Congenital heart conditions

Congenital heart conditions are conditions which affect people from birth. Congenital heart disease is an umbrella term, which is used to describe a range of defects that affect the heart. Congenital heart disease is the most common type of birth defect – it is estimated that around 6 in 1,000 babies are born with congenital heart disease.

There are over thirty different types of congenital heart defect but there are two main types of congenital heart disease. These are cyanotic heart disease and acyanotic heart disease. Cyanotic heart disease means that the blood does not contain enough oxygen and acyanotic heart disease causes the blood to be pumped around the body abnormally.

What are the symptoms of congenital heart disease?

Symptoms of cyanotic heart disease include:

• cyanosis: this is a blue-ish discolouration of the lips, fingers and toes
• chest pain
• fainting
• breathing difficulties: many children squat when they are experiencing difficulties with breathing, as this helps to relieve the symptoms associated with breathlessness
• hypoxia: hypoxia occurs when there is a sudden shortage of oxygen; during a bout of hypoxia a child may start to hyperventilate and they may develop cyanosis

Symptoms of acyanotic heart disease include:

• extreme tiredness
• breathing difficulties
• chest pain

Symptoms associated with cyanotic and acyanotic heart diseases include:

• poor appetite
• difficulties with feeding and eating
• delayed growth and development
• sweating
• low weight

Causes of congenital heart disease

In the vast majority of cases there is no clear cause of congenital heart disease, however experts in cardiac medicine have identified the following risk factors for congenital heart disease:

• maternal diabetes: women who have diabetes are five times more likely to have a baby with a birth with congenital heart disease
• drinking: drinking during pregnancy increases the risk of a baby being born with congenital heart disease; around 30-50% of women who drink heavily during pregnancy will have a baby with congenital heart disease
• rubella: women who contract rubella during pregnancy have an increased risk of having a baby with congenital heart disease; if the woman contracts rubella during the first trimester, there is an 80 percent chance that the baby will be born with a birth defect
• genetic conditions: many genetic conditions, including Down’s syndrome, are associated with a high risk of congenital heart disease

Treatment for congenital heart disease

Surgery is usually carried out to treat congenital heart defects. Surgery may be carried out shortly after the baby is born or doctors may adopt a watchful waiting policy, which means that they will monitor the baby’s condition and then decide whether to operate. Medication can also be used in less serious cases.

In extreme cases, a heart transplant may be required. Priority for heart transplants is based on need rather than the time spent on the transplant list, which means that children who are most ill are often given priority.

What causes coronary diseases?

Coronary heart disease is the UK’s biggest killers but there are many cases that could be avoided. Coronary heart disease is commonly associated with an unhealthy lifestyle and making a few changes could dramatically decrease your risk of having a heart attack or suffering from angina.

Coronary artery disease, more commonly known as coronary heart disease, is caused by the collection of fatty deposits on the walls of the coronary arteries. This process is known as atherosclerosis. The coronary arteries are very important because they deliver blood to the heart. The heart muscle requires a constant flow of oxygen-rich blood to enable it to continue pumping blood around the body. Coronary heart disease affects the body’s ability to pump blood around the body because the fatty deposits obstruct the blood flow. This means that blood cannot reach the heart. If the arteries are narrowed as a result of atherosclerosis then this can result in chest pain and angina. If the artery is completely blocked this can cause a heart attack.

Risk factors for atherosclerosis include:

• a diet that is high in saturated fat, which contributes to high cholesterol levels
• smoking:
• high blood pressure
• diabetes
• living a sedentary lifestyle
• being overweight
• family history: if you have a close relative with CHD you have a higher risk of suffering from the disease

Cholesterol

Cholesterol is essential for good health but elevated levels can be very dangerous. Cholesterol is a form of fat made by the liver. Cholesterol levels in the body are related to the amount of saturated fat we eat; cholesterol is carried around the body by lipoproteins and there are two main types of lipoprotein: high density and low density. Low density lipoproteins (LDL) are often known as ‘bad cholesterol’ because the lipoproteins take the cholesterol to the cells, while high density lipoproteins (HDL) are known as ‘good cholesterol’ because the lipoproteins take the cholesterol away from the cells and back to the liver so that it can be broken down. Cardiac medicine experts recommend a maximum total blood cholesterol level of 5mmol/litre and a maximum LDL of 3mmol/litre.

High blood pressure

High blood pressure is dangerous because it puts pressure and strain on the heart muscle. High blood pressure is defined as a systolic pressure of 140mmHg or above and a diastolic pressure of 90 mmHg or above. If you have high blood pressure you can make lifestyle changes, including changing your diet, giving up smoking, decreasing the amount of alcohol you drink and exercising more frequently to lower your blood pressure reading. If these do not work then you may be advised to take medication.

CPR (cardiopulmonary resuscitation)

If you come across somebody who has lost consciousness or stopped breathing, you will need to act quickly and you should be prepared to carry out CPR. CPR stands for cardiopulmonary resuscitation. CPR is most commonly associated with cardiac medicine and more specifically heart attacks.

What does CPR involve?

CPR (cardiopulmonary resuscitation) is a lifesaving process which can be used to revive a person who has stopped breathing normally. CPR involves a mixture of chest compressions and rescue breaths. The aim of CPR is to maintain the flow of oxygen and blood around the body.

How is CPR carried out?

CPR is carried out in different ways for different people. CPR is different for children and babies.

CPR for adults:

1. Put your hands on the middle of the casualty’s chest and press down using the heel (bottom of the palm) of your hand; press down between 4 and 5 centimetres at a balanced speed. You should aim for a slightly quicker rate than one per second.
2. Carry out thirty chest compressions and deliver two breaths: pinch the casualty’s nose, place your mouth over their open mouth so that there is a seal and blow firmly at a steady pace. When you blow, check that the casualty’s chest expands. Give two breaths that last more than one second each.
3. Continue with a cycle of thirty chest compressions to 2 rescue breaths until the emergency services arrive or the casualty starts to breathe normally.

CPR for children over the age of one:

1. Place one hand on the child’s forehead and tilt their head back to open their airway; take care to be gentle, especially if the child is very young. Check the child’s airway and remove any obstructions.
2. Pinch the child’s nose and place your mouth over theirs, forming a seal. Blow into their mouth firmly and check to see that their chest expands. Give 5 rescue breaths.
3. Put your hands on the middle of the child’s chest and using the heel of your hand, press down using one or both hands; press down between 3 and 4 centimetres.
4. After 30 chest compressions (aim for a slightly faster pace than 1 compression per second), give 2 rescue breaths.
5. Maintain the sequence of thirty chest compressions to two rescue breaths until the child starts to breathe normally or the emergency services arrive.

CPR for children under the age of one

1. Place one hand on the baby’s forehead and very gently tip their head backwards and lift their chin to open their airway; check that the airway is clear and remove any obstructions.
2. Put your mouth over the baby’s mouth and nose and blow firmly; give five rescue breaths and check to see that their chest rises.
3. Put two fingers in the centre of the baby’s chest and push down around a third of the deepness of the baby’s chest. Give 30 compressions at a slightly faster pace than 1 compression per second and then give another two rescue breaths.
4. Carry on with the sequence of thirty chest compressions to two rescue breaths until the baby starts to breathe normally or the emergency services arrive.

When is CPR carried out?

If you come across somebody who has lost consciousness or stopped breathing normally, phone 999, ask for an ambulance and give as many details as you can about the casualty and their condition. This will help the paramedics to prepare to treat the casualty. If you are unsure of what to do, stay on the phone and the operator will give you advice. While you wait for the paramedics to arrive, start CPR. To make sure that somebody is unconscious and not breathing, check their airways, breathing and circulation.

Coronary heart disease

Coronary heart disease kills thousands of people in the UK every year. Figures show that coronary heart disease is the UK’s biggest killer with the disease affecting 1 in 5 men and 1 in 7 women. Coronary heart disease affects more men than women but the number of women affected by the disease is increasing steadily. The disease is most common amongst people over the age of 50.

What is coronary heart disease?

Coronary heart disease is a condition which is caused by the collection of fatty deposits in the coronary arteries. Over time, the deposits become thicker and this can prevent the blood from flowing freely around the body. If the blood flow to the heart is disrupted this can cause angina, and if the flow is obstructed completely, this can cause a heart attack. A heart attack damages the muscle tissue of the heart and, if it is not treated quickly, the muscle can be severely damaged and may die. The process of fatty deposits collecting in the artery walls is known as atherosclerosis.

What are the symptoms of coronary heart disease?

Symptoms of coronary heart disease include:

• Angina: angina is chest pain; some people experience angina on a regular basis, while others only suffer sporadic pains. Angina can be mild or more severe; mild angina usually feels similar to indigestion, while severe angina can cause the chest to feel tight. Severe angina may also cause pain to spread to other parts of the body, including the neck, arms and back. Angina is usually triggered by physical activity or stress.
• Heart attack: heart attacks should always be treated as a medical emergency. Symptoms of a heart attack include chest pain, pain in the neck, jaw, arms and back, dizziness, nausea and vomiting and extreme anxiety. Heart attacks can cause permanent damage to the muscle tissue in the heart and therefore treatment should be given as quickly as possible.
• Heart failure: heart failure occurs when the muscle tissue is so damaged that it can no longer function; this means that the heart cannot pump blood around the body. Heart failure can occur suddenly (acute) or over a period of time (chronic).

Treatment for coronary heart disease

There are various treatments available for patients with coronary heart disease. If you have a heart problem, you will be referred to a specialist in cardiac medicine and they will decide the best possible course of action based on test results, family history and your general health. Treatment options include:

• self-help: this may involve changing your diet, increasing exercise, giving up smoking and cutting down on drinking
• medication
• surgery: if medication and self-help techniques have failed, surgery may be carried out; the aim of surgery is to improve the flow of blood around the body by removing blockages or diverting the flow of blood around blocked arteries.