endocardial

What are congenital heart defects?

Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a baby's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.

Congenital heart defects can change the way the heart pumps blood. They may make blood flow too slowly, go the wrong way, or block it completely.

There are many types of congenital heart defects. They can happen in one or more parts of the heart. The most common types are:

• Septal defects ("hole in the heart") - openings in the wall between the left and right sides of the heart
• Heart valve defects - problems with the valves that control the flow of blood through the heart
• Defects in the large blood vessels that carry blood in and out of the heart

Congenital heart defects can range from very mild problems that never need treatment to life-threatening problems at birth. The most serious congenital heart defects are called critical congenital heart disease. Babies with these defects usually need surgery in the first year of life. But the symptoms of milder heart defects may not show up until childhood or adulthood.

What causes congenital heart defects?

Researchers often don't know what causes congenital heart defects. They do know that changes in a baby's genes sometimes cause a heart defect. The changed genes may come from the parents, or the changes may happen during pregnancy.

Who is more likely to have a baby with a congenital heart defect?

Several things may increase the chance that your baby has a congenital heart defect, such as:

• Your health before and during pregnancy, including:
  • Having diabetes before pregnancy or developing it in the first 3 months of pregnancy (diabetes that develops later in pregnancy isn't a major risk for heart defects). Carefully controlling your blood sugar before and during pregnancy can lower your baby's risk of congenital heart defects.
  • Having phenylketonuria (PKU), a rare inherited disorder that affects how the body uses a protein in foods. If you have PKU, eating a low-protein diet before getting pregnant can lower your baby's risk of having a congenital heart defect.
  • Having rubella (German measles) during pregnancy.
• Your contact with certain substances during pregnancy, including:
  • Smoking or secondhand smoke (breathing smoke from another smoker).
  • Certain medicines, such as angiotensin-converting (ACE) inhibitors for high blood pressure and retinoic acids for acne. If you're pregnant or plan to get pregnant, talk with your health care provider about all the medicines you take.
• Your family history and genetics. In most cases, congenital heart defects don't run in families. But your chance of having a baby with a congenital heart defect does go up if you or the other parent has a congenital heart defect, or if you already have a child with a congenital heart defect.

What are the symptoms of congenital heart defects?

Congenital heart defects don't cause pain. The signs and symptoms are different, depending on the type and number of defects and how serious they are.

Common signs and symptoms of congenital heart defects include:

• Cyanosis - a bluish color to the skin, lips, and fingernails. It happens when there isn't enough oxygen in the blood.
• Fatigue - your baby may be unusually sleepy and may become very tired during feedings.
• Poor blood flow.
• Fast or difficult breathing.
• Heart murmur - an unusual sound between heartbeats.

What other problems do congenital heart defects cause?

Congenital heart defects don't always cause other problems. If they do, which problems you have would depend on the type and number of defects and how serious the defects are.

Children with congenital heart defects are more likely to:

• Be smaller than other children
• Have problems or delays in mental, and emotional growth, and behavior, such as:
  • Speech and language problems
  • Attention deficit hyperactivity disorder (ADHD)

People with congenital heart defects may develop other health conditions, including:

• Endocarditis - an infection of lining of the heart and valves
• Arrhythmia - a problem with the rate or rhythm of your heartbeat
• Heart failure - when your heart can't pump enough blood to the body
• Pulmonary hypertension - high blood pressure in your lungs
• Kidney and liver disease

How are congenital heart defects diagnosed?

• Before a baby is born, your provider may use ultrasound pictures of the baby's heart to look for heart defects. This is called a fetal echocardiogram. It's done between weeks 18 and 22 of pregnancy.
• During the first few days after birth, all newborns are checked for congenital heart defects. A pulse oximeter is clipped to your baby's hands or feet to measure blood oxygen. If it shows low levels of blood oxygen, more tests will be needed to find out if your baby has a heart defect.
• To diagnose congenital heart defects in babies, children, and adults, a provider may use many tools, including:
  • A physical exam.
  • Certain heart tests to see how the heart is working.
  • Genetic testing to see if certain gene problems caused the defect.

What are the treatments for congenital heart defects?

Treatment depends on the type of congenital heart defect and how serious it is. Possible treatments include:

• Cardiac catheterization to repair simple defects, such as a small hole in the inside wall of the heart. A catheterization uses a thin tube guided through a vein and into the heart.
• Heart surgery may be needed to:
  • Repair defects in the heart and blood vessels.
  • Repair or replace a heart valve.
  • Place a device in the chest to help the heart pump blood.
  • Do a heart transplant.
• Medicine is often used if your baby has a specific type of congenital heart defect called patent ductus arteriosus.

All children and adults who have congenital heart defects need regular follow-up care from a cardiologist (a doctor who specializes in heart diseases) throughout their life, even if their defect was repaired.

Some people may need several heart surgeries or catheterizations over the years. They may also need to take medicines to help their hearts work as well as possible.

NIH: National Heart, Lung, and Blood Institute

What is endocarditis?

Endocarditis is sometimes called infective endocarditis. It's a rare but life-threatening inflammation of the lining inside your heart's chambers and valves (the endocardium).

Endocarditis is usually caused by germs that get into your bloodstream and travel to your heart. Once they get inside your heart, the germs can attach to the lining or get trapped in the valves. They start to grow, causing an infection. If not treated quickly, the infection can cause damage to the heart and lead to serious health problems.

What causes endocarditis?

Bacterial infections cause most endocarditis. Normally, many bacteria live in your mouth, on your skin, or in other parts of the body. Sometimes the bacteria can get into your bloodstream from injuries such cuts or scrapes. Dental work and certain surgeries can also allow small amounts of bacteria to enter your bloodstream.

In some cases, fungal infections cause endocarditis. The fungi, such as yeast, can live in parts of your body. Fungal infections generally happen in people who have weakened immune systems that can't stop the fungus from growing. This includes people who have HIV.

Who is more likely to develop endocarditis?

In general, endocarditis is rare. If you're healthy, your immune system usually destroys the germs in your bloodstream before they can cause harm.

But your chance of developing endocarditis may be higher than most people if you:

• Have certain heart conditions. Damaged or abnormal heart tissue and devices in your heart can trap germs more easily than healthy heart tissue. That means your risk of endocarditis is higher if you have:
  • Heart valve disease.
  • Certain congenital heart defects.
  • A pacemaker or an implantable defibrillator.
  • A heart valve replacement.
• Are older. Age-related changes to the heart valves, such as mitral valve prolapse or calcium deposits in the aortic valve, create places for germs to attach to the heart.
• Inject illegal drugs. Unclean needles may carry bacteria into the bloodstream.
• Have a condition that weakens your immune system.
• Don't take care of your teeth and gums. Poor dental health makes it easier for germs to get into your bloodstream through your gums and mouth.
• Have a long-term central venous line, a tube that stays in a large vein for weeks or months for medical treatment.
• Have already had endocarditis. Endocarditis can damage heart tissue, which increases your risk of getting it again.

What are the symptoms of endocarditis?

Endocarditis symptoms may be severe or very mild. They may start suddenly or slowly. And they can vary from person to person. The possible symptoms of endocarditis include:

• Fever and chills
• New or worsening heart murmur (an unusual sound heard between heartbeats)
• Chest pain
• Cough
• Muscle, joint, and back pain
• Night sweats (heavy sweating during sleep)
• Shortness of breath (feeling like you can't get enough air)
• Skin changes, including:
  • Broken blood vessels
  • Painful red or purple bumps
  • Painless flat red spots on the palms of your hands or soles of your feet

What other problems can endocarditis cause?

When the germs are in your heart, they can clump together with blood cells. These clumps can break off and travel through your bloodstream. They may block blood flow, spread infection, or damage your organs, including your brain, lungs, kidneys, and spleen.

Endocarditis may sometimes lead to sepsis, a medical emergency that happens when your body has an extreme response to the infection.

Endocarditis can also cause serious heart problems including:

• Heart valve damage
• Heart failure
• Arrhythmia (a problem with the rate or rhythm of your heartbeat)

How is endocarditis diagnosed?

To find out if you have endocarditis, your health care provider will:

• Ask about your medical history, including your symptoms, recent illnesses, and other health conditions that affect your chance of developing endocarditis.
• Do a physical exam.
• Likely order tests, such as:
  • Blood tests to check for signs of infection, bacteria, or fungi in your blood.
  • Chest x-rays.
  • Heart tests.

What are the treatments for endocarditis?

If you have endocarditis, it's important to get treatment quickly. Treatments may include:

• Medicines:
  • Antibiotics to treat bacterial infections. Antibiotics are usually started through an intravenous (IV) line in the hospital.
  • Antifungal medicine to treat fungal infections. Your provider may suggest taking antifungal medicine for the rest of your life to prevent the infection from coming back.
• Heart surgery may be needed to repair or replace damaged valves and heart tissue. Surgery may also be done to remove infected tissue.
• Dental care, especially cleanings, can help reduce the amount of bacteria that grows in your mouth.

Treatment may last weeks, and you may need tests to make sure it's working. Your provider will also check you for problems that could develop from endocarditis, such as heart failure or an irregular heartbeat.

Can endocarditis be prevented?

If you have a higher chance of developing endocarditis than most people, you can reduce your risk if you:

• Take good care of your teeth and gums every day
• Have dental exams and cleaning at your dentist's office every 6 months
• Make heart-healthy habits part of your daily life to help prevent heart disease
• Call your health care provider right away if you have symptoms that could be endocarditis

People with the highest risk for bacterial endocarditis need antibiotics before dental visits or certain medical or surgical procedures. Ask your provider if you're part of the highest risk group. If so, let all your providers know about your risk.

NIH: National Heart, Lung, and Blood Institute