Congenital heart disease

Congenital heart disease (CHD) means a heart problem present from birth. These are structural differences in the heart or blood vessels that develop while a baby is growing in the womb. CHD is the most common type of birth defect — affecting roughly 8-10 per 1,000 live births in India, or about 200,000 babies born with it each year. Many cases are mild and need no treatment; others need medicines, procedures, or surgery, sometimes urgently.

Common types

• Septal defects ("hole in the heart") — atrial septal defect (ASD), ventricular septal defect (VSD) — gaps in the wall between heart chambers
• Patent ductus arteriosus (PDA) — a blood vessel that normally closes after birth remains open
• Tetralogy of Fallot — a combination of four heart defects causing "blue baby" symptoms
• Transposition of the great arteries, pulmonary stenosis, coarctation of the aorta, aortic valve problems, and many others

Symptoms

Some CHDs cause symptoms from birth — others not until later in life. Watch for:

• Bluish tinge of the lips, tongue, nails (cyanosis)
• Rapid breathing or breathlessness, especially during feeding in babies
• Poor feeding or poor weight gain
• Getting tired quickly
• Swelling in the feet, ankles, or abdomen (in older children/adults)
• Chest pain, palpitations, fainting
• Heart murmur heard on examination

Diagnosis

Many CHDs are now detected before birth through foetal echocardiography at the anomaly scan (around 18-22 weeks). After birth, diagnosis involves:

• Physical examination — listening for heart murmurs
• Pulse oximetry screening in newborns
• Echocardiogram (heart ultrasound) — the most important test
• ECG (electrocardiogram)
• Chest X-ray
• Cardiac MRI, CT, or cardiac catheterisation for complex cases

Treatment

• Monitoring — many small defects (small VSDs, ASDs) close on their own or never need intervention
• Medicines — diuretics, heart-failure medicines, blood thinners as needed
• Catheter-based procedures — device closure of ASDs, PDAs, or balloon valvuloplasty, done through a blood vessel without open surgery
• Surgery — open-heart surgery for complex defects; most are done in the first year of life for severe conditions
• Heart transplant — rarely, for severe conditions

Paediatric cardiac care has advanced hugely in India, with many specialised centres now offering surgery and catheter-based procedures at costs much lower than in most high-income countries. Free screening and treatment programmes exist for children; ask your paediatrician or a nearby government hospital about what's available where you live.

Adults with CHD need lifelong follow-up with a cardiologist, ideally one with adult congenital heart disease (ACHD) expertise.