It refers to structural abnormalities of the heart that are present at birth. These defects can affect the heart’s walls, valves, or blood vessels, leading to problems with blood flow. CHD varies in severity, ranging from mild conditions that require little or no treatment to severe defects that need surgery or lifelong care.
Types of Congenital Heart Disease
CHD can be categorized into cyanotic (causing low oxygen levels in the blood) and acyanotic (normal oxygen levels but abnormal blood flow). There are two types include-
1.Acynotic heart defect 2. Cynotic heart defect
1. Acyanotic Heart Defects (Normal oxygen levels)
1.atrial Septal Defect (ASD) – A hole in the atrial septum (wall between the upper heart chambers).
2.Ventricular Septal Defect (VSD) – A hole in the ventricular septum (wall between the lower chambers).
3.Patent Ductus Arteriosus (PDA) – The ductus arteriosus (a fetal blood vessel) fails to close after birth.
4.Pulmonary Stenosis – Narrowing of the pulmonary valve, obstructing blood flow from the right ventricle.
5.Aortic Stenosis – Narrowing of the aortic valve, restricting blood flow to the body.
6.Coarctation of the Aorta – Narrowing of the aorta, leading to high blood pressure.
2.. Cyanotic Heart Defects (Low oxygen levels
1.Tetralogy of Fallot (TOF) –
2.Transposition of the Great Arteries (TGA) –
Causes and Risk Factors
The exact cause of CHD is often unknown, but risk factors include:
Genetic Factors –
Maternal Health – Diabetes, infections
Environmental Factors –
Consequence marriage –
Radiation contact during pregnancy
Symptoms
Symptoms depend on the type and severity of the defect but may include:
Cyanosis (bluish skin/lips)
Rapid breathing or shortness of breath
Poor feeding and slow weight gain in infants
Fatigue and swelling in the legs or abdomen
Heart murmurs
Diagnosis
CHD can be detected through various methods that are following below –
Fetal Ultrasound (Echocardiogram) – Can diagnose CHD before birth.
Echocardiogram – Evaluates heart structure and function.
Electrocardiogram (ECG/EKG) – Assesses heart rhythm.
Chest X-ray – Identifies heart size and lung issues.
Cardiac MRI or CT Scan – Provides detailed heart images.
Management of Cyanotic Congenital Heart Disease (CCHD)
Cyanotic congenital heart disease (CCHD) refers to congenital heart defects that result in low oxygen levels in the blood, leading to cyanosis (bluish skin, lips, and nails). These conditions require early intervention and long-term management.
1immediate Newborn Management
A)Oxygen Therapy-
Oxygen supplementation may be given to improve oxygen levels, though its effectiveness depends on the defect.
In some cases, excessive oxygen can reduce pulmonary resistance and worsen cyanosis (e.g., in Tetralogy of Fallot).
b) Prostaglandin E1 (PGE1) Infusion
Given to newborns with ductal-dependent circulation to keep the ductus arteriosus open, ensuring adequate blood flow.
C) Mechanical Ventilation & ICU Support
Severe cases may require mechanical ventilation, inotropic support (medications to improve heart function), and intensive care.
2. Medical Management
Diuretics – Reduce fluid overload and decrease heart strain.
Beta-blockers (e.g., propranolol) – Used in Tetralogy of Fallot to prevent “tet spells” (sudden cyanotic episodes).
ACE Inhibitors – Improve heart function in some patients.
Anticoagulants (e.g., aspirin, warfarin) – Prevent clot formation in patients with artificial shunts or valve issues.
b) Management of Hypercyanotic Spells (“Tet Spells”)
Knee-chest position – Increases systemic vascular resistance and improves oxygenation.
Morphine – Reduces respiratory drive and calms the infant.
IV Fluids – Maintain blood volume and perfusion.
Beta-blockers (propranolol) – Prevent further cyanotic episodes.
3. Surgical and Interventional Management
a) Palliative Procedures (Temporary Solutions Until Definitive Surgery)
Blalock-Taussig (BT) Shunt – Connects the subclavian artery to the pulmonary artery to increase pulmonary blood flow (used in TOF, pulmonary atresia).
Balloon Atrial Septostomy – Creates a hole in the atrial septum to improve oxygen mixing (used in Transposition of the Great Arteries).
Blog By:
Monika Bari
Asst. professor
Nursing Department