HEART MURMUR - Congenital heart disease
Unborn baby in the mother's womb grows and develops in ideal conditions. It receives blood rich in food and oxygen through the umbilical cord, and cleared from all unnecessary substances. During the nine months of pregnancy the baby is floating in amniotic fluid without using the lungs - the baby does not breathe through its own lungs, but through mother's.
In order for this an ideal exchange to take place baby's heart has a special appearance and fetal circulation, with the aim of circumventing inactive fetal lungs. Thanks to temporary openings on the heart and blood vessels, there is an adequate communication between the right and the left half of the heart, arterial and venous circulation, but this kind of flow through the heart irreversibly stops with the baby's first breath. The duration of these structures after birth permanently damages the heart, lungs and blood vessels.
In the first hours of life mechanical, chemical and hormonal incentives will be activated to permanently close holes in the heart and blood vessels, because what was necessary for survival in the womb is more dangerous when the baby starts to breathe through its lungs.
In most cases, this process begins with crying of a baby at birth. However, some children will keep elements of fetal circulation or there will be a disorder in the structure and position of the heart and major blood vessels - the child will have a congenital heart defect.
Congenital heart defects are being detected even during pregnancy ultrasound. A special team of experts make a decision about the kind of defect and what will be the procedure immediately after birth. Such pregnancies are high-risk; delivery is planned and usually ends by Caesarean section. Cardiologist examines newborn at birth and plans dynamics of treatment. The largest number of congenital heart defects is today revealed early and diagnostic procedures and treatment (mainly operational) are conducted under the same principles throughout the world. The occurrence of congenital heart defects is greatly influenced by the health status of the mother (diabetes, smoking, taking drugs, age of mother, viruses), legacy and external environment (radiation).
The most common symptoms and signs of the existence of heart defects in children are growth and development problems, difficult and rapid breathing, sweating during feeding, and frequent infections of the airways in the form of recurrent bronchitis or pneumonia. There are also pallor, cyanosis (bluish discoloration), lips, tongue, sudden loss of consciousness, and it is not uncommon that the children with a congenital heart defect have no difficulties and that the murmur is detected incidentally during a systematic medical examination.
Murmur is usually described by intensity or by numbers 1:00 to 6:00, with a description of the quality of audibility (in which part of the heart action is heard), and place of the strongest audibility in the chest. The direction of the spread (propagation in the back, neck ...) is also described.
When the characteristics of the murmur are determined, the conclusion is made if there is a pathological or physiological murmur on the heart. Physiological murmur is by far more common (inorganic, the murmur of the healthy heart). This is the murmur resulting from the specific structure and blood flow during childhood. As a rule it can be heard during systole (when the heart pumps blood into the circulation), it is short in duration, the intensity never exceeds the strength of 3, it is usually vibratory in character and does not spread to places with the strongest audibility.
The sound of a healthy child's heart increases when a child is sick, when s/he has a fever and cough. It is moat common after the third year, when visiting the pediatrician usually due to respiratory infections. The pediatrician is then in a dilemma whether to tell the parents that the child has a heart murmur, which is his professional duty, or to consider the finding physiological for the age and to continue monitoring it during medical examinations.
If the murmur is heard in infant, it is necessary to send it to a cardiologist for monitoring and early detection of the nature of murmur. Usually it is a slow closing of fetal structures, but sometimes anomalies in the structure of atrial or ventricular septum are detected, as well as narrowing at the outlet elements of large blood vessels of the heart, disorders in the structure and function of valves.
Early detection, drug or surgical treatments today provide the ability to successfully treat very complex heart defects. Therefore, it is necessary that every infant is carefully examined and that, if there is a heart murmur, it is referred to a cardiologist.
Today we rarely meet children who are seeing pediatricians with more developed symptomatology congenital heart defects.
There are also defects in which the murmur is not heard – growth problems, difficulty feeding, sweating, blue color of skin and mucous membranes (especially when they cry), very frequent, severe infections of the lower respiratory tract, which are all signs that a child should be referred to a cardiologist regardless of absence of a heart murmur.
Parents are never happy when their pediatrician tells them that their child has a heart murmur. The doctor is obliged to patiently explain the nature of the murmur, the possibility that the murmur is physiological or pathological. If the child is healthy, doesn`t have difficulties, does not lag behind in growth and development - there is no reason to worry.
A planned visit to a cardiologist will include ultrasound examination of the heart and ECG. The controls are mandatory and depend on the nature of the murmur and nature of heart defects. Today, the available diagnostics and treatments will provide your child a normal life. Once again, the most common is the physiological murmur of a healthy heart, which does not require any treatment, and the child is capable to perform all daily activities and sports.
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