Congenital heart disease is a cardiovascular malformation caused by abnormal or impaired cardiovascular development during fetal life. Common congenital heart malformations include: ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary valve stenosis and tetralogy of Fallot. Normally, blood in the heart flows in one direction. The structure of the heart is altered in patients with congenital heart disease. It can cause impaired blood supply to tissues and organs of the body, resulting in tissue hypoxia and affecting the growth and development of the affected children; it can cause increased blood flow to the lungs, which is prone to repeated lung infections; it can increase the burden on the heart, resulting in heart failure and inducing malignant arrhythmia or even sudden death; blood turbulence can cause damage to the local endocardial structure, which is prone to breeding bacteria and infective endocarditis. In addition to the above damage, precardiac disease can also cause psychological damage to the affected child.
For parents of children, how to identify whether they have congenital heart disease in time according to their symptoms and signs is the first step to get timely, effective and reasonable treatment for their children. In general, we can strengthen the careful observation of children in the following aspects.
I. Is there feeding difficulty?
Because children with congenital heart disease are born with a greater load on their heart function, they may have different degrees of feeding difficulties and poor digestive function after birth: children often show poor appetite and low milk intake, and if their condition is severe, they may have shortness of breath, repeated choking and coughing, vomiting and other abnormal performance soon after eating, and their stools are often with milk flaps, greenish in color, or even mucus-like stools. Even so, nausea, acid reflux, diarrhea, and indigestion often occur. The severity of symptoms is often related to the size of the fractional flow and the degree of hypoxia. Difficulty in feeding is one of the important early manifestations in identifying a pediatric patient with precordial heart, but due to the lack of specificity, it is again easily overlooked or mistaken for a simple digestive disorder.
Second, is there frequent pneumonia?
The nasal tract is narrow in infancy, the nasal mucosa is tender and vascular, and there is a lack of nasal hairs. The trachea and bronchial lumen are narrow, the mucous membrane is rich in blood vessels, the mucus gland secretion is insufficient, the mucous membrane cilia movement is poor, so it is drier, and it is not easy to eliminate microorganisms, so it is easy to suffer from respiratory system diseases. In the classification of precordial disease, there are two types of left-to-right shunts and right-to-left shunts: atrial septal defect, ventricular septal defect, arteriovenous ductus arteriosus, etc., which is often referred to as pulmonary polycythemia. The normal respiratory movement, the lungs are constantly exchanging gases, which makes the respiratory tract in contact with the air, the airborne bacteria and fine microorganisms are easy to grow and multiply through the respiratory tract, and so children with prediabetes are more likely to get pneumonia than normal children.
Is the child sweating profusely?
Normal children generally do not sweat when they are awake and quiet. However, children with preeclampsia may sweat profusely during feeding or even in a quiet state. The easiest way to understand sweating is to be tired! Because of the cardiac insufficiency of children with precordial disease, the heavy heart load in a quiet state can show easy sweating, when in the process of breastfeeding due to repeated sucking, breathing intermittently suspended, the autonomic respiration can not meet the body’s oxygen needs, causing hypoxia resulting in the whole body metabolism accelerated dripping with sweat. If a child sweats disproportionately or to a significant degree, it is important for parents and doctors to pay close attention.
Is there shortness of breath?
Some children with precocious heart disease have obvious shortness of breath. In precocious heart disease with polycythemia vera, because there is a lot of blood in the lungs, the ratio of air to blood is out of balance, and the amount of inspiration is not enough each time, and because small children have a strong metabolism and high oxygen demand, they need to increase the frequency of inspiration to meet their own needs; in children with less blood in the lungs, because there is less blood in the lungs, the body needs to speed up the ventilation frequency to increase the oxygen content, which is more obvious when combined with lung infection. Parents should pay more attention to early detection and early consultation.
V. Is there cyanosis?
In cyanotic precocious disease, the lungs are usually low in blood, and the cyanosis occurs due to the increase of reduced hemoglobin as a result of severe systemic hypoxia. Some children have obvious cyanosis after birth, which often indicates a serious condition; while another part of the children’s cyanosis is gradual, can be obvious only at 3-6 months of age, the condition of such children is gradually aggravated; there are some children’s cyanosis is localized or asymmetric, but no matter which type as long as the performance of cyanosis should be highly suspected of congenital heart disease problems However, it is important not to speculate and deceive oneself to delay the condition of the child.
Is there a growth lag?
As children with congenital heart disease have excessive heart load or varying degrees of hypoxia, resulting in insufficient caloric intake and increased energy consumption, growth and development are significantly behind that of children of the same age, mainly in terms of motor development and weight.
VII. Are there any intellectual and motor abnormalities?
Motor abnormalities in children with precocious heart disease are mainly manifested in the backward development of movement, abnormalities in the course of the disease, and reduced motor endurance. For example, some children have squatting, some children have increased bruising after exercise, some children cannot walk until they are one and a half years old, and some children have difficulty climbing stairs and even have to stop to rest after climbing a few floors. Due to chronic hypoxia, children with chronic hypoxia often have poorer intellectual development than normal children, such as late pronunciation, inarticulate speech, slow comprehension and reaction speed.
VIII. Is there syncope?
For sudden pediatric syncope, part of it is caused by cardiovascular malformations, part of it is caused by cardiac arrhythmias, and part of it is due to diseases of the nervous system. However, for the heart due to abnormal heart structure resulting in less pulmonary blood and severe systemic hypoxia, when there is a sudden increase in activity, a sudden increase in metabolism after continuous crying; or a sudden pulmonary vasospasm, can lead to instantaneous severe hypoxia causing hypoxemia and syncope in the brain due to lack of oxygen. It can be seen that after excluding neurological diseases should be alert to cardiovascular problems.
9. Is there a heart murmur?
Most children with precordial disease have a heart murmur. When you auscultate the child’s precordial area with the side ear, you will find that the child has an irregular heart rhythm, and the first or second heart sound is followed by an additional sound like “thumping” or “whirring”, and the heart sound is not clear, which is called a heart murmur by the doctor. If a child with precordial disease has a large intracardiac fractional flow, a clear heart murmur can often be heard, and the murmur is extensive and loud. It is not difficult to determine the diagnosis of precordial disease, once found should be early consultation.
In daily life, parents pay enough attention to children, especially for infants within one year of age, in these areas, then the detection of pediatric precordial disease will be more timely. Of course, the above-mentioned manifestations are only part of the clinical manifestations of precocious heart disease, and these manifestations cannot be viewed in a single way, but must be considered in the context of relevant examination results and disease characteristics. For how to correctly identify pediatric precocious heart disease, how to obtain a specific and pertinent diagnosis of pediatric precocious heart disease, it remains to be established by a professional pediatric cardiovascular doctor.
Daily precautions for children with precordial disease.
First, the development of a living system suitable for the amount of activity of the child is treated differently according to the condition of the child. Mild asymptomatic children should live like normal children; symptomatic children should limit their activities, avoid emotional excitement and crying, so as not to increase the burden on the heart; heavy children should be bedridden and given proper care.
Prevent infection. Introduce the knowledge of self-protection and infection prevention to children and parents, and avoid contact with patients with infectious diseases. The room should have fresh air and be dressed appropriately to prevent exposure to cold. Once an infection occurs, it should be treated actively.
Third, supply nutrition needs to give high protein, high calorie, high vitamin diet to enhance physical fitness. The little one should also limit the intake of milk, and at the same time should be fed according to the principle of less food and more meals, which can reduce the burden of heart function and promote the growth and development of the affected child. For older children, the diet should be appropriately limited to salt intake, but also to give the right amount of vegetable-based coarse fiber food to ensure stool pass; heavy children with feeding difficulties, should be particularly careful, patient, less food and more meals, so as not to lead to choking, shortness of breath, breathing difficulties, etc., if necessary, from intravenous supplementation.
Children with cyanotic congenital heart disease, due to hypoxia, the body’s own regulation, increase the high content of hemoglobin to improve oxygen-carrying capacity, so the blood viscosity is high, when in the summer, fever, sweating, vomiting and diarrhea when the amount of body fluids decreased, aggravating the blood concentration, easy to form thrombosis, resulting in the risk of embolism of important organs, so for cyanotic children should pay attention to drink more water, intravenous fluids if necessary.
V. Combined anemia can aggravate hypoxia and lead to heart failure, which should be corrected in time.
Health education should be provided to the child and parents to establish a reasonable living system and activity level according to the condition, maintain nutrition, strengthen resistance, prevent various infections, and acquire the knowledge of observing changes in the condition. Those with good heart function can receive vaccination on time. Regular visits to the hospital for checkups will enable the child to safely reach an age suitable for surgery.
It should be noted that children with precardiac disease should not only focus on daily dietary activities, but more importantly, to ease the hearts of the children, period to liberate the excessive burden of thought, so that the children can maintain a healthy psychological state before the surgical treatment.
Family emergency treatment plan for children with precardiac disease
For patients who have been clearly diagnosed but cannot be operated in time due to economic reasons, especially those who are in critical condition and may have hypoxic attacks and fainting at any time in daily life, the following are some family emergency treatment plans.
I. Atrial septal defect
The clinical manifestations are asymptomatic in mild cases, and cyanosis may appear when complicated by pulmonary hypertension.
Family emergency treatment: 1. For mild cases without cyanosis, take proper rest and avoid heavy physical work. 2. For those with cyanosis caused by pulmonary hypertension, rest in bed, with the patient in a sitting position; with both lower limbs hanging down or in a semi-recumbent position, which can relieve respiratory distress and reduce cyanosis. 3. Go to hospital for examination and elective surgery.
II. Ventricular septal defect
Patients with small defects are generally asymptomatic, while those with large defects with pulmonary hypertension can develop cyanosis.
Family emergency treatment: 1.Lighter patients should avoid heavy physical labor and prevent the occurrence of colds. 2.Heavier patients, especially those with pulmonary hypertension, should go to the hospital for elective surgery.
Arteriovenous catheterization
The clinical manifestations are asymptomatic in mild cases, but cyanosis may appear when pulmonary hypertension is complicated.
The family emergency treatment: 1. light cases do not need surgery and should avoid heavy physical work. 2. when cyanosis appears, go to hospital to confirm the diagnosis and elective surgery. 3. when pulmonary hypertension is significantly higher and accompanied by right-to-left shunt, surgery is not effective.
IV. Tetralogy of Fallot
Clinical manifestations of cyanosis since childhood (cyanosis, refers to the blue color of skin and mucous membranes, often most obvious in the lips, tongue, oral mucosa, nose tip, cheeks, earlobes and finger (toe) ends. The main cause is abnormal hemoglobin in the blood caused by hypoxia or other causes.) , accompanied by pestle-like fingers (toes) and erythrocytosis. With squatting habit, some patients may have syncopal episodes.
Family emergency treatment: 1, fainting attack, the patient should be allowed to lie flat and bend the legs, and give a small dose of insulin oral. 2, go to the hospital to confirm the diagnosis and elective surgery.