Q: What are the heart valves?

A:There are four valves which control the blood flow through the heart. They all consist of two or three flaps which swing open to allow blood through with each heart beat, and swing closed to prevent blood going back in the wrong direction.

Deoxygenated (blue) blood returning from the body collects in the right atrium. It flows to the right ventricle through the 'tricuspid valve'. It is then pumped through the 'pulmonary valve' into the pulmonary artery on its way to the lungs. Oxygenated (red) blood returning from the lungs collects in the left atrium and flows through the 'mitral valve' into the left ventricle. It is then pumped through the 'aortic valve' into the aorta and to the body. (Illustration)

Q: How common are congenital heart problems?

A: Abnormalities of the heart are present in nearly 10 in every 1,000 babies born. Some of these are mild and cause no significant disturbance to heart function. In many cases, such minor problems need no treatment and do not affect the life or the health of the child. More serious abnormalities are present in about five of these ten individuals with congenital heart problems.

The total frequency of all birth defects affecting different parts of the body is quite high. Some abnormality occurs in about 25 in every 1,000 babies born. This, however, includes many minor abnormalities.

Q: Why do congenital heart problems occur?

A:In most cases the cause of the heart abnormality is unknown. By the end of the 7th week of pregnancy the heart is fully formed. It changes little in its basic structure until birth when the circulation of the blood alters as the lungs start to function. Major abnormalities in development of the heart must therefore occur early in pregnancy.

Parents will naturally worry about things which might have affected the formation of their child's heart. In most cases the heart abnormality is only an unfortunate occurrence which has not resulted from any identifiable cause. However, in some cases there are genetic errors which are responsible for the problem. If this is at all likely you may be offered a consultation with a geneticist.

Some illnesses in a pregnant mother may result in abnormalities in her baby's heart and vessels. One example is German measles (rubella), if contracted early in the pregnancy. Occasionally medications or alcohol taken during the pregnancy can cause problems - though small quantities of alcohol are not likely to cause harm. Many medications, which are needed during pregnancy for a wide variety of reasons and are prescribed by a doctor, do not lead to any damage to the baby. Smoking is certainly very undesirable during pregnancy, as it has adverse effects on growth of the baby and is associated with an increased rate of premature birth and stillbirth. However, there is no evidence linking smoking with heart problems in babies.

Q: Can there be complications from heart surgery?

A:Complications from surgery may arise, but with improvements in technology, in surgical procedures and with more surgery being performed at a younger age, the risk of complications is continually being reduced.

The possible complications are related to the specific type of surgery being performed and they vary widely depending on the nature of the problem which requires surgery.

Your child's cardiologist and cardiac surgeon will discuss this subject with you prior to surgery.

Q: What are the various causes of chest pain?

A. Trauma

1. Sprain of the chest wall muscles and ribs, from heavy lifting , pulling and other strenuous activities.

2. Blunt trauma to chest wall including rib bruise, or fracture.

B. Anxiety and tension causing muscle spasms of chest wall are the most common causes of chest pain,especially under the left breast,which is nonradiating,lasting a few seconds to days.It may coexit with angina pectoris (see figure 70).

C. Radicular pain into the chest wall from irritated nerves,which innervate the chest wall, i.e. arthritis, herniated disc in the cervical and thoracic spines.

D. Inflammation of rib,cartilage junctions in the front of the chest,especially close to the left sternum (i.e. Tietz's syndrome).

Also, shingles due to herpes zoster infection of the thoracic nerves may be a cause of chest pain.

E. Inflammation of the stomach,duodenum,esophagus and gall bladder can cause chest pain.
To go further, pain originating in the gastrointestinal tract, especially in the esophagus,is commonly confused with ischemic chest pain due tocoronary heart disease. Diffuse esophageal spasm with pain behind the sternum associated with swallowing. Also reflux esophagitis due to regurgitation of the stomach's acid content into the esophagus can cause high epigastric or retrosternal "heartburn" pain after meals, coffee etc. Esophagoscopy etc may be necessary to diagnose the condition. In addition,peptic ulcers and gall bladder diseases (biliary colic) may be confused with chest pain of cardic origin.

F. Inflammation of the pleurae (thin sheets of tissue covering the lungs and inner chest wall) of the lungs(pleuritis)can cause chest pain,especially when taking a deep breath.

G. Inflammation of the bronchial tubes(bronchitis) and pneumonia can cause chest pain.

H. Chest pain due to coronary atherosclerotic heart disease (see figure 70) has specific characteristics,and occurs when the coronary blood flow is not adequate to supply enough oxygen for the activity currently being performed,while it is sufficient when the patient is at rest.Spasm or thrombosis in the coronary artery can impede blood flow to cause the chest pain,which is brief and is called angina pectoris.

1. It can be described variously as an aching ,a heavy feeling, chest pressure, chest tightness, indigestion in chest, or a squeezing in the chest.

2. It can occur with exertion or rest, or when one lies down,orgets up in the morning, as well as with emotions, after meals or exposure to cold.

3. It may be under the sternum of the chest or across the front (upper part) of the chest, affecting an area the size of a clenched wist.

4. It can radiate into the neck, tongue ,jaw,palate, left arm, right arm, elbow, wrist, upper back or abdomen.

5. It usually lasts for 1 to 3mins. If the provoking cause is discontinued(like walking too fast). Anger may cause the pain to last 10 mins.

6. The pain is promptly relieved by putting nitroglycerine under the tongue.

7. The recognition of angina pectoris is strengthened when the pain is reproducible and when a specified degree of effort produces the discomfort.

I. Anterior chest,excruciating pain may be due to a rupture or dissection of the walls of the great vessel(aorta,see figure 51c,51d,51e) coming out of the heart.The pain may last hours and is often of maximal intensity at the onset,radiating into the back of the chest.

J. Pain due to an inflammation of the covering of the heart(pericardium)called acute pericarditis(see figures 27,104a,104b)is not related to effort and is aggravated by breathing,located over the left chest and may radiate to the neck and shoulders.It may be aggravated by turning the body from side to side,while leaning forward may relieve it.

K. Blood clots from other parts of the body may go to the lungs(called pulmonary emboli) and cause no chest pain . If there is pain, it may mimic angina pectoris or pleurisy, aggravated by breathing.

Q: What is meant by ‘Congenital Heart disease?

A: This refers to various abnormalities of the heart which are present at birth. The abnormalities can be of the following:

• Holes in the walls ( Septum) separating the chambers.
• Narrowing of valves or blood vessels.
• Abnormal location of blood vessels attached to the heart.

Q: What are the treatment options available for the blocked arteries besides Bypass surgery?

A: A severely narrowed coronary artery needs treatment to reduce the risk of a heart attack. Various treatment options apart from surgery are:

• Angioplasty: Dilatation of a narrowed blood vessel with a help of a balloon.
• Stent : It involves insertion of a mesh or spring like metal device inside an artery at a site of narrowing after angioplasty. This will prevent collapsing of the artery.