Symptoms of Patent Ductus Arteriosus - Ways to Know If Your Baby Has PDA

Patent Ductus Arterosus or PDA is a birth defect that is associated with the improper flow of blood from higher to lower pressure aorta. Since all babies are almost the same upon birth, the symptoms of PDA will not be noticeable until the baby is first week or a couple of weeks old and to some a few months old, but how do you know when a baby is suffering from a disease when babies show the same symptoms of pain and suffering? To know whether or not your baby is suffering from PDA, you have to know the symptoms of patent ductus Arteriosus.

The symptoms of PDA vary depending on the size of the baby's ductus arteriosus. Some babies have normally small ductus arteriosus and these babies appear to be normal and healthy. Symptoms for this case will not be diagnosed unless the heart beat and heart sound is evaluated by a doctor and for babies with relatively larger ductus arteriosus, signs and symptoms may be different.

Even though the signs and symptoms of PDA are exhibited differently depending on the size of the baby's patent ductus arteriosus, there are some common signs named to help parents and doctors detect whether or not the baby is suffering from PDA. The first common sign is the heart murmur. Healthy babies have very silent heart murmur most especially when they are sleeping. It is almost impossible to hear the murmur unless you listen to it by intentionally placing your ears to the heart area of the baby. However, when a baby is suffering from PDA, the heart murmur is louder which is very much observable and noticeable upon examinations. Another symptom visible upon X-Ray is the congestion of the lungs. When the X-Ray result shows that your baby's lungs are congested, another examination should be done to ensure the diagnosis of the birth defect. Heart enlargement may also be seen during the test and this is also of the signs of PDA.

There are also symptoms of PDA which are noticeable even without the examinations and tests. Fast breathing, poor growth, resistance to feeding or when the baby gets tired while feeding and poor weight will give parents or just the mother alone a hint of the birth defect present in the baby.

Although some cases of Patent Ductus Arteriosus do not require treatment because it recovers by itself as the baby grows, there are cases when ductus arteriosus doesn't. So when you see that your baby exhibits some of the symptoms of patent ductus Arteriosus, take him to the doctor immediately. Tell your doctor the signs you see and request the doctor to perform clinical trials and examinations. It is always taught that prevention is better than cure and knowing the signs and symptoms of a certain disease is always the first step to prevention.

Rare Heart Diseases That Affect Children From Birth

Congenital Heart Defect is a condition, which includes a defect in the walls, valves, arteries, and veins of the heart in a newborn child. This imperfection in heart structure can possibly decrease the blood circulation or make it flow in the wrong direction or get completely blocked. This is a rare disease and approximately 9 out of 1000 kids are born every year, with poorly structured heart.

Types of well-known Congenital Heart Defect

• Coarctation of aorta

Aorta is the main and largest blood vessel that transports the blood from the heart to various parts of the body. In Coarctation of aorta, a section of aorta remains constricted or narrow, at birth. It becomes difficult for the heart to pump blood out through the aorta. This heart issue is found in people with a particular genetic disorder like Turner syndrome.

Symptoms

The curved part of aorta points upwards to the head and straight part points downwards. Coarctation of aorta can happen anywhere within the vessel. However, its tendency to occur at the top or aortic arc (C-shaped curve) is more. This makes it hard for blood to go out, so the blood pressure, before the narrowed segment is high, and after the constricted part, is low.

• Headaches from HBP (high blood pressure) 

• Camps in legs 

• Cold legs or feet 

• Abnormal heart sounds 

• Poor weight gain in babies because difficulty in feeding 

• Fainting or dizziness

Symptoms occur only, when the narrowing is severe in the aorta.

Treatment

The narrowed section is repaired, before the child's age turns 10. It can be repaired through balloon angioplasty or open-heart surgery.

• Hypoplastic Left Heart Syndrome (HLHS)

'Hypoplastic' means 'underdeveloped'. In HLHS the heart's left side that includes the left ventricle, aortic valve, mitral valve and aorta do not get developed in the womb. A healthy heart has two ventricles. Right ventricle pumps blood towards the lungs to get oxygenated, whereas the left ventricle pumps the oxygenated blood to the other parts of the body.

In HLHS, the left ventricle is very small to pump blood effectively. Usually, there is a hole in the wall that divides the right ventricle and left ventricle.

Symptoms

In the womb the fetus receives oxygen from the mother's circulation via placenta. In a couple of days, after birth the HLHS symptoms can be seen. This occurs because the placenta is disconnected and the newborn has to depend on its own heart for oxygenated blood circulation.

• Rapid heart beat 

• Rapid breathing 

• Cool, clammy and pale skin 

• Blue color lips and face 

• Weak pulses in arms and legs (because of poor circulation)

Treatment

Infant with HLHS, at birth will be given an IV (intravenous) to enhance blood flow. A series of heart surgeries are performed to reroute the blood in the right ventricle. The right side will perform the functions of both ventricles. Even if possible, a heart transplant surgery can be performed to provide the infant with a well-functioning heart.

• Patent Ductus Arteriosus

In the womb, ductus arteriosus allows the blood to evade the lungs of the baby. After birth as soon as the baby starts to breath, the responsibility of ductus arteriosus gets concluded and it shuts down automatically, in a few days. In certain cases, ductus arteriosus remains open and can cause abnormal blood circulation. This condition is called Patent Ductus Arteriosus. The cause of PDA is still unknown.

Symptoms

• Shortness of breath or rapid breathing 

• Sweating with playing or crying 

• Fast heart rate 

• Tire out easily 

• Poor eating & poor development

Treatment

PDA treatment focuses on closing ductus arteriosus to prevent complications. Closing of PDA is done either through medications, catheter, or surgery.

• Tetralogy of Fallot

A group of 4 heart defects at birth is called Tetralogy of Fallot. The flow of blood gets deteriorated, due to these defects causing a reduction in oxygen level.

The four defects are - 

1. Ventricular septal defect - There is a hole in the muscle wall between right and left side of the heart. 

2. Pulmonary valve stenosis - It is the narrowing of large blood vessel entrance. 

3. Over-riding aorta - Basically, aorta function starts from the left ventricle but in Tetralogy condition it begins from the center of the heart, just over the hole between two sides. 

4. Right ventricular hypertrophy - Due to the upper three heart defects the right side has to overwork, so the heart muscle on that side gets enlarged.

Symptoms

• Bluish tint on the lips, fingernails and skin 

• The tint darkens during activities like crying 

• Abnormal heart murmur 

• While feeding the baby gets tired easily, which hinders the growth 

• Fingertips have abnormal rounded shape

Treatment

Open heart surgery is applied to repair the defects of Tetralogy of Fallot. The pediatric cardiologists continue to check the child regularly, even after surgery. Sometimes, the child may need additional surgery, as they grow up because sudden complications may develop.

• Transposition of great arteries (TGA)

Basically, in normal condition the blood from heart goes to lungs to get oxygenated through pulmonary artery. After it comes back the aorta pumps the oxygenated blood through the body. In TGA, the blood comes to the heart but is pumped out directly without going towards the lungs for getting oxygenated.

Symptoms

• The baby has bluish colored skin 

• Rapid heart rate and breathing

Treatment

The baby receives intravenous medication, shortly after birth. If a hole is present in the hearts mid-wall then a hole will be made surgically. This allows the oxygen to mix with blood that is pumped out. Balloon atrial septostomy technique is used. Although this is a temporary treatment but the baby will require open-heart surgery called arterial switch operation within 4 weeks after birth, to correct the defect.

Aneurysm

Aneurysm is the swelling in the walls of blood vessels especially arteries. The swelling and widening of blood vessels causes them to weaken over time and they can rupture. The most commonly observed causes of aneurysm are congenital defects, uncontrolled high blood pressure and atherosclerosis (growing of fatty deposits in arteries). Aneurysm is usually classified by shape, size and location of the bulge. It is most common in arteries at the base of the brain referred as brain or cerebral aneurysm, and in aortic arteries known as abdominal aortic aneurysm. Although aneurysm can occur at any age it is most commonly observed in adults than children. Women are also found slightly more susceptible than men in this regard.

Aortic Aneurysm:

Aorta is the main artery that supplies blood from heart to the rest of the body. Aneurysm can develop anywhere in the aorta but they are most commonly found in aorta with in the abdominal region below the kidneys. The majority of aneurysms which actually start in the abdominal path of aorta eventually extend up to iliac arteries. It may occur in the chest near the heart as well (thoracic aortic aneurysm). The aortic aneurysm usually does not show any symptoms. Mild to moderate symptoms of aneurysm can sometimes be seen though. Pain in the effected area is a common symptom. One of the main causes of aortic aneurysm is smoking. The smokers over 60 years of age seem to have atherosclerosis. It has to be stopped immediately as it increases the risk of aneurysm's widening.

Treatment:

To treat the aortic aneurysm a procedure known as stenting is performed. After locating the position of the bulge, an X-ray guided polyester tube (stent-graft) is passed through a small cut in upper thigh leading to aorta. Now the blood instead of flowing through the damaged artery flow through the stent-graft and eliminates the chance of rupture.

Brain Aneurysm:

Brain Aneurysm usually originates from the base of the brain where the larger arteries combine. This area is known as circle of willis. The causes of brain aneurysm are generally genetic disorders which includes connective tissue disorders, polycystic kidney disease or some circulatory disorder. Patient having brain aneurysm may be found having the symptoms such as excruciating headache, problem with vision, thinking and decrease in concentration level, difficulty in speech and perception, pain in neck or eye and extreme tiredness.

Treatment:

Surgical clipping and coil embolization are methods usually applied for the treatment of brain aneurysm. Patient has to go through some test to get the right diagnosis after which the doctor will determine the method of treatment that is best suited to repair the blood vessel.

Congenital Heart Disease and Physical Therapy

Congenital Heart Disease

Congenital heart diseases refers to the structural (anatomical) or physiological defects in the normal functioning of the heart as a result of birth defects that may be diagnosed soon after birth or may take years to produce full blown cardiac insufficiency. Valvular heart defects form the most common variety of congenital cardiac defect that is associated with high morbidity and mortality in adult years if no management options are employed. This is because the metabolic demands of the body increase with growth and development that poses more pressure on the heart leading to cardiac failure or circulatory deficits. With overall prevalence of 26.6%, it was suggested that only 12.1% cases can be detected by clinical evaluation. Among the most prevalent congenital cardiac defects, ventricular septal abnormalities comprise 17.3% of all congenital anomalies followed by atrial septal defects (6.0%) and other less common cardiac diseases. The mortality is highest with cyanotic heart diseases. 

According to the research statistics reported by Julien I.E Hoffman, over 1 million patients were born with congenital heart defects (during 1940 to 2002). Considering the quality of medical services and surgical/ medical advancements, Hoffman suggested that the total number of survivors with mild heart disease (who may reach well into adulthood) is 750,000 with mild heart disease, 400,000 with moderate heart disease and 180,000 with severe disease (with treatment). Without any management or treatment the survival rate may fall to 400,000 with mild disease, 220,000 with moderate disease, and 30,000 with severe heart disease, suggesting very high mortality. 

Congenital heart diseases are also associated with stunted growth and development in children marked by poor weight gain, failure to thrive and frequent hospitalizations while growing up. In addition, these children also develop frequent episodes of shortness of breath, rapid heart rate (also known as tachycardia) and attacks of fatigue associated with decreased exercise endurance.

Physical therapy 

Physical therapy and mild exercises are helpful in the growth and development of children born with congenital heart disease. It is extremely important not to initiate exercise therapies in these children without seeking the guidance from registered physical therapists who work in coordination with the pediatric cardiologist to deliver best exercise regimens in order to optimize health without overloading the heart. Generally, children and adults can perform moderate static exercises of mild intensity without any complications; however, healthcare providers strongly restrict weight lifting in pediatric aged children and even in adults born with cardiac defects. Caution should be maintained to avoid lifting weight of more than 25 pounds in children and more than 50 pounds in adults. Physical therapist and pediatric cardiologist must assess every child individually and advice customized exercises and treatments according to the severity of illness and overall physical health. Treadmill test, bicycling and echocardiography are mainly used as assessment tools as the risk of sudden death increases if vigorous activity is attempted in children born with aortic stenosis, cyanotic heart diseases and coarctation of the aorta. 

Hardcore or traditional gym exercises increase cardiac output that may overload the heart and may increase the risk of complications or sudden cardiac death. On the contrary, exercises performed under the guidance of physical therapists serve multiple benefits. Exercise or physical activities are needed in order to build stamina and maintain exercise endurance especially in school going children who engage in physical activities with peers. Physical therapy improves the pace of mental and physical development that allows children to develop healthy social relationships with peers, muscle and motor coordination and mental concordance. Physical therapy and periodic assessments are also needed in order to know the physical capacity of child and to track worsening of cardiac defect with age (in order to avoid accidents or unwanted incidents at schools) by restricting excessive physical activity. In some children, healthcare providers delay surgery until the child crosses some developmental milestones; however, it is very important that until then child stays in best possible physical shape to lessen the risk of surgical complications. 

According to the scientific peer-reviewed journal- American Family Physician there are 5 stages of physical activity recommendations of Physical Activity in Children with CHD, ranging from no restriction to extreme limitation of physical activity (wheel chair bound). 

Without any physical therapy, the progression into the severe disability is fairly high. It is the duty of parents to promote healthy physical activity but make sure to prevent contact sports or vigorous activities that may affect cardiac functioning.