Know Your Child’s Heart

Every year, at least 3 to 8 out of every 1000 babies are born worldwide with defective heart. In addition, a small proportion of children who are born with normal heart acquire heart conditions such as Rheumatic heart disease, Kawasaki disease, Myopathies etc.

Rheumatic heart disease usually follows a simple throat infection caused by the bacteria called beta-haemolytic streptococcus, which in some children damage the heart valves causing their malfunction.
Kawasaki disease starts as a fever, subsequently affecting the coronary arteries leading to complications such as heart attacks in children.

Myopathies are diseases of the heart muscle usually caused by some viral infections. The heart muscle weakens and becomes ineffective in its function as a pump, resulting in heart failure.

It is very important to suspect and diagnose these heart defects early. All these defects CAN be corrected with appropriate treatment. It IS possible for you to protect your children from these illnesses and help them live normal and full life.

Who is a paediatric cardiologist?
A Paediatric Cardiologist is a Children’s Heart Specialist who specializes in diagnosing heart diseases in children and offers solutions for normal life and growth.

When do parents need to take their children to a paediatric cardiologist?

• When either of the parents OR a previous child OR a close relative in the family has been diagnosed with a heart defect previously
• When the parents suspect that their child may have a heart problem

When should the parents suspect a heart problem in their child?
When the child shows any of the following symptoms:

As a baby: Breathing fast (tachypnoea), very slow interrupted feeding (suck-rest-suck cycle), sweating over the head while feeding (diaphoresis), poor weight gain (failure to thrive), going blue or dusky all over the body while crying (central cyanosis).

As an older child: Getting tired easily while playing (exertional fatigue), getting frequent chest infections (pneumonia), complaining of chest pain (palpitation), complaining of giddiness (syncope) and bluish discolouration (cyanosis).

How does the Paediatric Cardiologist check the baby’s heart?
The Paediatric Cardiologist checks the baby clinically for abnormal discolouration (cyanosis), abnormal pulse (rhythm disturbances and heart function) and abnormal heart sounds (murmurs). The common tests undertaken are Chest X-Ray (to see the position and size of the heart), ECG (to check the heart rhythm) and Echocardiography (to check for any structural problems in the heart and assess the heart function).

Can heart problems of babies be detected during pregnancy?
Yes, it can be done by using Foetal Echocardiography at 16-20 weeks of pregnancy. Elderly diabetic mothers, those with birth defects of the heart, and those who have previously given birth to babies with heart defects are advised foetal echocardiography.

What are the heart problems usually seen in children?
Heart problems in children may be CONGENITAL: these are defects at birth which are of two kinds – simple and complex.

Simple defects are those such as holes in the heart (ASD, VSD, PDA) and blocked valves (Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta).

Examples of complex defects are blue baby conditions (TOF -Tetralogy of Fallot, TA -Truncus Arteriosus, TGA - Transposition of Great Arteries).

Heart problems in children may also be ACQUIRED: children have a normal heart at birth and then their heart becomes diseased (Cardiomyopathy, Rheumatic heart disease, Kawasaki disease).

Can these heart problems in children be cured?
About 95% of heart problems in children can be treated successfully. Majority of the simple problems can now be cured without operations by device closures and Angioplasty. Conditions cured without surgery are ASD, VSD, PDA, Coronary fistulas, Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta. These procedures are carried out first by inserting small tubes called catheters into the heart through the blood vessels in the leg. Next with careful manoeuvres through the catheter, the holes in the heart are closed with devices; or the blockages in the heart are opened up with balloons and stents.

The advantages of these procedures are:

• complete cure of the heart without a visible scar on the body
• without blood transfusions
• without pain
• minimal hospitalisation period (usually 2-3 days)
• without a need for post-procedure resting period.

The complex blue baby conditions also have very good surgical solutions these days, providing the growing child with an excellent quality of life.

For more details on these procedures log on to www.hxplain.com

Article by Dr. R. Prem Sekar, Senior Consultant Interventional Paediatric Cardiologist, Kauvery Hospital, Chennai

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Importance of Immunizing a Child

Remember the old adage – “Prevention is better than Cure”? Well, immunizing your child is just that. There are certain diseases prevalent worldwide, especially in India, which can lead to dire consequences – even death. Diseases such as measles, diphtheria, mumps, polio, whooping cough, tetanus, rubella or German measles, Haemophilus influenza and rotavirus can all be prevented with vaccinations.

For instance, “Small Pox”, one of the most disfiguring diseases has been wiped off the face of our planet, thanks to the invention of an excellent vaccine. Immunizing your child helps not only protect your child effectively, but also prevent all the diseases named above.

Vaccines contain antigens that help the body produce antibodies to fight the disease causing germ. True, a vaccine contains in part the viruses or bacteria that cause the disease, but the immune system fights and destroys or weakens the viruses/bacteria, so that your children do not become sick. Children develop immunity through vaccinations and thus we, as parents, can help protect our children from contracting the actual disease.

Here are a few more facts why immunization is important.

1. A newborn baby is immune to many diseases as the baby has got the necessary antibodies from mother. The immunity, however, is effective only for the duration of the first year of life.
2. Prior to the advent of vaccinations, many children died from diseases such as measles, polio, and whooping cough. An unvaccinated child exposed to any of these diseases is not usually strong enough to fight the disease. Immunization with proper and timely vaccinations gives the baby better protection and a better fighting chance against these harmful diseases.
3. Diseases caused by failure to administer vaccinations lead to frequent visits to the doctor, hospitalization, loss of time, dislocation of work, avoidable medical bills and in some cases premature death.
4. Immunization of every child assures a healthy and wealthy future of the nation, as health is the real wealth.

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Stay Safe from Dengue Mosquitoes

Stagnant waters of any type are favorite breeding grounds for all types of mosquitoes. With the recent downpour and flooding of Chennai City and many districts in Tamil Nadu, there are pools of undrained stagnant water in many places.

Rainwater by itself is harmless, though it does carry many pathogenic material, such as bacteria, pollutants, algae, plant parts, soil, mold, fungi, amoeba, pesticides, dust, protozoa, lead, arsenic and insect parts. This kind of contamination can be expected in a large city. Pools of stagnant water or slow draining water provide ideal breeding grounds for many insects, including mosquitoes. Add poor and inadequate sanitation facilities to the mix, and an epidemic is waiting to happen.

Lay to rest the thought that Dengue mosquitoes only breed in clean water. Research has clarified that these mosquitoes may breed in clean waters sprinkled with dust or in muddy waters that have been stagnant for 6 days and more.

Dengue flourishes in Chennai, in the months of July, October, November and peaks in January. July generally is the month when the Monsoons from the west coast of India, drop a few showers in Tamil Nadu, but October and November are generally the months when the East Coast Monsoons inundate the state.

For the year 2014-2015 dengue cases and deaths are reported to be 2357 cases from January to Mid-September, which includes 5 deaths. Of the 2357 cases, 80 cases were from Chennai City. There has been a rise in the number of dengue fever cases, as against 1146 cases reported in the previous year.

The following districts in Tamil Nadu have been earmarked as high risk districts for cases of dengue fever.

1. Dharmapuri
2. Krishnagiri
3. Salem
4. Theni
5. Tirupur
6. Trichy

Symptoms

Children and teenagers may not exhibit signs or symptoms in mild cases of infection. The symptoms normally surface 4 – 10 days after the person has been bitten. Signs and symptoms to watch out for:

1. High Fever (106F or 41C)
2. Pain behind the eyes
3. Headaches
4. Bone, Muscle, and joint pain
5. Rash all over the body
6. Minor bleeding from gums or nose
7. Vomiting and nausea

Recovery is generally within a week, but in cases where the infection is severe, the following symptoms will be prevalent, as the blood clotting ability of the body drops:

1. Bleeding from the nose and mouth
2. Bleeding under the skin, which could look as if there are bruises
3. Severe abdominal pain
4. Lungs, liver and the heart show signs of distress
5. Persistent vomiting

Causes

There are 4 types of dengue viruses spread by mosquitoes that flourish around human dwellings. After a mosquito bites a human being having dengue virus, it in turns becomes the vector. When this mosquito vector bites the next person, that person gets infected with the dengue virus. If a person has had dengue fever once, though they do develop an immunity to that particular strain, they, however are now at high risk to being infected by the other three strains. Besides, such people are in the high risk category to develop dengue hemorrhagic fever.

Prevention

Dengue fever vaccines are still in the nascent stage of development. Therefore, it behooves that precautionary measures be taken to stay safe.

• Live or stay in air-conditioned housing or dwellings where there are mosquito screens on windows / mosquito protective gear
• Ensure good lighting. Contrary to some understanding, that these mosquitos bite in the dawn, dusk and evening hours, it has been proved by research, that dengue causing mosquitos like to feed (bite) in the dark
• Wear long sleeved protective clothing, long pants, socks and shoes when in mosquito infested areas
• Use mosquito repellents, coils and chemicals
• Ensure you do not create mosquito breeding habitats such as old automobile tires

If you have been unfortunate to have been affected by Dengue Fever, please contact a doctor immediately and get treated. 

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Removal of Gallbladder by Laparoscopy

The Gallbladder is a small organ located under the liver. Its purpose is to store the extra bile produced by the liver, and secrete it to the small intestines, where the bile aids in the digestive process. The bile is a fluid and is composed of:

• Cholesterol
• Bile Salts
• Bilirubin (an orange-yellow pigment in the bile formed as a breakdown product of haemoglobin)

The bile thus helps digest the fat in the food that is consumed.

Gallstones that are formed in the gallbladder can happen due to several reasons, such as genetics, reduced motility in the gallbladder, diet and body weight. There are two types of gallstones:

• Cholesterol stones: In 80% of the cases, the gallstones are of this type. They are greenish yellow in colour. The cholesterol stones form when there is too much cholesterol in the bile. Another reason for cholesterol stone formation is attributed to the inability of the gallbladder to empty itself quickly.
• Pigment stones: Made of bilirubin, these stones are smaller in size and darker in colour. These stones are more common in people with certain medical conditions like cirrhosis of the liver, and blood disorders such as sickle cells or anaemia.

Risk factors for developing gallstones

• Hereditary factor: Anybody with a family history of gallstones is at risk.
• Uncontrolled weight/obesity: Being one of the biggest risk factors, obesity can cause rise in the cholesterol levels in the bile, which prevents the gallbladder from emptying itself.
• Estrogens: High levels of estrogens too can reduce motility in the gallbladder. Pregnant women and those who have undergone hormone replacement therapy are at greater risk.
• Gender and age: Women and elderly people are more prone to develop gallstones.
• Cholesterol Medications: A few types of cholesterol-lowering medications can increase the amount of cholesterol in the bile, thus increasing the possibility of developing gallstones.
• Weight Loss and Fasting: Losing weight rapidly causes increased levels of cholesterol formation in the bile, which in turn causes the development of gallstones. Fasting causes the gallbladder to contract less, thereby increasing the chances of gallstones formation.
• Diabetes: Diabetic people tend to have a higher level of triglycerides in their blood. This is a big risk factor for formation of gallstones.

The Procedure
Laparoscopic gallbladder removal surgery or cholecystectomy is a very safe and effective procedure. There are very low risks involved in this surgery.

The surgeon makes four small (keyhole size) openings in the abdomen. A laparoscope with a lighted scope attached to a camera is inserted into the incision closest to the belly button. The surgeon uses a video monitoring screen for guidance while inserting the surgical instruments through the remaining incisions, to remove the gallbladder. Prior to removing the gallbladder, a special X-ray procedure called intraoperative cholangiography may be performed to view the anatomy of the bile ducts.

Anaesthesia
General anaesthesia is administrated prior to the procedure.

Post Laparoscopic Surgery

• The recovery time is very quick. You may be required to stay in hospital for 3-4 days.
• The bile will flow directly from the liver to the small intestine and will not affect the digestive process.
• Some discomfort maybe there for a week, but 10 days (normally), after the procedure, you will be able to resume all normal activities.
• No special diet is required.

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