How to diagnose and manage a hole in the heart?
Q: My grand daughter is 6 weeks old. During routine check up the child specialist has observed her heart sound as LUV SHO DUB and referred to a cardiologist. She was, however given vaccination and she had fever and difficulty in feed and became subdued. She was taken to the cardiologist as per paediatricians advice next day after the immunisation. Cardiologist asked for an ECHO though he felt there is a possibility of a hole in the heart which can be ascertained after ECHO. He wants to do the ECHO next day provided there is no fever. He also said that for doing the test, the baby has to be given a sleeping drug. My questions are: a) Is it normal convention that sleeping drug is given to a new born baby of her age during such testing? b) Since baby has become weak due to fever and pain due to immunisation will this drug have any adverse effect on her? c) Prior to immunisation, baby was active; what is the possibility of her having hole in heart? d) If it is detected, can it get cured on its own? e) If not, then what are the medical options safe for the baby and when the same, any operation, can be carried out? f) If doctor decides to wait till she grows 1-2 years will it have any risk factor? g) What monitoring is then required to prevent any deterioration? Can she lead a long, normal life? h) Will crackers in Diwali create any problem for her? Should plugging of ear be done to avoid noise pollution in these days? I shall be obliged if you can answer.
A:A number of your questions are really hypothetical, as they depend upon the results of tests yet to be done and the final diagnosis, as a hole in the heart has not been confirmed in your child. However, my responses are as follows: a) If your baby has been fed and is sleeping contentedly, then there is no need for sleep medicine. The requirement is that the baby should be quiet and peaceful, not necessarily sleeping. b) It is unlikely that sleeping medicine if given in the appropriate doses, will have any adverse effects. c) If there is any doubt about the possibility of a hole in the heart, then this needs to be confirmed and evaluated. d-g) Some holes will close spontaneously. After the ECHO test, your doctor will be able to advise you accordingly. Generally, operations for holes in the heart are effective and safe, in the correct hands and the timing of the operation depends upon the specific type of defect. Long term outcome also depends upon the actual diagnosis, which most often can be confirmed by ECHO. Monitoring will be advised accordingly. h) Diwali crackers or noise will not do anything and will not cause any harm.