Congenital Heart Disease: Holes in the Heart

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Guest: Dr. David Gregg

Host: Dr. Pam Morris

Dr. Pam Morris: Hi, I am Dr. Pam Morris and you are listening to Heart Sounds. I am here today with Dr. David Gregg who is director of the Adult Congenital Heart Disease program at the Medical University of South Carolina. Welcome, Dr. Gregg.

Dr. David Gregg: Thank you, good to be here.

Dr. Pam Morris: Dr. Gregg, one of the problems that we hear about for congenital problems in the heart are holes in the heart. What is a hole in the heart?

Dr. David Gregg: It sounds awfully scary. I remember when I was five or six; I went to the doctor and was found to have a heart murmur. He said, “Well, you need to go to the hospital and have an ultrasound of your heart because you may have a hole in your heart.” At that time, I was healthy, playing soccer and thought, how could I possibly have a hole in my heart? I would be bleeding if I had a hole in my heart. It turned out that I did not have one. But, you do not have to bleed if you a hole in your heart. It is a confusing sounding term, and it really means that the heart is not formed correctly. There may be a leak of blood from the normal blood flow that it should take.

Dr. Pam Morris: Now, is this something that you would feel? Would someone know that they have a hole in their heart because of symptoms they might have?

Dr. David Gregg: That is one possibility. Many patients are discovered like I was, at least evaluated for, because they have heart murmurs which is when the doctor hears an extra sound of the blood not flowing smoothly through the heart. Other patients come in feeling tired and then on the exam the doctor, and potentially imaging of the heart, discovers that there is a hole in the heart which allows blood to usually go backwards. The heart is divided into two sides. The right side of the heart, blood comes back from the body with no oxygen in it, to the lungs where it gets oxygen put back into it. The left side of the heart gets blood back from the lungs and then pumps blood to the body. If you have a hole, blood may bypass or skip where it is supposed to go. Blood might be able to come and not go to the lungs but go right back to the body again. In that case, the blood does not get the oxygen that it needs from the lungs. That is where you hear sometimes the term blue baby. A child may who may look blue because they have low oxygen levels. Other times, blood may go backwards from the left side of the heart, back to the right, resulting in extra flow of the blood through the lungs again which, over time, may result in the heart getting tired or the pump getting weaker.

Dr. Pam Morris: Are there simple ways to diagnose this type of a problem, to find a hole in the heart?

Dr. David Gregg: The most common way, now, is through ultrasounds of the heart or echocardiograms which use sound waves to take pictures of the heart.

Dr. Pam Morris: Is this sort of like ultrasound when a woman is pregnant?

Dr. David Gregg: Exactly the same thing. It involves using sound waves, like sonar, the same way we see the bottom of the ocean in a boat, that bounce off the heart. Then, through a special computer, we are able to make pictures of the heart and see what the structure of the heart looks like.

Dr. Pam Morris: Can you ever diagnose a hole in the heart when the baby is still in the uterus?

Dr. David Gregg: We have become advanced over the course of time with these ultrasounds. Now, most everybody gets pictures, before they are born, of their baby and looks to make sure that the heart as well as all the rest of the body is forming normally. So, now some holes in the heart are discovered even before the baby is born.

Dr. Pam Morris: Are there treatments for these holes in the heart? Do all holes in the heart need to be fixed?

Dr. David Gregg: No. If they are small and patients are feeling normal, we sometimes just watch them over time. Other holes that are bigger may require surgery to repair them. Recently, over the last 10 years or so, technology has advanced to allow us to now repair some of these holes through catheters where we just put small needles into the artery or the vein in the leg and are able to go into the heart, like patients, you hear, may go for what are called angiograms or pictures of the heart. We may be able to fix these just through tiny little needles.

Dr. Pam Morris: Now, what about adults that are found to have holes in their hearts later in life. How are those not picked up when they are younger?

Dr. David Gregg: If the hole is relatively small, patients may not have symptoms until years and years of extra work potentially from the heart, from the hole. You may then have your first symptom when you are 40 or 50. You may even be 70 or 80. Those may or may not need anything done with it. Part of it is that we take a lot more pictures of people’s hearts these days. You may come in for something completely unrelated to the hole that you had and we just happen to discover this.

Dr. Pam Morris: Are there any restrictions, are there certain things, you cannot play sports, you cannot run a marathon? Are there any restrictions on your activities if you have a hole in your heart?

Dr. David Gregg: Most patients do not. It depends on the severity of the hole, whether you have had treatment, whether you are having symptoms from it. The vast majority of people are able to compete doing sports, do really almost any activity, but it is important to see a doctor who has some experience in this area to help advise you on what limitations you may have if you are a patient who has been told that you have a hole.

Dr. Pam Morris: You know, it would make me kind of nervous if I knew that I had a hole in my heart and it was not being fixed. What kind of emotional concerns or issues do adults have when they have been followed with a problem like this without having it treated?

Dr. David Gregg: Many people get used to it with time. It may be a shock when you first are told that you have a hole in your heart, but over time you often get adjusted to it. But, it is a significant worry to many people. It does sometimes require continued visits to the doctor. Unfortunately, we are not able to fix all the holes with a good risk profile. It may be riskier for the patient to go for a surgery or procedure to try to fix it rather than just watch and see what happens.

Dr. Pam Morris: Are there any precautions that patients need to take if they have a hole in their heart? I am thinking about things like, I know people who take antibiotics before they go to the dentist or before their colonoscopy.

Dr. David Gregg: Right, the one important component of many holes in the heart is taking antibiotics before going to, particularly, the dentist, anything that may get bacteria or an infection into the heart. For those patients, we recommend taking antibiotics before. The other one that is a pretty common concern is patients who might do scuba diving, things like that. It is important to specifically talk with your doctor about what limitations, if any, you may have.

Dr. Pam Morris: You know, it sounds to me like one of the things that is very important with having any type of hole in the heart, is having good medical follow up so that you have a plan for follow up and diagnosis over time.

Dr. David Gregg: That is very important. I think one of the challenges is that as patients may have these discovered in childhood, that they then move into adulthood, is finding a doctor who is comfortable with, you know, holes in hearts and heart malformations, but also is accustomed to taking care of adults.

Dr. Pam Morris: Well, I guess this is a great tribute to our medical system. You know, we think so often of the only heart problems being heart attacks and diseases of the blood vessels. It is really exciting to see that children who are born with problems or holes in the heart are now living into adulthood.

Thank you so much for being here today, to talk with us about this interesting problem, Dr. Gregg.

Dr. David Gregg: Thank you.

If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.

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