Protecting heart health requires regular monitoring, specialised care and awareness for adults with congenital heart disease.-123rf.com
ADVANCEMENTS in surgical, medical, anaesthetic and intensive care have significantly improved survival rates for children with congenital heart disease (CHD), allowing more of them to reach adulthood.
However, despite survival into adulthood, many individuals may not realise that regular monitoring is crucial for maintaining heart health.
“Adults born with congenital heart disease should be more aware that even after recovery, regular monitoring and ongoing care for their condition are essential, as surgical or medical interventions may still be required at times,” says National Heart Centre Singapore Cardiology department senior consultant and Adult Congenital Heart Disease (ACHD) programme co-director Dr Foo Jie Sheng.
Even if a patient underwent a surgery in childhood, ACHD can still pose risks as they age. Recognising symptoms and seeking timely medical attention can help prevent complications.
Understanding ACHD
Congenital heart disease refers to structural abnormalities in the heart present from birth. These defects affect how blood flows through the heart and can lead to serious complications later in life.
ACHD is classified into three major categories:
- Right-to-left shunts (cyanotic heart defects): An abnormal connection between the heart’s right and left sides allows low-oxygen blood to mix with oxygen-rich blood, leading to a bluish tint in the skin (cyanosis);
- Left-to-right shunts: This condition causes excessive blood flow to the lungs instead of being properly circulated throughout the body;
- Blood flow obstruction: Defective heart valves or blood vessels restrict blood flow in or out of the heart.
Symptoms of ACHD
Many patients with ACHD do not experience noticeable symptoms until adulthood.
However, when symptoms do appear, they may include:
- Fatigue
- Abnormal heart rhythm (arrhythmia)
- Breathlessness
- Swelling of organs and body tissues
- Blueness in the fingernails, skin and lips
‘It is important for patients to recognise when their heart is ‘asking for help’ and identify symptoms like heart palpitations,’ said Dr Foo.
Dr Foo advises, “It is important for patients to recognise when their heart is ‘asking for help’ and identify symptoms like heart palpitations.”
Causes and risk factors of ACHD
The exact cause of most congenital heart diseases is unknown, but researchers believe genetic changes, certain medications, health conditions and lifestyle factors like smoking may contribute.
Dr Foo explains that risk factors include:
- Genetics: A family history of congenital heart defects increases the risk.
- German measles (rubella): If a mother contracts rubella during pregnancy, it can affect fetal heart development.
- Diabetes: Poorly controlled diabetes during pregnancy raises the likelihood of CHD in newborns.
- Medication, alcohol and smoking: Exposure to certain medicines, alcohol consumption and smoking during pregnancy can increase the risk of CHD.
Diagnosing ACHD
Dr Foo explains that diagnosis often begins with a physical examination, assessment of medical history and routine tests.
Diagnosing ACHD may require various tests, including cardiac computed tomography (CT) scans.
He states that diagnosing ACHD may involve a range of tests, including an electrocardiogram (ECG), exercise stress test, echocardiogram, cardiac catheterisation, chest radiograph (X-ray), cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT scan) and transoesophageal echocardiogram (TEE).
“These tests help cardiologists assess heart function and detect any abnormalities that may require treatment,” he explains.
Treatment options
ACHD treatment depends on the type and severity of the heart condition.
“If the heart condition is mild, regular health check-ups may be the only treatment needed,” Dr Foo points out.
However, more severe conditions may require additional medical intervention, including medications, medical devices or surgery.
Challenges of ACHD
Despite improved life expectancy, adults with congenital heart disease face numerous challenges.
“Having survived into adulthood, ACHD patients are now facing a new set of challenges encompassing not only medical or surgical problems, but extending to psychological, vocational, and lifestyle issues,” Dr Foo highlights.
This emphasises the importance of holistic care, he adds.
ACHD in Malaysia
According to the Health Ministry's data¹, the incidence of congenital heart disease (CHD) among children in Malaysia is about eight to 10 per 1,000 live births.
With an average of 500,000 births in Malaysia each year, around 5,000 newborns are diagnosed with CHD annually, two-thirds of whom will require surgical intervention.
This growing number highlights the urgent need for greater awareness and specialised adult congenital heart disease (ACHD) care in Malaysia.
As medical advancements improve survival rates, more children with CHD are reaching adulthood, creating a rising demand for long-term, specialised cardiac care.
Investing in ACHD services will ensure better healthcare outcomes and improve the quality of life for these patients.
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