Hole in Heart: Symptoms, Causes, Life Expectancy

A hole in the heart is a nonmedical term used commonly for a congenital heart defect. It is characterised by the presence of a hole, which occurs due to structural abnormality.

This heart structure issue is known as an atrial septal defect when it occurs between the two atria and as a ventricular septal defect when it happens between the ventricles. 

The effect of a heart hole on health varies based on its size and where it's located. Small holes might not have noticeable symptoms and might naturally close up. But bigger ones require medical attention because they can result in issues like pulmonary hypertension and heart failure.

A baby with a hole in the heart can grow up normally and lead an active and healthy life with appropriate medical care.

Several types of holes in the heart can occur, and they are often congenital, meaning they are present from birth. These holes can affect the normal flow of blood through the heart and the body. These holes in the heart can vary in size and severity. The main types are:

1. Atrial Septal Defect (ASD): This is a hole in the wall (septum) that separates the two upper chambers of the heart, known as the atria. It allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium, which can lead to various heart and lung problems.
2. Ventricular Septal Defect (VSD): This type of hole occurs in the wall between the two lower chambers of the heart, called the ventricles. It allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle, resulting in an increased workload on the heart.
3. Patent Foramen Ovale (PFO): A PFO is a small hole in the septum between the atria. It is a remnant of a fetal opening necessary for blood circulation in the womb. While it usually closes shortly after birth, it can remain open in some individuals. A PFO may not cause symptoms but can be associated with certain medical conditions.
4. Patent Ductus Arteriosus (PDA): This is a connection between two major blood vessels near the heart, the pulmonary artery and the aorta. Normally, this connection closes shortly after birth, but in some cases, it remains open. An open PDA can increase blood flow to the lungs and heart.

Small holes (less than 5 mm) do not result in any considerable passage of blood through them and thus do not cause enough strain on the heart or lungs to result in symptoms. The larger holes in the heart, however, may cause any of the following symptoms:

1. Heart murmur and palpitations
2. Rapid heart rate
3. Cyanosis (bluish discolouration of the skin)
4. Frequent respiratory tract infections in children
5. High blood pressure
6. Migraine
7. Shortness of breath
8. Getting tired easily
9. Swelling in the extremities (arms and legs) or abdomen
10. Stroke
11. Transient ischemic attack
12. Heart failure

The heart is divided into four chambers - two on top called atria and two below called ventricles. These chambers are separated by a wall known as the septum, which is made up of different parts that come together as a baby develops in the womb. 

Normally, these parts fully connect to create a solid wall. But in certain situations, they don't fuse completely, and this can result in a gap. The causes are:

1. Congenital Heart Defect: A heart hole can develop before birth due to abnormal development of the heart during pregnancy.
2. Environmental Factors: Exposure to toxins or radiation during pregnancy may contribute to heart defects.
3. Infections: In some cases, maternal infections during pregnancy, such as rubella, may lead to heart defects in the developing fetus.

While the exact cause of a hole in the heart is not always known, certain risk factors are believed to raise the likelihood of a baby being born with a hole in the heart. These include:

1. Genetics: A positive family history of congenital heart defects, including holes in the heart, is considered to raise the risk for other family members.
2. Premature Birth: In babies born prematurely, the heart of the baby is still developing. The wall might not have closed completely by the time of the birth and may present as a hole in the heart.
3. Maternal Factors: Maternal Factors: Certain maternal factors during pregnancy, such as diabetes or exposure to certain medications or infections, can increase the risk of a heart hole in the baby.
4. Advanced age (above 35 years) Pregnancy: It may slightly raise the risk of congenital heart diseases, including holes in the heart. This may happen because older age women have a greater tendency to suffer from chronic conditions like hypertension, diabetes, etc. The quality of the egg also deteriorates with age.
5. Chromosomal Disorders: Certain chromosomal disorders, such as Down's syndrome, are associated with a higher risk of congenital heart defects. Almost half of the children with Down's syndrome have CHD.

Though prevention of this condition is not possible, precautions can be taken. These include:

1. Healthy Lifestyle: Maintain a balanced diet, exercise regularly, and manage your weight to reduce the risk of heart defects.
2. Prenatal Care: If you're pregnant or planning to be, seek proper prenatal care. Regular check-ups with a healthcare provider can help monitor the baby's development and detect any issues early.
3. Avoid Harmful Substances: Steer clear of alcohol, tobacco, and recreational drugs during pregnancy, as these substances can increase the risk of heart defects in the developing baby.
4. Manage Chronic Conditions: If you have chronic health conditions, like diabetes, it's crucial to keep them under control during pregnancy to minimize the risk of heart defects.
5. Medications: Ensure that any medications you take are safe during pregnancy, and consult with a healthcare provider if you have concerns.

Diagnosing a hole in the heart involves several steps to determine the presence and type of defect. The cardiologist will recommend the following to diagnose:

1. Physical Examination: A doctor may conduct a physical exam to listen to the sounds of the heart and check for any unusual signs, such as abnormal heart murmurs.
2. Medical History: The doctor will ask about your medical history, including any family history of heart conditions and any symptoms experienced.
3. Imaging Tests: To confirm the diagnosis, various imaging tests may be used, including:
   Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can help identify abnormal rhythms.|
   Echocardiogram: This is a painless ultrasound test that provides real-time images of the heart. It can reveal the presence and type of hole in the heart.
   Chest X-ray: It provides images of the chest to see the size and structure of the heart.
4. Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can help identify abnormal rhythms. 
5. MRI (Magnetic Resonance Imaging): This advanced imaging technique may be used to provide more detailed images of the heart and its blood flow.
6. CT Scan (Computed Tomography): A CT scan can offer a three-dimensional view of the heart and help diagnose specific heart defects.

How to Prepare for the Doctor Consultation?

If the baby is exhibiting some symptoms suggestive of a hole in the heart, the parents need to get the baby examined by a physician. For a fruitful visit, consider the below-mentioned recommendations:

1. Make a prior appointment to avoid long waiting hours at the hospital.
2. If the baby has been diagnosed with a hole in the heart, ask the doctor about its size, severity, what are the chances of it getting closed on its own and how much time that can take.
3. If the doctor is advising surgery, enquire if it is possible through a minimally invasive approach or if open-heart surgery will be required. You can also ask about the possible risks of the surgery and the estimated recovery time.

Expectations from the Doctor

While visiting a doctor for consultation regarding a hole in the heart, be prepared to expect the doctor to do one or more of the following:

1. The doctor will do a physical examination to look for the symptoms and hear the heart sounds through a stethoscope to detect any murmur.
2. The physician will ask if any other family members also have congenital heart disease.
3. The doctor may ask if the mother suffered from any medical conditions during pregnancy.
4. Depending on the findings, the doctor may recommend further investigative tests or imaging.
5. The doctor may suggest the best treatment approach for the patient, which should be followed for the best outcomes.
6. The physician may refer the patient to a superspecialist doctor, such as a pediatric cardiologist.

Many a time, the hole in the heart closes on its own as the child grows. However, sometimes it may not. In such cases, if they are large enough to adversely affect the health of the heart or lungs, they need to be closed surgically.

Non-surgical Treatments of Hole in the Heart

If surgery is not possible due to some reason or while waiting for the hole in the heart to close on its own, management of the condition can be done by the following methods:

Home Remedies

Although home remedies cannot be considered a treatment for a hole in the heart, they can help to some extent in preventing and managing the symptoms:

1. Dietary Modifications: Include foods with antioxidant and anti-inflammatory properties, such as flaxseed and garlic, as they are healthy for the heart. Take omega-3 fatty acids, coenzyme Q-10, or vitamin K2 supplements. These are considered to lower the risk of cardiac diseases and also optimise heart function.
2. Lifestyle Modifications: Some lifestyle changes are suggested for people with holes in their hearts. Manage a healthy weight to avoid symptoms like shortness of breath and tiredness. Avoid strenuous activities that can strain the heart.

Alternative Treatment

Many people have faith in alternative treatment approaches like Ayurveda and Homeopathy for the treatment of heart conditions like a hole in the heart. Find below the best options in alternative forms of therapy:

1. Ayurveda: Ayurveda has the power of tissue generation of some herbs to treat holes in the heart. Amlaki is one such herb that is believed to be a potent rejuvenator in Ayurveda.
2. Homoeopathy: Homoeopathic medicines like Phosphorus 30,200, Sulfur 200, Calc Phos 6x, Apis and Lachesis are used to treat ASD(6).

Surgical Treatment of Hole in the Heart

Many cardiologists advise surgery for a moderate to large atrial septal defect after it is diagnosed in childhood or adulthood. After undergoing atrial septal defect surgery, regular check-ups and echocardiograms are vital for monitoring potential complications.

The surgical treatment of ASD are:

1. Cardiac Catheterization: This method involves inserting a thin, flexible tube (catheter) into a blood vessel, typically in the groin, and guiding it to the heart using imaging techniques. A mesh patch or plug is passed through the catheter to seal the hole. Over time, heart tissue grows around this seal, permanently closing the opening.
2. Open-Heart Surgery: This type of surgery requires an incision through the chest wall to directly access the heart. Cardiac surgeons employ patches to close the hole. Occasionally, minimally invasive surgery with small incisions or robot-assisted heart surgery can also be used.

Cost of Hole in the Heart Treatment

The cost of open heart surgery in India can vary depending on several factors, including the type of surgery, the hospital or clinic where the procedure is performed, and the location. Here is a table highlighting the cost of the surgery:  

Depending on the type and size of the hole in the heart, there may be a wide range of complications. Small ASDs or VSDs may never be of concern and frequently close on their own over time. The risks of the hole in the heart are:

1. Heart Strain: A hole in the heart can cause extra blood to flow through the heart, which may lead to strain and enlargement of the heart chambers over time.
2. Irregular Heartbeats (Arrhythmias): Some individuals with heart defects may be at a higher risk of developing irregular heart rhythms. It affects the ability of the heart to pump blood effectively.
3. Pulmonary Hypertension: In some cases, increased blood flow to the lungs can result in high blood pressure in the lung arteries (pulmonary hypertension), which can strain the heart.
4. Heart Valve Problems: The altered blood flow patterns associated with a heart defect can cause damage to heart valves, leading to leakage or narrowing.
5. Stroke: In rare cases, a hole in the heart can allow small blood clots or debris to travel from the right side of the heart to the left side and then to the brain, potentially causing a stroke.
6. Heart Failure: In severe cases or when the defect remains untreated, it can result in heart failure, where the heart cannot pump blood effectively to meet the body's needs.

When to Consult a Doctor for a Hole in Heart?

Prompt diagnosis and treatment play a vital role in successfully treating a hole in the heart. Thus, if the baby is showing symptoms suggestive of this condition, do not delay visiting a doctor. The symptoms that warrant a consultation with a doctor are:

1. Getting tired easily while feeding or playing
2. Getting short of breath while crying
3. Rapid heart rate
4. Poor weight gain
5. Frequent respiratory infections

Diet for Hole in Heart 

For individuals with a heart defect, it's essential to maintain a heart-healthy diet to support overall well-being. The diet may include the following:

1. Balanced Diet: A balanced diet should include a variety of foods from all food groups, like fruits, vegetables, lean proteins, whole grains, and low-fat dairy products.
2. Limit Salt: Reducing salt intake is essential as it can help control blood pressure. Avoid adding extra salt to your meals, and be cautious of high-sodium processed foods.
3. Healthy Fats: Opt for unsaturated fats found in foods like olive oil, nuts, seeds, and fatty fish (like salmon and mackerel). These fats can support heart health.
4. Fibre-Rich Foods: Include plenty of fibre in your diet through whole grains, fruits, and vegetables. Fiber aids in digestion and can help manage cholesterol levels.
5. Limit Sugary and Fatty Foods: Reduce the consumption of sugary beverages, sweets, and high-fat, processed foods. These can contribute to weight gain and unhealthy cholesterol levels.
6. Moderate Portion Sizes: Be mindful of portion sizes to prevent overeating, which can lead to weight gain and strain on the heart.

While a hole in the heart may initially seem daunting and present challenges, it is comforting to know that this is a manageable condition. With continued research and innovations in the treatments available nowadays, the prognosis of patients with a hole in the heart continues to get brighter.

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