About Heart Conditions

mother and infant

Heart conditions can be congenital (present at birth) or acquired, meaning they developed over time, usually later in life. Some conditions develop during childhood and are temporary, such as those caused by infection, while others last a lifetime. Many heart conditions are chronic; that is, they last for a long period of time or even a lifetime. Others are acute; they happen suddenly, with variable severity, and end quickly.

Heart conditions can range from the simple to the complex. Here are some of the main types of heart conditions children experience:

  • congenital heart defects
  • heart rhythm problems (arrhythmias)
  • inflammatory heart diseases
  • cardiomyopathy
  • heart infections
  • pulmonary hypertension
  • hyperlipidemia (high cholesterol)
  • heart tumours

What are some examples of congenital heart disease?

Some examples of heart conditions present at birth include congenital heart defects and heart-related syndromes like Down syndrome. Pulmonary hypertension or heart rhythm problems (arrhythmias) can either be present at birth or develop later.

Congenital conditions are not necessarily hereditary, though a family history of heart conditions suggests a genetic component. Often, they simply occur for unknown reasons during the development of the fetus.

About 1 in 100 babies has some kind of congenital heart disease, and many need critical medical attention before they turn 1. About 25% of these cases are cyanotic, meaning that the oxygen level in the child's blood is low.

Congenital heart defects make up the biggest portion of heart disease in children.

What are some examples of acquired heart disease?

Some examples of heart disease than can be acquired later in life include:

  • inflammatory heart diseases like rheumatic fever and Kawasaki disease
  • cardiomyopathy
  • heart infections

Heart rhythm problems (arrhythmias) can either be present at birth or develop later.

Acquired heart disease is more common in adults than children.

What causes congenital heart disease?

Heart conditions tend to occur early in fetal development, just after a woman becomes pregnant. What causes them is not very clear. One key factor that seems to increase the risk of a defect is family history, or genetics. If someone in your family has a heart problem, it is slightly more likely that your child will too.

Another possible factor contributing to congenital heart disease is the mother’s experience during pregnancy. This could include, for example:

  • the use of prescription or over-the-counter drugs such as Accutane to treat acne, lithium to treat a mental health condition, and some anti-seizure medications
  • alcohol: babies with fetal alcohol syndrome often have heart defects
  • illegal drugs such as cocaine
  • a viral infection like rubella (German measles) during the first 3 months of pregnancy
  • a pre-existing chronic condition like diabetes, although risk can be minimized through proper control of the diabetes

One recent study indicated that fever early in pregnancy (from the flu, for example) can increase the risk of congenital heart disease. Another study has shown that some populations living near hazardous waste sites in the 1980s were more likely to have children with congenital heart disease. Also, being overweight or obese prior to pregnancy has been tied to an increased risk of heart defects and other abnormalities, and maternal diabetes has also been connected.

In general, doctors believe that genetic factors play a bigger role than environmental factors. The key thing to know is that in most cases the problem could not have been prevented. Most heart conditions simply occur by chance.

How is congenital heart disease detected?

Sometimes abnormalities are initially detected in the womb before birth during an ultrasound. Sometimes drugs can be given to the fetus by way of the mother to help manage things like arrhythmias. The early detection of abnormalities may also prompt an earlier delivery or delivery at a major centre to get a jump on treatment. More often than not, however, signs and symptoms are noted by the paediatrician after birth.

Can congenital heart disease be detected before birth?

The best technology for detecting a heart problem before birth is an echocardiogram (heart ultrasound). This is usually done after a routine ultrasound suggests a potential problem, or for families with a history of significant congenital heart disease.

Detecting a problem early enough means that treatment can sometimes be provided sooner: for example, if it involves an irregular heartbeat. For structural problems, little can be done, but doctors can at least be prepared to act as soon as the baby is born.

Not all heart conditions can be detected before birth.

Can congenital heart disease be prevented?

Generally, congenital heart disease cannot be prevented. However, if there are factors in the environment that could lead to congenital heart disease, steps can be taken to minimize risks. For example:

  • Women should make sure they are vaccinated against rubella.
  • Women with chronic conditions like diabetes or epilepsy should discuss pregnancy ahead of time with their doctors so that their treatment regimen (diet, drugs) can be adjusted accordingly.
  • Of course, all women should follow guidelines for healthy pregnancies, including taking folic acid and avoiding drugs and alcohol.

Jennifer Russell, MD, FRCPC

Fraser Golding, MD, FRCPC

1/15/2010


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