients with certain preexisting heart conditions, antibiotics are recommended before certain dental procedures to prevent an infection of the heart’s inner lining or heart valves called endocarditis. See our page on endocarditis to learn about which patients have the highest risk.

Consider your heart disease before taking any over-the-counter medications, vitamins, herbal preparations or prescription medications or before having any medical or surgical procedures. Discuss any potential cardiac side effects or drug interactions with your primary care physician, cardiologist or pharmacist.One of the most important things that you can do to maintain your health is to learn about your heart disease. Don’t rely on your parents, primary care doctor or anyone else to do this for you!

Physical Activity and Exercise

One of the most common questions people with heart defects ask is, “Do I have to limit my physical activity?” Activities like walking, jogging and swimming help keep the cardiovascular system fit. They’re good for almost everyone, including most people with heart defects. But some people with heart defects do need to limit their activities. Usually this means forgoing intense competitive sports and certain exercises, including isometric exercises and weightlifting, rope climbing, sit-ups, chin-ups and push-ups. In some (rare) instances even more restrictions may be needed.

• Exercise and Your Heart
  Your heart’s workload can be increased in two ways: (1) by increasing the amount of blood the heart pumps, and (2) by pumping at a higher blood pressure. Physical activity makes your heart work more in both these ways. However, the amount of extra work for the heart varies a lot from one activity to another.

Low-intensity sports like golf, baseball and doubles tennis — and activities like dancing, casual swimming, cycling and power walking — don’t put much strain on the heart. They’re fine for almost anyone with congenital heart defects. Household activities such as digging in a garden, raking leaves, mowing the grass and vacuuming are also fine. Shoveling snow isn’t a good idea.

People with some heart defects may be asked to avoid high-intensity sports like basketball, competitive swimming, rowing, competitive cycling, jogging and wrestling.

Finally, certain sports like diving, football and ice hockey have a significant risk of bodily injury. People with certain problems (for example, a pacemaker or Marfan syndrome) should avoid these sports.

• Finding the Right Activity Regimen
  Every person with congenital heart disease, whether or not they’ve had their defect repaired, is different when it comes to participating in sports. Only your cardiologist can tell you for sure which activities are right for you. Sometimes tests to evaluate your heart, like an echocardiogram, Holter monitor or exercise test, may help your doctor determine what level of activity is safest. If you have chest pain, palpitations, shortness of breath or faintness, stop exercising immediately! Contact your doctor as soon as you can — even if your symptoms go away.
• Job Restrictions
  Most people with heart defects can work in virtually any occupation. Some may be asked to avoid intense physical activities like heavy lifting. If your heart condition has a high risk of causing fainting or dizziness, you may need to avoid jobs where fainting could be dangerous to you or others. If you have concerns about how your occupation might affect your health, ask your cardiologist.

Sex, Pregnancy and Birth Control

It’s very important to discuss your sexual activity, the need for birth control and the advisability of becoming pregnant with your physician.

• Menstruation
  Menarche, or the onset of menstrual periods, occurs slightly later than normal in adolescents with congenital heart disease. This is especially true in women who are cyanotic. Women with cyanosis also may be more likely to have irregular periods.
• Birth Control
  Use of birth control must be tailored to a woman’s specific type of heart problem. Women should discuss the best form of birth control to use with their primary care physician, gynecologist or cardiologist. Women with many forms of heart disease can use most of the effective methods safely. However, some women with complex heart disease, cyanosis, or pulmonary hypertension, should not use oral contraceptive agents. The reason is that they increase the risk of blood clots. Depo-provera or low-dose estrogen can be used in some cases. Intrauterine devices (IUDs) may predispose patients to endocarditis, an infection of the heart’s inner lining or the heart valves. These devices generally aren’t recommended for women at risk.
• Pregnancy
  Many women with congenital heart disease can have a successful pregnancy. Still, discuss this with your cardiologist before becoming pregnant. The changes pregnancy brings to a woman’s body, particularly in the second and third trimesters, can make symptoms of congestive heart failure worse. They can also cause women who’ve had no symptoms to develop problems. For some types of heart disease, especially those associated with pulmonary hypertension or significant ventricular dysfunction, pregnancy creates significant risk for the mother. The mother’s condition also can put the fetus at risk for poor growth or other problems. Many commonly prescribed heart disease medications pose added risks to the fetus. In many cases, women will be advised to have their pregnancy monitored by a high-risk obstetrician, often along with with a cardiologist familiar with their condition. Usually, babies can be delivered vaginally. A Caesarean section isn’t necessary unless problems develop during birth.
• Risk to the Baby
  The risk of heart disease in the fetus is higher if either parent has a congenital heart defect. In these cases, it’s often smart to have an ultrasound performed to check the fetus’s heart for possible defects. This test, a fetal echocardiogram, must be done by a specially trained physician. It’s usually done in about the 18th week of pregnancy.Menopause

No information is available about whether estrogen replacement is safe or advisable for women with congenital heart disease.

Genetic Counseling for Adults with Congenital Heart Disease

Two of the most common questions after the birth of a child with a heart defect are: “Why did this occur?” and “What’s the risk of having more children with heart defects?” These same questions arise when a person with congenital heart disease considers starting a family. Evaluating this risk is part of genetic counseling.

• Cause of Congenital Heart Disease
  The heart is one of the earliest organs to completely form in a fetus. This allows blood to be pumped to the developing embryo. The heart is completely formed by about eight weeks after conception. Heart development involves a number of complex steps that must occur at certain times. When these don’t occur, a wide variety of defects can result. Much remains unknown about the exact origin of most heart defects, but many known factors might be related to them.
• Maternal Factors
  The mother’s good health affects the infant’s overall well-being. It can influence such things as premature delivery and the size of the baby. But birth defects of the heart may occur despite good health and a normal pregnancy. Mothers often may feel guilty that they caused the child’s defect. Usually this isn’t the case. However, maternal illnesses such as diabetes have been linked to a slightly increased incidence of birth defects, including heart defects.

People with congenital heart disease are at greater risk of having a child with a heart defect. This is true whether the affected person is the father or the mother. The frequency of disease increases from less than 1 percent in the general population to 2-20 percent when a parent is affected. There also seems to be a difference depending upon the nature of the parent’s defect. Defects such as coarctation of the aorta or aortic valve stenosis have the greatest risk of occurring in the child. Each time another close family member is also affected, the risk increases even more.

• Chromosomal Factors
  Most people with congenital heart disease have normal chromosomes. People with Down syndrome (trisomy 21) and other chromosomal anomalies such as other trisomies or Turner’s syndrome, have a high incidence of heart defects related to their syndrome. If they can conceive, these people can expect their offspring to have a high likelihood of the same syndrome and heart disease.

There are more subtle chromosomal abnormalities, such as 22q11 deletion (Di George syndrome), that are just now being discovered. These may significantly affect the ability to predict the presence of heart disease in some people.
As the science of genetics and our ability to understand and define the genetic code improves, more definite answers to the genetics of congenital heart disease may be revealed.

• Exposure to Substances
  A mother’s exposure to certain prescription medications, industrial chemicals or solvents, ionizing radiation (X-ray), alcohol, viral infections such as rubella (German measles), and possibly recreational drugs, leads to a higher incidence of heart disease. Often the particular exposure and its risk are known. Yet, this is a particularly difficult area for predicting how big the risk is. It may depend upon the extent of exposure, timing of exposure relative to the pregnancy and unknown maternal factors that make some people more susceptible to a particular agent. That’s why you should avoid these potentially toxic agents.
• Genetic Counseling
  In most cases, having congenital heart disease shouldn’t stop you from having a family. But realize that you’re at greater risk for having children with heart defects, and that if defects occur, they’re most often like your own. The severity of the defect may vary, and this may have a profound impact on the child. Further testing, such as chromosome analysis before pregnancy or amniocentesis during pregnancy, may be recommended. Most often a fetal echocardiogram done by a specialist such as a pediatric cardiologist familiar with imaging congenital heart disease will be indicated.

Insurance, Legal Issues and Advance Directives

• Health Insurance
  Most significant heart conditions require lifelong, expensive health care. That’s why it’s important to obtain and maintain adequate healthcare coverage with a policy that lets you access physicians experienced with congenital heart disease. As you reach adulthood, in most cases, you won’t be able to obtain health insurance through your parents’ policy.

Generally, the best way to get coverage is to get group health insurance through your employer. Most large companies will offer group health plans at reasonable rates, despite your heart condition. Seek plans that don’t have pre-existing condition clauses that may exclude coverage for your heart disease. If your heart condition is relatively complex, be sure your plan allows you access to a cardiologist who is experienced in treating congenital heart disease in adults.

If group coverage isn’t possible, you may need to get insurance through a “high-risk” pool. Unfortunately, this can be expensive.

If you’re now covered under a group plan, such as your parents’ policy or a policy through work, and your coverage is due to end, you need to know about a federal law known as COBRA. This law lets you continue your policy for up to 18 months. To be eligible for COBRA, you must notify the appropriate person at your employer about your wish to extend the policy. You must do this within 60 days of the termination.

If you now have health insurance through your employer, be very careful when changing jobs or policies. You may not be eligible for new policies, based on specific exclusions, or there may be waiting periods before you can receive full benefits.

• Life Insurance
  Young adults with many congenital heart conditions can usually buy life insurance without difficulty, but the cost may be higher. Term life insurance, especially if bought through a group, such as an employer, is often affordable and requires less medical information to enroll. Insurance companies vary a lot in how they consider congenital heart disease. Compare information from different companies before drawing conclusions about your insurability. An insurance agent who doesn’t work for just one company (i.e., an independent agent) may help you compare policies.

Even if you were denied a life insurance policy as a child, reapply as an adolescent or adult. Many insurance companies will consider applications from adolescents or adults once the severity of their heart condition is known with greater certainty.

Information from life insurance applications is centralized at the Medical Information Bureau, Inc., where insurance companies can see it. If you’re having trouble getting insurance, you may want to have your bureau information forwarded to your doctor to verify its accuracy.

If you can’t get life insurance, you may need to consider other ways to protect your family financially.

• Medical Power of Attorney
  In a medical power of attorney, you name another person, called your agent, to make medical decisions and give medical consent when and if you are unable to do so. In this document, you can specify your desire and limitations on medical treatment. Generally speaking, your agent should carry out your wishes when making your medical decisions together with your healthcare providers. Having a medical power of attorney is a good idea for any person of any legal age. In most states a spouse can make medical decisions and give medical consent while you are unable. But if you don’t have a spouse or medical power of attorney, healthcare providers may require a guardianship proceeding if you aren’t mentally or physically able to make an informed medical decision or give consent.

The person you choose as your agent should be someone you trust and who agrees to be appointed as your agent. You may choose your spouse, parents, adult children and friends as agent. You may not appoint your healthcare provider, their staff or any person associated with the healthcare facility treating you. Provide a copy of your executed medical power of attorney to your physician and make sure your agent keeps the original copy in a safe, fireproof location in case of an emergency. It’s very important to discuss your personal opinions with your appointed agent(s) and healthcare providers, even if your present state of health is good. It’s even more important if your health isn’t good.

• Living Will
  A living will gives advance written notice to your physician, family and friends and instructs them about your wishes if you become unable to give directions. It says that you don’t want any life-sustaining procedures, including mechanical ways to restore a bodily function, that would only artificially delay the moment of death. An example of a life-sustaining machine is a respirator. Pain medications, food and water aren’t considered life-sustaining substances. A living will usually requests that your wishes be honored by family and physicians.
• Advance Directives
  An Advance Directive is a document in which you can declare specific healthcare requests and name another person to make healthcare decisions and give necessary medical consent when you are unable to do so. The two major forms of advance directives used in most states are the medical power of attorney and living will.
• How To Obtain Advance Directives?
  An attorney can prepare advance directive documents, usually at a minimal cost. You can usually obtain more information from your attorney, state bar association referral system or your physician. Whether or not you use an attorney, it’s critical that the document you sign be in a legal form that satisfies the requirements of your state’s law and is properly executed to be effective. An agent named in your medical power of attorney is often required to act in a crisis. You don’t want questions about the validity of the document to arise. The person creating the medical power of attorney and living will must be mentally competent when signing it and it must be witnessed. Just as healthcare providers and staff can’t be appointed as agents, they also can’t act as witnesses to these documents.

Treatments for Congenital Heart Defects:

The treatments for the congenital heart defects are based on the severity of the heart condition. Some mild heart defects do not require any treatment, while others can be treated with medications, invasive procedures or surgery. Most adults with congenital heart disease should be monitored by a congenital heart specialist. You may need to take precautions to prevent endocarditis-an infection of the heart throughout your lifetime.

Preventive care and medical management of the congenital heart disease may be sufficient to keep the heart healthy for a patient have one of the following conditions:

1. Pulmonary hypertension due to congenital heart defects
2. Heart failure
3. Arrhythmias (heart rhythm disorders)

If CHD is more serious, then surgical intervention may be required, that includes:

• Pulmonary heart replacement
• Heart transplant
• Valve repair and replacement
• Congenital structural heart interventions
• Septal defects

Why Prefer India for treating congenital heart defects?

India has been emerging as a quality medical service provider at an affordable cost. Indian healthcare professionals are expertise and highly skilled in performing complex cardiac procedures and treatments. The physicians have specialized training and experience in dealing with the complexities of CHD. Indian hospitals are equipped with advanced medical technology and have state of the art infrastructure that are at par with the top hospitals in the western countries. Choosing India for treating the congenital heart defects will cost you only 25% of what will be charged at the developed countries.

FAQ’s

• What Is Congenital Heart Disease?
• Congenital Heart GraphicCongenital heart disease, or CHD, is a broad term that covers a range of conditions present at the time of birth that can affect the structure and function of the heart.

 

• What are the common conditions that cause congenital heart disease?
• Some of the common conditions that cause CHD include:
• Atrial septal defects (ASDs)
• Bicuspid aortic valve disease
• Coarctation of the aorta
• Ebstein’s anomaly
• Ebstein’s anomaly
• Tetralogy of Fallot
• Transposition of the great arteries
• Ventricular septal defects (VSDs)

 

• How do I know that I have Congenital Heart Defect?
• Check for the following signs and symptoms to know if you have CHD:
• Heart murmur
• Blue Skin
• Breathing Difficulties
• Excessive Sweating

 

• How do I make an appointment with the best cardiologist in India?
• All you have to do is send us your medical report and be rest assured. We will choose the best suitable surgeon for you, after consulting the experts.

 

• Can I speak with the doctor before I come to India for treatment?
• You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.