By Melody Sun, clinical pharmacist, & Dr. Nita Doshi, fetal cardiologist at CHOC Children’s
About eight in every 1,000 babies in the US are born with a heart defect. In some cases there are known risks such as pregestational or first trimester maternal diabetes, a previous child with congenital heart disease, mother or father with history of congenital heart disease, certain genetic syndromes, or certain prenatal medication exposures. Many cases, however, do not have a known reason. The heart is formed by week 12 of pregnancy, but sometimes, the usual developmental stages of the heart do not occur. Your prenatal care team may refer you to a fetal cardiologist for additional testing and monitoring. Sometimes, the defect does not significantly impact the quality of life, and the child can grow into adulthood without restrictions. It is when the defect causes severe consequences that the child may require surgery and/or long-term medications.
With advancing imaging technology, the majority of significant congenital heart defects may be detected during pregnancy. The state of California’s newborn screening program mandates newborn pulse oximetry screening for detection of congenital heart disease. If diagnosed with significant congenital heart disease, young patients may exhibit the following warning signs and symptoms:
- Difficulty with feeding and/or poor weight gain
- Difficulty with breathing
- Turning blue inside or around the mouth, or in certain areas of the face
- Cool arms and legs
- Tiring quickly with exertion or activity
In severe cases of significant congenital heart disease, medical, minimally-invasive (catheterization-based), or surgical therapy may be considered by your child’s cardiology team. Medications may be started before and after the surgery to improve heart and lung function.
Examples of medications that may be recommended to treat a patient with heart disease include:
|Aspirin||Decreases the risk of clot formation|
|Furosemide (Lasix), chlorothiazide (Diuril)||Reduces the heart’s workload by decreasing the amount of blood volume the heart has to handle|
|Spironolactone (Aldactone)||Helps counteract the loss of potassium from diuretics and may help support heart function|
|Sildenafil||Reduces elevated pressure in the lung arteries|
|Captopril/enalapril/lisinopril||Reduces the resistance and heart’s afterload to improve the heart’s function or to help reduce certain types of valve leakage|
|Propranolol, Digoxin, Sotatol, Amiodarone||Treats rhythm disturbances due to abnormal electrical signals through the heart cells|
- Ella underwent heart surgery at CHOC Children’s when she was just 7 months old to correct her coarctation of the aorta. Today, she’s thriving.
- Veer was born with a hole in his heart, and needed surgery to repair it when he was four years old. Today, he’s thriving.
- T.J.s parents were expecting a healthy baby boy and were shocked when shortly after birth he was diagnosed with transposition of the great arteries.