Enlarged heart, a mystery baby killer
- Prabhneet Kaur, Hindustan Times, Chandigarh Updated: Aug 07, 2015 13:25 IST
Routine cardiac evaluation is necessary to detect decline in heart function, since symptoms may develop later. (HT Photo)
A young couple from Khanna were in for a shock when they went for an X-ray of their four-month-old baby after he had been experiencing shortness of breath and constant cough.
The doctor suggested a test called echo (echocardiography) for the child, as his heart appeared to be larger than normal. On April 20, they reached a laboratory in Sector 24, Chandigarh, for the same test that had been performed a week before the baby was born. While the old reports were normal, the new reports showed a lot of complications. The child failed to survive the exertion of the day and died in the hospital.
While the couple didn’t know what caused it, the doctors assured them nothing could have been done to save his life. “Cardiomyopathy, heart muscle disease literally, is not common among children,” said Dr Harinder Singh Bedi, pediatric cardiologist at Christian Medical College, Ludhiana. The poorly understood dilated cardiomyopathy (DCM) (enlarged heart) is its most prevalent form.
Every year, cases of congenital heart disease (present at birth) are registered in hospitals, while the cases of acquired disease (which develops post-fetally) are increasing. Dr Manoj Kumar Rohit, cardiologist at the Post Graduate Institute of Medical Education and Research (PGIMER), says that nearly 50 cases of DCM were registered at the institute in the last decade, and even if the chances of acquiring the disease are lesser in children, there is greater mortality. “In children, DCM pursues a heterogeneous course with a high mortality rate,” he said.
In a study at Cardiothoracic Centre of the AIIMS, record of 82 children (below the age of 12) with DCM (including 50 males) was compared. On an average, 11.5% patients died in 25.09 months. Jalandhar cardiac surgeon Dr Balram Bhopal says adult patients include certain who have survived with only 10% of the heart functioning, while in some cases, it is fatal.
What is DCM?
Dilated cardiomyopathy, in which the heart muscle weakens and becomes enlarged because of which the lower chambers of the heart are unable to pump blood efficiently. The lungs become congested, causing heart failure. As the heart becomes sicker, not only the systolic action (contraction) is impaired but also the ability of the heart to relax suffers.
Heartbeat faster than normal
Abnormal, life-threatening heart rhythms
Shortness of breath after small exertion
Poor appetite, decline in growth rate
Problem in breathing while lying down.
Unknown, generally, though one might be a viral infection that results in the inflammation of the heart, but it affects only a few and not all. Routine cardiac evaluation is necessary to detect this decline in heart function, since symptoms may develop later. Unlike HCM (hypertrophic cardiomyopathy, in which the heart muscle or myocardium becomes abnormally thick), in the case of DCM, only a few cases are genetic.
Alike diseases that can be cured
There are diseases that might mimic DCM, like narrowing of the aorta, aortic valve, ALCAPA (anomalous origin of the left coronary artery arising from the pulmonary artery) and PSVT (paroxysmal supraventricular tachycardia, or episodes of rapid heart rate that start in a part of the heart above the ventricles). While DCM is not curable, all diseases that mimic it can be cured permanently.
At an earlier stage, when this disease is termed as myocarditis, it can be treated through therapy and medicines. However, once it takes the shape of DCM, it is not curable. Research is on for a possible cure.
Berlin Heart Excor Pediatric Heart Pump Gets FDA Approval
by GENE OSTROVSKY on Dec 19, 2011 • 12:10 pm
Having received unanimous recommendation from its Circulatory System Devices Advisory Panel to grant a humanitarian device exemption to the Berlin Heart Excor Pediatric Ventricular Assist Device (VAD), the FDA did just that.
Here are some details from our earlier postabout the study that led to the approval:
The sponsors of the VAD presented data from a recent prospective, non-randomized, multi-center, single arm study assessing the safety and probable benefit of the device. 48 children were enrolled in the trial and their outcomes were compared to those receiving ECMO (extracorporeal membrane oxygenation), which is considered the standard of care for bridging children to transplant. Regardless of a 29% stroke rate, 90% of the children survived to transplant or were successfully weaned off the VAD. The overall rate of serious adverse events was less in the Excor group versus the ECMO group. Although the committee wants further investigation of the stroke rates with better-defined outcomes and causes, they do suggest this can be done in the setting of post-approval studies.