Congenital heart disease (PJB) 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 from and to the heart so that it can be life-threatening.
Congenital heart disease is the most common cause of birth defects with various types and degrees of severity. Some sufferers of congenital heart disease only need routine check-ups, but some need to undergo surgery up to heart transplantation .
Causes of Congenital Heart Disease
Congenital heart disease (CHD) occurs as a result of disturbances in the formation and development of the fetal heart.
The human heart is divided into four chambers, namely two vestibules (atriums) and two chambers (ventricles), each on the right and left sides. The right atrium serves to receive dirty blood from the rest of the body.
Blood that enters the right atrium will be pumped to the right ventricle, then pumped to the lungs to be filled with oxygen. This oxygen-rich blood then returns to the heart through the left atrium. Next, the blood will enter the left ventricle, to then be pumped throughout the body through the aorta.
In PJB sufferers, the cycle and blood flow can be disrupted. This condition can occur due to disturbances in the valves, heart chambers, the partition wall between the heart chambers (septum), or blood vessels from and to the heart.
Congenital heart disease risk factors
The cause of the abnormality of the heart structure during the process of the formation of the heart organ in the fetus is not known for sure. However, a number of conditions in pregnant women can increase the risk of congenital heart disease in babies, namely:
- Having a family history of congenital heart disease or genetic abnormalities, such as Down 's syndrome or Edward's syndrome
- Suffering from uncontrolled type 1 or 2 diabetes
- Excessive alcohol consumption or smoking during pregnancy
- Suffering from a viral infection, such as rubella , in the first trimester of pregnancy
- Consuming certain drugs during pregnancy, such as anticonvulsant drugs, retinoid anti-acne drugs , and statin drugs, without a doctor's prescription
- Exposed to organic solvents that are generally found in wall paint products, nail polish, or glue
- Suffering from certain diseases that can be passed down from parents to their children, such as phenylketonuria
Types of Congenital Heart Disease
Congenital heart disease can be divided based on the part of the heart organ that is affected. Here is the explanation:
Congenital heart disease with abnormalities in the valves
This type of congenital heart disease occurs as a result of weakened or closed heart valves since the baby is born. Some types of congenital heart disease with heart valve abnormalities are:
- Tricuspid atresia , occurs when the valve between the right atrium and the right ventricle does not form perfectly
- Pulmonary atresia , occurs when there is a disturbance in 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 so that the heart has difficulty pumping blood
Congenital heart disease with abnormalities in the heart wall
Abnormalities in the walls of the atria and ventricles can interfere with the function of the heart in pumping blood and the blood collects in areas where it shouldn't.
Congenital heart disease of this type, including:
- Ventricular septal defect and atrial septal defect, which occur when there is a gap or hole between the two chambers or atria of the heart
- Tetralogy of Fallot , which occurs when there is a combination of four congenital heart diseases at birth, such as a septal defect and narrowing (stenosis) of the blood vessel valve from the heart to the lungs (pulmonary artery)
Congenital heart disease with abnormalities in blood vessels
Congenital heart disease occurs in the arteries and veins from and to the heart. This condition causes blood flow from and to the heart to be blocked.
Some of these types of congenital heart disease are:
- Patent ductus arteriosus (PDA), which 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), which occurs when the positions of the pulmonary artery and the aorta are reversed
- Truncus arteriosus , which occurs when the process of separating the aorta and pulmonary artery does not occur perfectly
- Coarctation of the aorta , which occurs when the aorta narrows
In addition to the three types above, congenital heart disease can also be divided into two categories, namely cyanotic and asianotic. Cyanotic causes low levels of oxygen in the blood, which is marked by a blue tinge to the skin and difficulty breathing. While Asianotics generally do not cause these symptoms.
Symptoms of Congenital Heart Disease
Congenital heart disease can be detected during a routine pregnancy ultrasound or shortly after the baby is born. One of the symptoms of congenital heart disease in the fetus is an irregular heartbeat ( arrhythmia ).
Whereas in babies, the most common symptoms of congenital heart disease are:
- Bluish or blackish color in the lips , skin, or fingers ( cyanosis )
- Fatigue and difficulty breathing, especially when breastfeeding
- Low body weight
- Stunted growth
- Swelling in the legs, abdomen, or area around the eyes
- Recurrent lung infections
- Frequent cold sweats
In certain cases, the symptoms of congenital heart disease only appear a few years after the baby is born, it can be during childhood or adolescence. The symptoms can be:
- Irregular heartbeat (arrhythmia)
- Dizziness and fatigue, especially when exercising
- Difficulty breathing or shortness of breath
- Swelling ( edema ) in the feet, ankles, or hands
- Bluish skin ( cyanosis )
- Fainting easily
In some cases, congenital heart disease does not cause chest pain or other complaints, it can even occur without certain symptoms.
When should you go to the doctor?
Immediately check yourself with a doctor if you or your child experiences the symptoms of congenital heart disease as mentioned earlier. Early treatment should be done immediately to prevent more serious conditions.
If you have ever been convicted of congenital heart disease, check regularly with your doctor to monitor the progress of the disease.
The risk of the baby suffering from congenital heart disease will be higher in pregnant women who suffer from diabetes or have a history of genetic diseases in the family. If you are or have suffered from the condition, consult your doctor regarding the possibility of reducing congenital heart disease to your baby.
Immediately go to the IGD of the nearest hospital if you or your child have difficulty breathing, the skin and lips appear bluish, or experience swelling in the limbs or other parts of the body.
Diagnosis of Congenital Heart Disease
Congenital heart disease can generally be detected earlier during pregnancy ultrasound examination. If the symptoms of this disease appear in teenagers or adults, the doctor will ask questions about the symptoms, the patient's and family's medical history, followed by a physical examination.
When a patient is suspected of having congenital heart disease, the doctor will perform several further examinations including:
- Heart echo , to see the ability of blood flow through the heart and heart valves
- Electrocardiogram , to detect abnormalities in the electrical activity of the heart
- Cardiac catheterization , to find out the condition of blood flow and pressure in the heart
- X -ray, CT scan, or MRI, to see the image of the heart and blood vessels of the heart
- Pulse oximetry, to measure the level of oxygen in the blood
- Stress test, to evaluate the work of the heart when the patient is active or exercising
- DNA test , to detect certain genes or genetic syndromes that can cause congenital heart defects
Treatment of Congenital Heart Disease
The treatment of congenital heart disease aims to improve heart abnormalities or overcome complications that may occur as a result of this condition. The method given will be adapted to the type of abnormality and the level of severity.
Some abnormalities or mild heart defects usually do not require special treatment. However, patients need to see their doctor regularly to monitor their condition.
In moderate to severe congenital heart disease, doctors can perform the following methods:
A number of drugs can be given by the doctor to the patient to ease the workload of the heart or make it work more efficiently. These drugs include:
- ACE inhibitor , to make blood vessels more relaxed so that the heart can pump blood more easily
- Beta blockers , to slow the heart rate and dilate blood vessels
- Diuretic , to reduce the volume of blood in the body
- Indomethacin , to help close the opening in the blood vessel
- Prostaglandin , to help close the channel between the aorta and the pulmonary artery
Some types of congenital heart disease that can be treated with drugs are patent ductus arteriosus , transposition of the great arteries, and truncus arteriosus .
Implantable pacemaker and defibrillator (ICD)
Installation of a pacemaker and ICD ( implantable cardioverter-defibrillator ) can be done to help the heart beat more regularly. This method can prevent complications due to congenital heart abnormalities.
Catheterization is performed to correct heart abnormalities without the need for surgery. In this procedure, a thin and flexible tube (catheter) will be inserted through the blood vessels in the patient's legs towards the heart with the help of image scanning, namely X-rays and CT scans.
Once the catheter is in the right position, a small device will be inserted through the catheter to overcome abnormalities or heart defects. Cardiac catheterization can be done with angioplasty procedures and heart valve repair (valvuloplasty).
The types of congenital heart disease that can be treated with cardiac catheterization are aortic valve stenosis, septal defect, and transposition of the great arteries.
Heart surgery can be done if cardiac catheterization is not effective in overcoming congenital heart disease. Surgery aims to patch or sew holes in the heart, repair or replace heart valves, and widen blood vessels.
CABG ( coronary artery bypass grafting ) is one example of a heart surgery procedure. Some types of congenital heart disease that can be treated with heart surgery are coarctation of the aorta and Tetralogy of Fallot .
If heart abnormalities cannot be corrected with drugs or other treatment methods, heart transplantation can be the last treatment option.
A heart transplant is a procedure to remove a heart that is no longer working optimally, to then be replaced with a healthy heart from a donor.
After patients with congenital heart disease undergo treatment, routine check-ups with the doctor are still necessary. This is because this disease has the potential to occur again later in the day. In addition, heart function can also decrease with age.
In order to keep the condition of the heart healthy, patients are advised to exercise regularly. The recommended type of exercise is light intensity, such as walking or swimming.
Complications of Congenital Heart Disease
Congenital heart disease can cause a number of complications, such as:
- Heart rhythm disturbances or arrhythmias
- Heart failure
- Pulmonary hypertension
- Respiratory tract infections, such as pneumonia
- Blood clots and stroke
- Learning disorders
Prevention of Congenital Heart Disease
To reduce the risk of congenital heart disease, there are several preventative measures that can be taken before and during pregnancy. Some preventive measures before pregnancy are:
- Undergo rubella and flu vaccinations
- Undergo the TORCH examination so that it can be treated before pregnancy
- Undergo genetic screening if you suffer from or have a family member with a history of congenital heart disease
Meanwhile, to prevent congenital heart disease in the fetus, pregnant women are advised to do the following during pregnancy:
- Do not smoke and avoid exposure to cigarette smoke
- Eating a healthy and nutritious balanced diet is suitable for pregnant women
- Consume folic acid supplements according to the doctor's advice
- Carry out routine pregnancy control
- Use cosmetics that are safe for pregnant women
- Avoid exposure to chemicals, such as solvents found in paint thinners or detergents