Congenital Heart Disease
last authored: October 2009, David LaPierre
Introduction
Congenital heart disease is the most common problem in development, occurring in 8 in 1,000 live births, or close to 1:100. If a child has a heart problem at birth, future siblings have a chance of 3-5%.
Some problems can have minimal consequences, while others can be severe and require immediate medical attention.
specific problems
- atrial septal defects (ASD)
- ventricular septal defects (VSD)
- patent ductus arteriosus (PDA)
- coarctation of the aorta
- tetralogy of Fallot
- transposition of the great vessels
- congenital aortic stenosis
- congenital pulmonic stenosis
Signs and Symptoms
Congenital heart problems generally do not cause substantial problems during pregnancy, as blood can shunt through the foramen ovale and the ductus arteriosus. It is usally only after birth, when the baby cannot depend on maternal oxygenation of the blood anymore, that symptoms arise.
Some problems are apparent at birth, while others are picked up weeks, months, or years later.
Problems can be categorized as cyanotic or acyanotic.
Acyanotic problems include intracardiac and vascular stenosis, valve regurgitation, and problems resulting in left-to-right shunts.
Large left-to-roght shunts cause pulmonary artery volume and pressure to increase, leading to pulmonary arteriolar hypertrophy and increased resistance to flow. Over time, this resistance can increase right heart pressure, resulting in a right-to-left shunt. This delayed development of hypoxemia and cyanosis is called Eisenmenger syndrome.
Increased pulmonary vascular resistance and heart dysfunction (ie a big VSD) can cause heart failure
Signs and Symptoms in Infants and Children
- failure to thrive
- cyanosis, especially during feeding, crying, or exertion, in some conditions
- increased rate of breathing or trouble breathing
- due to fluid buildup
- hepatomegaly, likely due to hyperinflation
- decreased energy or lethargy (ie more sleepiness)
NO pitting edema or orthopnea
At birth
blue neonate: transposition of great arteries
blue baby: tetrology of Fallot
1-4 weeks
In older children, first presenting problems include
- left sided obstruction:, aortic stenosis, coarctation
- myocardial obstruction
Diagnosis
Pathophysiology
Causes and Risk Factors
Genetic mutations, environmental factors, maternal illness, or toxins can lead to cardiac malformations. However, in most cases, the cause is unknown.
Treatments
Course
Patient Education
Community Resources
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