Congenital heart disease (CHD) or congenital heart disease is an abnormality in the structure and function of the heart that has been present since birth. This condition can interfere with blood flow to and from the heart, which can be fatal.
Congenital heart disease is the most common cause of birth defects. However, the types and severity of these conditions vary widely. Some conditions only require regular monitoring, others require surgery to a heart transplant (replacement).
Causes of Congenital Heart Disease
Congenital heart disease occurs due to disturbances in the process of formation and development of the heart since the baby is in the womb.
The human heart is divided into 4 chambers, 2 atria (atria) and 2 ventricles (chambers), each on the right and left sides. The right atrium receives dirty blood from all over the body. Blood that enters the right atrium will be pumped into the right ventricle, then to the lungs.
After binding oxygen in the lungs, blood returns to the heart via the left atrium. Next, the oxygen-rich blood enters the left ventricle, where it is pumped throughout the body through the aorta.
In people with congenital heart disease, this cycle and blood flow will be disrupted. This can be caused by disorders of the valves, heart chambers, septum (insulating walls between the heart chambers), or blood vessels to and from the heart. This blood flow disturbance will cause complaints and symptoms in the sufferer
Congenital heart disease risk factors
The cause of structural abnormalities of the heart during the process of fetal formation is not known with certainty. However, there are a number of conditions during pregnancy that can increase the risk of developing congenital heart disease in the baby, namely:
- Have a family history of congenital heart disease or diseases caused by genetic disorders, such as Down's syndrome or Edward's syndrome.
- Have uncontrolled type 1 or 2 diabetes.
- Excessive alcohol consumption and smoking while pregnant.
- Having a viral infection, such as rubella in the first trimester of pregnancy.
- Taking certain drugs during pregnancy, such as anti-seizure drugs, retinoid anti-acne drugs, and statin drugs, without a doctor's instructions.
- Frequent exposure to organic solvents commonly found in paint, nail polish, or glue products.
- Suffering from certain diseases that can be passed from parents to children, for example phenylketonuria.
Types of Congenital Heart Disease
There are many types of congenital heart disease. However, in general this disorder can be divided based on the part that is experiencing the disorder, namely:
Congenital heart disease with valvular abnormalities
This condition is caused by malfunctioning of the valves due to weakness or closed heart valves from birth. Some of the congenital heart defects of this type are:
- Tricuspid atresiaIt occurs when a valve does not form between the right atrium and the right ventricle.
- Pulmonary atresia, occurs when there is a problem with the valve between the right ventricle and the lungs, so that blood cannot flow to the lungs.
- Aortic valve stenosis, occurs when the valve between the left ventricle and the aorta is not fully formed and narrows, making it difficult for the heart to pump blood.
Congenital heart disease with abnormalities in the walls of the heart
Abnormalities in the walls of the atria and ventricles will cause impaired pumping of the heart and pooling of blood in areas where it should not be. Examples of this type of congenital heart disease are:
- A septal defect in the ventricles or atria, occurs when there is a hole in the wall of the chamber or atrium of the heart.
- Tetralogy of Fallot occurs when there is a combination of four congenital heart diseases at birth, such as a septal defect and pulmonary valve stenosis (narrowing).
Congenital heart disease with abnormalities in the blood vessels
This abnormality occurs in the arteries and veins to and from the heart. This causes obstruction to the flow of blood to and from the heart. Some examples of this type of congenital heart disease include:
- Patent ductus arteriosus(PDA), occurs when there is a gap or hole in the aortic blood vessel that carries blood from the heart to the rest of the body.
- Transposition of the great arteries (TAB), occurs when the position of the pulmonary arteries (blood vessels from the heart to the lungs) and the aorta is inverted.
- Truncus arteriosus, occurs when there is an incomplete separation between the aorta and the pulmonary arteries.
- Coarctation of the aorta, occurs when the aorta narrows.
In addition to the three categories above, congenital heart disease can also be divided into two categories, namely cyanotic and acyanotic. Cyanosis causes low levels of oxygen in the blood, which is characterized by a blue tinge to the skin and difficulty breathing. While asianotic patients generally do not experience this condition.
Symptoms of Congenital Heart Disease
Congenital heart disease can be detected since the baby is still in the womb or after birth. One of the symptoms of congenital heart disease in the fetus is the sound of an irregular heartbeat (arrhythmia). This condition can be detected during routine pregnancy examinations with ultrasound.
Even after routine ultrasound examinations, symptoms of congenital heart disease may not appear until the baby is born. Newborns with heart defects generally experience the following symptoms:
- A bluish or blackish tinge to the lips, skin, or fingers (cyanosis).
- Appears tired and has difficulty breathing, especially when breastfed.
- Have a low body weight.
- stunted growth.
- Swelling of the legs, abdomen, or the area around the eyes.
- Have recurrent lung infections.
- Frequent cold sweats.
In some cases, the symptoms of congenital heart disease may appear several years after the baby is born, such as during childhood or adolescence. Symptoms of this condition can include:
- Irregular heartbeat (arrhythmia).
- Dizziness and often feeling tired, especially when exercising.
- Difficulty breathing or gasping for breath.
- There is swelling (edema) in the feet, ankles, or hands.
- The skin looks bluish (cyanosis).
- Easy fainting or loss of consciousness.
In some cases, congenital heart disease may not cause chest pain or other painful symptoms, and it may even occur without certain signs or symptoms.
When to go to the doctor
Immediately consult a doctor or pediatric cardiologist if you or your child experience the symptoms of congenital heart disease mentioned above. Early treatment needs to be done to prevent a more serious condition.
If you have ever been sentenced to have congenital heart disease, do regular check-ups with your doctor to monitor the progress of the disease
The risk of congenital heart disease in the baby will be higher if the pregnant woman has diabetes or has a family history of genetic disease. If you have a history of this condition, consult your doctor to determine the possibility of congenital heart disease in your baby.
Go to the ER immediately if you or your child has difficulty breathing, bluish skin and lips, and swelling in the legs or other body parts.
Diagnosis of Congenital Heart Disease
The doctor will ask the patient's complaints, then perform a physical examination. This examination is done to look for signs of heart disease, as well as listen to the heartbeat and breathing sounds in the lungs using a stethoscope.
The doctor will also ask about the patient's and family's medical history. If the patient is suspected of having congenital heart disease, one or more of the following further examinations should be performed to confirm the diagnosis:
- Echo heart, to see the condition of the heart through sound waves.
- Electrocardiogram, to check the electrical activity in the heart.
- Cardiac catheterization, to determine the flow and pressure of blood in the heart.
- X-rays, CT scans, or MRIs, to see the structure of the heart.
- pulse oximetry, to measure the level of oxygen in the blood.
- stress test, to see the condition of the heart when the patient is exercising.
- DNA testing, to find out whether there are certain genes or genetic syndromes that can cause heart defects.
Congenital Heart Disease Treatment
Treatment for congenital heart disease aims to correct heart defects or treat complications caused by the condition. Treatment will be tailored to the type of disorder and its severity.
Some abnormalities or minor defects in the heart may not require special treatment. It is enough for the patient to have regular check-ups with the doctor to monitor his condition. Some babies born with this condition recover on their own over time.
However, if the congenital heart disease is classified as moderate to severe, the doctor can perform the following treatment methods:
Use of drugs
A number of drugs can be given by doctors to patients to lighten the workload on the heart or make it work more efficiently. The drugs include:
- ACE inhibitors, to relax blood vessels.
- Beta blockers, to slow the heart rate and dilate blood vessels.
- Diuretics, to reduce the volume of blood in the body.
- Indomethachin, to help close openings in blood vessels.
- Prostaglandins, to help close the channel between the aorta and the pulmonary artery.
Some examples of congenital heart disease that can be treated with drugs are: patent ductus arteriosus, transposition of the great arteries, and truncus arteriosus.
Device implants in the heart
Insertion of a pacemaker and ICD (implantable cardioverter-defibrillator) can be used to monitor and control the patient's heart rate. This method can prevent complications due to abnormalities in the heart.
Cardiac catheterization
Catheterization is performed to correct heart defects without the need for surgery. In this procedure, a catheter (a thin and flexible tube) is inserted through the blood vessels in the patient's leg to the heart with the help of image scanning technology (X-rays, CT scans).
Once the catheter is in the correct position, a small instrument is inserted through the catheter to treat abnormalities or defects in the heart. Catheterization can be done by angioplasty and valvuplasty.
Some examples of congenital heart disease that can be treated with this technique are aortic valve stenosis, septal defects, and transposition of the great arteries.
heart surgery
This step is performed if the catheterization is not successful. Surgery is performed to patch or stitch holes in the heart, repair or replace heart valves, or widen blood vessels. CABG (coronary artery bypass grafting) is an example of a cardiac surgical procedure.
Some examples of congenital heart disease that can be treated in this way are coarctation of the aorta and Tetralogy of Fallot.
Heart transplant
If the heart abnormality cannot be corrected, then a heart transplant may be the last treatment option. A heart transplant is performed by replacing a problematic heart with a healthy heart from a donor.
After treatment, regular check-ups to the doctor still need to be done. This is because the disease has the potential to reappear at a later date. In addition, heart function can also decline with age.
In order to maintain a healthy heart condition, patients are advised to be diligent in exercising. Generally, doctors recommend doing light exercise such as walking and swimming.
Complications of Congenital Heart Disease
There are several complications that can arise from congenital heart disease, including:
- Arrhythmia or irregular heartbeat.
- Heart failure.
- Infection of the heart (endocarditis).
- Pulmonary hypertension.
- Respiratory tract infections, such as pneumonia.
- Blood clots and strokes.
- Have a learning disorder.
Prevention of Congenital Heart Disease
Congenital heart disease is not completely preventable. However, pregnant women can reduce the risk of their baby experiencing this condition by taking the following steps:
- Get vaccinated for rubella and flu, if you haven't already.
- Diligently consume folic acid during the first trimester of pregnancy.
- Ensure that blood sugar is controlled before and during pregnancy, if you have diabetes.
- Carry out routine pregnancy control and always consult with your doctor before taking medication, including supplements and herbal remedies.
- Avoid excessive exposure to organic solutions, such as solvents used in paint thinners or detergents.
- Perform genetic screening if you have or have a family member with congenital heart disease.