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World Heart Day – Awareness About Heart Diseases by spshospitals(m): 1:45pm On Oct 02, 2016
As we celebrate World Heart Day on September 29th, we tend to associate it with a day related with creating awareness regarding heart diseases in adults. But what we must also remind ourselves is that children, much like adults, too suffer from a wide variety of heart diseases. In fact 8-10 out of a 1000 babies are born with some form of congenital heart disease amounting to almost 2 lakh children being born every year in our country. Upto 50% of these babies are critical requiring intervention in the first year itself, but regretfully just 10% are fortunate to avail of pediatric cardiac facilities. In fact children’s heart disease accounts for 10% of all infant mortality in India

The paucity of hospitals having dedicated pediatric cardiology services can be judged by an AIIMS status report where they mention that just about such institutes are equipped with such facilities while requirement is of around 200 to manage such a huge load of patients. The existing infrastructure in the government structure is stretched beyond limits while private institutes having the required therapeutic modalities are unable to cater to a vast majority of these unfortunate children because the cost of quality treatment is beyond reach for many parents. All together these statistics should prove to be an eye opener to the authorities concerned as the sheer discrepancy between the volume of patients and available facilities is appalling.

A common misconception is that these children either do not survive or even if they do so, they are likely to live with a major disability for the rest of their lives. On the contrary, with current modalities of treatment, a majority of these children have a good survival rate and an excellent quality of life.

Heart diseases in children are very different from heart diseases in adults. That is why their clinical presentation, course and outcomes vary immensely. Signs and symptoms may sometimes be so subtle that it may require a high index of suspicion from both the parents and the doctor.

But frequently, it is the alert parents who note certain symptoms and bring them to the attention of the child specialist. They may have noticed that their baby is a poor feeder who tires easily and sweats profusely while breast feeding. The baby suckles for a while but may soon unlatch itself from the breast and gasps for breath, typically referred to as the ‘suck-rest-suck cycle’. The child may also have poor weight gain with respect to children of similar age. Children may also present with frequent chest infections or pneumonia requiring repeated hospital admissions. Occasionally an older child may complain of an abnormal perception of heart beat or the parents note that their child’s heart beat seems fast. The child may also appear lethargic and tire easily during play activity. Some observant parents may even bring to the notice of doctors that the skin or nails of their child appear blue.

Children’s heart diseases include a wide array of conditions. One of the most common ones encountered are holes in the heart (Atrial and Ventricular septal defects) and extra connections outside the heart (Patent ductus arteriosus). Other diseases may be narrowed valves of the major arteries of the heart (Aortic and Pulmonary stenosis) or obstruction to the flow of blood in the major artery supplying blood to the body (Coarctation of Aorta).

With recent advancements in many of these conditions can now be completely cured without surgery. Button like devices is now widely used to close these holes and extra connections. Balloons and or stents are also used to relieved obstructions in the path of blood flow. These procedures obviate the need for prolonged hospital stay and potential ugly scars on the chest.

There are also certain other conditions called cyanotic heart diseases commonly known as blue babies (Tetralogy of Fallot’s, Transposition of Great arteries etc.). In these conditions there are major structural anomalies in the child’s heart which can only be corrected by surgery. Early diagnosis and management is imperative in most of these cases.

Besides this, some children also suffer from an irregular heartbeat (arrhythmia) varying from a very fast heart rate (200-300 per minute) to a complete heart block. Others may present with sudden loss of consciousness (syncope), diseases of the heart valves (eg. Rheumatic Heart Disease), Pulmonary Hypertension (high lung pressures), Kawasaki’s disease (disease affecting the arteries of the heart), Myocarditis (disease affecting the heart muscles), Cardiomyopathies etc.

Exciting advancements in the field of Fetal Echocardiography are helping us in early detection of heart diseases in the unborn baby while it is still in the mother’s womb. This proves invaluable for planning the delivery to take place in an institute where the newborn can be immediately be provided the requisite cardiac care.

Taking care of these children requires a team of highly specialized and dedicated professionals constituting a pediatric cardiac unit. This includes a Pediatric Cardiologist, Pediatric Cardiac surgeon, Pediatric Cardiac Anaesthetist, Pediatric Intensivist and highly trained nursing staff etc.

Unfortunately, as highlighted earlier, there is a gross insufficiency in the number of medical professionals with the required expertise and hospitals equipped with adequate facilities to take care of these children. Hapless parents of children with heart diseases have long been forced to seek succor in distant parts of the country. This is not always possible because many critically ill babies may not survive the perils of transportation. It is in this light that an efforts need to be made by to bring modern yet affordable facilities to the door step of the people of this geographical region.

Existing government schemes need to be better utilized and assistance from NGOs and philanthropists will go a long way in providing relief to the desperate parents.

With increase in high risk pregnancies and survival of smaller babies, patient burden is likely to increase in the future. Fortunately timely detection and newer modalities at our disposal have made successful treatment a reality. There is no greater satisfaction to see these so called “incurable children” leading normal lives and the smiles on the faces of their parents says it all.


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