What is a ‘hole in the heart’?

There is one paediatric hospital in the entire English-speaking Caribbean, and it’s right here in Jamaica. I have been privileged to work at this hospital for over 10 years across various sub specialities fulfilling my passion of caring for children.

We see and treat thousands of children with hundreds of illnesses across tens of sub specialities. I work in paediatric cardiology where we treat children with an array of heart conditions. The most common complaint is a “hole in the heart”. In fact, if I ask my patients (well, really their parents/guardians) what is wrong with their child’s heart, 80 per cent will say it’s “a hole in the heart”. And they’re probably right…. but there are so many kinds of “holes”. In fact, it may not even be a hole!

The heart is an organ that receives blood from and pumps blood to both the lungs and the body. It is divided into the right and left side by a wall, and again divided into a top and bottom chamber on either side by valves (or doorways) that allow or prevent the flow of blood. Each of the two bottom chambers have large blood vessels with valves carrying blood away from the heart. (Confused? I hope not.)

A hole in the heart refers to a hole between the wall separating either the two top or bottom chambers. Here’s a diagram that will hopefully help.

A hole in the heart could be between the two top chambers, or the two bottom chambers. The holes may be of different sizes, which may affect the severity of the heart condition. There should be multiple holes. But holes aren’t the only thing that could be abnormal.

There could be an extra blood vessel outside of the heart, it could be a leaking valve in the heart, it could be a narrowed blood vessel, or an abnormal connection between blood vessels, or even a problem with the size of part of the heart muscle. There are even heart conditions where the structure of the heart is normal, but the rhythm of the heart is unusual.

Some symptoms of heart conditions in children include: shortness or breath or fast breathing, getting tired easily and not being able to keep up with their peers (or in babies- pausing and sweating with feeds), getting chest infections often, not gaining weight appropriately, and heart racing.

If you are concerned that your child may have a heart condition, please go to your nearest health centre to have him/her assessed by a doctor so that if needed, tests can be ordered. The main tests that assess for heart conditions are ECG which looks as the rhythm of the heart, and echocardiogram (or heart ultrasound) which looks at the structure of the heart.

Now, for us doctors, it’s actually very important to know more than just “hole in the heart” because it may influence our plan for treatment. We want to know

• where exactly is the hole?

• Is it at the top or bottom part of the heart?

• Are there more than one holes?

• How big is the hole? Is it small or large?

• Is there any else wrong with the heart besides the hole?

• Do you need heart medications for this heart problem? Which ones? What are the doses?

• Does this heart problem affect your oxygen level? What is the normal oxygen level for your child?

All this information about a child’s heart condition is very important for your doctor to know. It can help us in deciding if this child needs to go to the hospital for treatment, or if a new prescription will do. It may also impact the medications we prescribe for a non-cardiac illness.

So, to help with my patients’/parents’ education and knowledge, I created a patient card with all that information. It has the (medical) name of the heart condition(s), the child’s acceptable oxygen level (meaning the normal oxygen level for your child), and the names and dosages of any heart medications.

Now, you as the parent can search the internet to your heart’s content about what a “CAVSD with unbalanced ventricles, ASD, RAVVR, elevated pulmonary pressures, PDA” means because your doctor wrote down the name of the heart condition for you.

And, when you bring your son or daughter to the health centre for a runny nose and sneezing, but the nurse sees an oxygen level of 90 per cent the doctor can look at the patient card you carried to see that his normal oxygen level is above 85 per cent because he has this kind of “hole in the heart”. That just saved you and your child a trip to the emergency room.

My hope is that even small changes like this can bring about a huge impact in the lives of patients and caregivers. Something as simple as a little piece of cartridge paper which you can easily carry around in a purse or wallet may positively influence how we manage our patients.

Dr Tal’s Tidbit

A hole in the heart is only one of many heart problems in children. It is important to know the kind of heart condition your child may have as well as the names and doses of any heart medications.

Dr Taleya Girvan has over 10 years’ experience treating children at the Bustamante Hospital for Children in the Accident and Emergency Department and Paediatric Cardiology Department.