www.elitecme.com | 2019 | HEART HEALTH 13 C ongenital heart defects are a heart condition that is present at birth. These conditions occur as a result of problems with growth during pregnancy. According to the Children’s Hospital of Philadelphia, CHDs can be classified into the following categories: • Problems that cause an abundance of blood to pass through the lungs. These CHDs cause blood to re-circulate through the lungs, which causes elevated pressure and stress on the lungs. • Problems that cause too little blood to pass through the lungs. When there is a lack of oxygen circulating through the lungs, there is a lack of oxygen circulating through the body. • Problems that cause too little blood to travel to the body. This occurs when the lungs are underdeveloped in general – the lungs may have underdeveloped chambers. There also may be blockages in the heart. CONGENITAL HEART DEFECTS There are many types of CHDs. Some of the most common include: • Atrial septal defect occurs when there is a hole between the upper chambers (the atria) of the heart. This hole causes the blood from one atrium to mix with the blood of the other atria. Luckily, the hole often closes on its own and surgical inter- vention is not always needed; this CHD is considered a simple CHD. • Patent ductus arteriosus occurs when the connection between the main arteries of the heart does not fully close. Because of this opening, blood can leak out. As the hole can often close on its own, this is considered a simple CHD. • Pulmonary stenosis is a narrowing of the valve between the heart and the lungs. Sometimes, children with pulmonary stenosis are observed rather than treated. • Ventricular septal defect occurs when there is a hole between the lower cham- bers (the ventricles) of the heart. This hole causes the blood from one ventricle to mix with the blood of the other ventri- cle. This can become problematic if the hole is large – the heart must then work very hard to pump blood throughout the body. • Tetralogy of fallot is the most common complex CHD. It is comprised of four different defects: š š Pulmonary stenosis š š A large ventricular septal defect š š An overriding aorta, which is when the aorta is located between the right and left ventricle and above the ven- tricular septal defect, which causes oxygen-poor blood to flow into the aorta rather than into the pulmonary artery to be oxygenated š š Right ventricular hypertrophy, when the musculature of the right ventricle is thickened because it has had to pump harder than normal DETECTION Babies are screened for CHDs in the initial days following birth. Women who are at a higher risk for having a baby with a CHD will have screenings prior to delivery of their baby. Fetal echocardiography is performed while a baby is in utero; this is performed by using sound waves to create moving pic- tures of the baby’s heart during pregnancy and is typically performed between 18 and 22 weeks. Pulse oximetry monitors oxygen levels in the blood when the baby is born. Low oxygen lev- els are a symptom of CHDs. Pulse oximetry is typically performed when the baby is more than 24 hours old, or when the baby is going home if the baby is less than 24 hours old. Unfortunately, some CHDs go undetected until later in life – in childhood or even adulthood. SIGNS Signs and symptoms will depend on the specific heart defect, as well as the severity of the defect. Serious CHDs will cause more seri- ous symptoms. These symptoms typically become evident shortly after birth, or in the first months after birth. These symptoms may include: • Cyanosis (a blue tint to the skin, nails, and lips) • Rapid breathing • Shortness of breath during feedings, which causes poor weight gain • Swelling in the lower extremities, the abdomen and around the eyes Less serious CHDs, which may not be diag- nosed until later in childhood, may exhibit symptoms such as: • Tiring easily during exercise and activity • Becoming short of breath during exercise and activity • Fainting during exercise and activity • Swelling in the lower extremities n Krystina is a 30-something RN, BSN, CDE who has worked in a variety of nursing disciplines, from telemetry to allergy/immunotherapy to most recently, diabetes education. She is also a writer and has enjoyed expanding her writing career over the past several years. She balances her careers as a nurse and a writer with being a wife and a mother. She has a four year old son who is an inquisitive, energetic little guy who is up for anything. She also enjoys reading, travel- ing, cooking, baking, and yoga (both practicing and teaching). RESOURCES Centers for Disease Control. (2018, November 2). What are congenital heart defects? Retrieved from https://www.cdc. gov/ncbddd/heartdefects/facts.html Children’s Hospital of Philadelphia. Congenital heart disease. Retrieved from https://www.chop.edu/conditions-diseases/ congenital-heart-disease Mayo Clinic. (2018, March 6). Congenital heart defects in children. Retrieved from https://www.mayoclinic.org/diseases-con- ditions/congenital-heart-defects-children/ symptoms-causes/syc-20350074 National Heart, Lung, and Blood Institute. Congenital heart defects. Retrieved from https://www.nhlbi.nih.gov/health-topics/ congenital-heart-defects |  PEDIATRICS