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Examinations and Test for detecting - 12-14-2009, 11:51 PM

Many congenital heart defects are found within the first month after a baby is born. To diagnose a heart defect, a doctor will ask certain questions about the baby's symptoms, appetite, and other habits and give the baby a physical exam. An echocardiogram and possibly a heart catheterization (angiogram) may be needed.

While details of possible questions, physical exam are explained here echocardiogram and heart catheterization are explained in separate posts. This would help parents prepare before seeing doctor.



When determining whether baby has a congenital heart defect, the health professional will ask questions about baby's medical history and parents medical history. These may include the following:
  • What symptoms does your baby have?
  • When are symptoms usually present? Symptoms may be present only when your baby is eating or crying.
  • Has your baby been less active than usual?
  • How is your baby's appetite? How much does your baby usually eat and drink? Describe a typical feeding. Does he or she have trouble feeding or tire easily while feeding?
  • Has your baby been urinating less often than usual?
  • Does your baby's color change when crying? If so, does the color quickly return to normal after crying stops?
  • What position does he or she seem most comfortable in when resting?
  • Has your baby ever passed out? If the child is older, has he or she ever complained of the heart beating funny?
  • Did you have or were you exposed to rubella (German measles) or any other infections during your pregnancy?
  • Did you take any medicines, use illegal drugs, or drink alcohol during your pregnancy?
  • Do you have a family history of congenital heart defects?
During a physical exam for a congenital heart defect, the health professional will:
  • Check your child's weight and length.
  • Check your child's heart rate and blood pressure.
  • Listen to your child's heart and lungs with a stethoscope to detect whether a heart murmur is present. A heart murmur can be normal in children but should be checked by a health professional.
  • Check your child's heart rate (pulses) on the neck, wrist, legs, and feet.
  • Check your child's nail beds, lips, and skin for a bluish tint (cyanosis) and/or clubbing. Your health professional may also check the amount of oxygen in your child's blood with an oximeter.
  • Look at the skin over the blood vessels in the neck to see whether the vessels bulge. This may happen if the heart is weak (heart failure).
  • Look at and feel your child's belly to check for an enlarged liver. The liver may be enlarged in children who have heart failure.

More tests may be needed, depending on the symptoms and type of defect. These may include:
  • Chest X-ray, to check the size and blood vessels of the heart.
  • Electrocardiogram (ECG, EKG), to check for irregular heart rhythms (arrhythmias) that may be related to a congenital heart defect.
  • Stress test (exercise electrocardiogram), which may be done around the time the child starts school to find out how much exercise your child can do.
  • Blood tests, to check for anemia, polycythemia, or levels of certain chemicals in the blood.
  • Oximetry, to see whether oxygen-poor blood is being pumped to the body. This test would be done if your baby has severe difficulty breathing or has a bluish tint (cyanosis) to the skin, lips, and nail beds. The amount of oxygen in the blood can also be measured by an arterial blood gas (ABG) or a transcutaneous monitor (in infants).
  • MRI of the heart and major blood vessels, to view abnormal heart structures and/or blood vessels. If this test is done, your child will probably be given medicine to make him or her relax and sleep during the test
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Echocardiogram (Echo) - 12-14-2009, 11:53 PM

An echocardiogram is well known as echo is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

The different types of echocardiograms are:

Transthoracic echocardiogram (TTE): This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall.

Stress echocardiogram: During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease, or CAD).

Doppler echocardiogram: This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.

Transesophageal echocardiogram (TEE): For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because the lungs and bones of the chest wall do not block the sound waves produced by the probe. A sedative and an anesthetic applied to the throat are used to make you comfortable during this test.

Echo can be used as part of a stress test and with an electrocardiogram (EKG) to help your doctor learn more about your heart.
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Heart catheterization for congenital heart defects - 12-14-2009, 11:58 PM

A heart catheterization is a procedure used for both diagnosis and treatment of congenital heart defects. The procedure allows health professionals to see how blood flows through the heart chambers and arteries. This test may also be called angiography (angiogram), cardiac catheterization, or heart cath.

To perform a heart catheterization, a thin, flexible tube called a catheter is threaded through a blood vessel in the groin, or sometimes in another location, and into the heart. Through the catheter, the doctor can measure pressures, take blood samples, and inject a special dye (contrast material) into the chambers of the heart or the coronary arteries. The doctor watches the movement of the dye through the heart's chambers and blood vessels.


A heart catheterization can be used to:
  • See whether the structure (anatomy) of the heart is normal.
  • Measure pressures in the heart chambers and see how the blood is flowing through the heart.
  • Collect samples of blood from inside the heart.
  • Inject a dye into the heart or arteries to see whether there are abnormal blockages in the blood vessels or abnormalities of the heart chambers (such as defects or holes between chambers).
  • View and correct certain heart defects.
A heart catheterization usually takes between 2 and 3 hours to complete. After the test, pressure must be applied over the catheter site for 10 to 20 minutes to stop bleeding and bruising. Then a large bandage is used to apply pressure to the catheter site for 4 to 6 hours.

Why catheterization is done?
The main purpose of a heart catheterization is to view the condition of the blood vessels in the heart.
Some procedures to correct congenital heart defects can be done during a heart catheterization. These include:

Septostomy: For a septostomy, an opening is made in the wall of the heart between the upper chambers to allow blood to mix between the heart chambers. This procedure is generally used to treat transposition of the great vessels, tricuspid atresia, and hypoplastic left heart syndrome. It does not correct the congenital heart defect but allows oxygen-rich blood to get out to the body until surgery can be done to correct the defect.

Closing a defect: During a heart catheterization, doctors may use a device called a septal occluder or coil to close an atrial septal defect, ventricular septal defect, or patent ductus arteriosus.

Balloon valvuloplasty: For a balloon valvuloplasty, a small balloon is inflated in a heart valve, widening the heart valve. This procedure can be used to treat pulmonary valve stenosis and aortic valve stenosis.

Balloon angioplasty: A balloon is inflated in an artery to widen the artery. This procedure can be used to treat coarctation of the aorta.

Stents: Small wire-mesh coils (stents) can be placed in arteries to hold them open. Stents for treatment of congenital heart defects are often placed in arteries outside the heart, such as the pulmonary arteries or aorta.

Results
In a child who has a congenital heart defect, a heart catheterization shows how the blood is flowing through the heart. The exact heart problem can be seen and sometimes treated during the same procedure or a later procedure.

What To Think About
Major problems very rarely occur in people who have a heart catheterization. These problems can include:
  • Irregular heartbeats (arrhythmias).
  • Puncture of the heart muscle or a blood vessel.
  • Problems where the catheter was inserted, such as a blood clot, a blocked artery, or an infection.
  • Allergy to the X-ray dye (allergic reactions may range from mild itching to life-threatening situations).
  • Death from bleeding, blood clots, or an allergic reaction.
Before the test, child receives medicine to make him or her relax and sleep-sedatives or sometimes general anesthesia. After the test, child will need to lie still for 5 to 8 hours and keep the leg in which the catheter was inserted straight to prevent bleeding. You may need to hold your child in your lap after the test to prevent leg movement, or child can wear a leg board with a strap to hold the leg still.

Last edited by NeedyHearts; 12-15-2009 at 12:02 AM.
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CHD Treatment: Overview - 12-22-2009, 11:45 PM

Your child's treatment for a congenital heart defect will be based on the type of problem he or she has. Your child's age, size, and general health also are important.

Treatment helps most children to live fairly normal lives. Your child may need:
  • Medicines to help with symptoms. Some medicines can control a heartbeat that is not regular. Others make the heart stronger until a defect can be fixed. Your child may need some medicines after surgery.
  • Heart catheterization to find out details about the heart defect or sometimes to repair the defect. With heart catheterization, a doctor threads a thin, flexible tube called a catheter through a blood vessel-typically in the groin-and into the heart. This lets the doctor see how blood is flowing through the heart and heart arteries.
  • Surgery to repair the structural defect. If a young baby (for example, newborn to 3 months old) has a life-threatening defect, surgery may be needed right away. For some defects, the best time for surgery is before the child is 2 years old. For other defects, the best time may be between the ages of 2 and 4. In some cases, surgery may be done when a child is older. Surgery may be delayed if the defect is likely to heal on its own.
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CHD Treatment: Initial treatment - 12-22-2009, 11:47 PM

If your child has a mild heart defect, a doctor may want to see if the defect gets better on its own. Your child may need some medicines during this time to help his or her heart work better. For example, a medicine called a prostaglandin inhibitor can be given to a premature baby to help close a patent ductus arteriosus.

Heart catheterization may be done to partially or completely repair a defect. More severe defects require surgery.

If a newborn needs surgery, the surgery may be delayed until the baby is stronger. If the defect threatens the baby's life, surgery will be done right away.

Medicines may be given in a vein for severe defects such as coarctation of the aorta, transposition of the great vessels, or tetralogy of Fallot.

Medicine, heart catheterization, or surgery may also be used as initial treatment for a mild congenital heart defect that is not noticed until later in childhood, adolescence, or early adulthood.
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CHD Treatment: Ongoing treatment - 12-22-2009, 11:49 PM

If your child needs surgery, your doctor may want to wait until your child is about 2 to 4 years old. Meanwhile, caring for your child who has a heart problem can be hard. You may need to keep track of many medicines and make frequent trips to the doctor. Costs can be overwhelming. And you may feel guilty, as if something you did caused the child to have a heart defect. The defect is not your fault. Try to find support groups and other parents who can help you with the many emotions involved.

Until your child can have surgery, you may need to focus on:
  • Making sure your child has enough nutrients.
  • Giving medicines.
  • Taking special precautions if your child has problems getting enough oxygen.
Some congenital heart defects can be completely repaired with one surgery. More complex defects often require several surgeries over the years. Knowing what to expect in the hospital can help you plan ahead. For example, you can consider what kinds of items to bring and how you will want to record instructions from the health professionals in the hospital.

If your child is older, talking to him or her about what to expect may be helpful.

With most congenital heart defects, your child's heart will not be completely normal even after surgery. Medicines and trips to the cardiologist may be needed throughout life.

It can be difficult to accept that your child has a heart defect, and it is normal to worry about his or her future. Make sure you take time to adjust to these challenges.
Adults who have congenital heart defects also need regular checkups. You also may need to be careful when you exercise or avoid exercise altogether.

Last edited by NeedyHearts; 12-23-2009 at 12:29 AM.
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12-22-2009, 11:50 PM

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CHD Treatment: Treatment if the condition gets worse - 12-22-2009, 11:54 PM

If your child has a severe congenital heart defect or develops complications, more treatment is needed.

Medicines often are used for young children with large defects who have heart failure. Complex cyanotic heart defects usually require medicines more often than acyanotic heart defects.

At this stage, medicines are used to help the heart work better:
  • In a child with heart failure, medicines called diuretics can reduce the amount of extra fluid in the body. Cardiac glycosides may be used to increase the strength of the heartbeats. Vasodilators can enlarge blood vessels. All of these medicines make it easier for the heart to pump blood.
  • Antiarrhythmics may be used to control irregular heartbeats.
  • Prostaglandins and prostaglandin inhibitors may be used to improve blood flow to the lungs or the body.
Additional heart catheterization procedures or surgeries are sometimes needed to further correct-either fully or partially-the defect.
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CHD Treatment: What to think about - 12-22-2009, 11:56 PM

Some people die from severe congenital heart defects or related complications, such as heart failure.

If your baby is born with a severe heart defect, be assured that there is a good chance that he or she will survive with treatment. But you must also prepare for the possibility that your child may die. Talk with your doctor about local resources and organizations that can help you manage the many emotional and practical struggles when faced with this possibility. It may help to talk with other parents who have had children with congenital heart disease.
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CHD Treatment: What to expect in the hospital for a CHD child - 12-23-2009, 12:00 AM

If child is born with a heart defect, many trips to the hospital and one or more surgeries may be needed.


While in the hospital, your child's treatment may involve:
  • Receiving intravenous (IV) fluids until he or she wakes up after surgery and can eat.
  • Having oxygen levels in the blood measured with a pulse oximeter.
  • Making adjustments to help make breathing easier. Your child may have the head of the bed or crib raised, be given oxygen (through a hood, tent, or face mask), or sometimes be given treatment with a breathing machine called a ventilator.
  • Draining fluids from the chest after surgery. Pressures within the body also may be measured.
It is normal to be frightened and worried about your child being in the hospital. Ask questions about any procedures that you don't understand or any special care that is needed. Generally, it is important to try to be with your child as much as possible.


Consider the following suggestions to help your child while he or she is in the hospital:
  • Take some of your child's familiar things to the hospital. Favorite toys or blankets will help the child feel more at ease.
  • If you cannot stay with the child, visit often.
  • Take some pictures of the family. Place them where your child can easily see them. Talk about what is happening with other family members or sing favorite songs.
  • Tell the nurses about your child's habits, typical routines, and general preferences.
  • Tell the nurses about any special words that your child may use to tell others what he or she needs.
  • If your child is a newborn, hold and touch him or her often to promote bonding.
  • As much as possible, help the hospital staff with your child's care. Find out whether you will be responsible for any treatments at home. Take this time to learn how to do these treatments while the hospital staff is there to teach you.
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