Congenital heart care

A congenital heart condition is one that forms in the womb before birth. These tend to be structural, and can include common problems such as a 'hole-in-the-heart' between the chambers of the heart, or a narrowed or leaky heart valve.

While congenital heart conditions can have a genetic component, most congenital heart conditions are not inherited from your parents.

Among the most common inherited conditions is cardiomyopathy, a structural deformity that causes the heart muscle to become either thickened or stretched.

There are also inherited conditions where the heart appears normal structurally, but has electrical changes that can cause abnormal heart rhythms (arrhythmias), such as long QT syndrome, and Brugada syndrome.

For the majority of people presenting with arrhythmia, the cause will be down to age and to some extent lifestyle. As we get older, the heart will show signs of wear and tear over time, which can lead to changes in rhythm.

For patients with congenital heart issues however, particularly those who've had corrective surgery, arrhythmias are very common. The reason is that both the abnormality and the surgery can lead to the formation of scar tissue in the heart. This can, in turn, lead to electrical instability and a change in rhythm.

Heart rhythm changes present in many different ways. While some people might not experience symptoms at all, others will feel tired and like they’re not functioning as well as usual. For many people, it’s only then when they get a check-up, they discover they have a heart problem.

For others, the symptoms can be much more obvious. They may feel their heart racing, beating very fast. Some people may lose consciousness and, in extreme cases, go into a cardiac arrest.

While the following symptoms can indicate an arrhythmia, experiencing them doesn’t necessarily mean you have a heart condition. However, it’s worth talking to a GP if you experience:

• dizziness
• fainting (syncope)
• palpitations
• shortness of breath

A change in heart rhythm diagnosis is based on a patient’s history. For example, if someone has been experiencing a sensation that could indicate a rapid heartbeat, a missed, or extra, beat, or something more serious such as a collapse. In these cases, a simple electrical recording of a heart (an electrocardiogram, or ECG) can give very useful diagnostic information. If patients have an inherited heart condition, it will usually show up on their ECG.

There are also tests which help us to assess the structure of the heart, such as an echocardiogram. This is an ultrasound scan that allows the consultant to look at the size of the heart muscle, its chambers and valve function.

If necessary, we will suggest further tests, such as a CT scan, or a cardiac MRI scan, to look at heart function and evidence of scarring.

There are several treatment types. In terms of medication, beta blockers are commonly prescribed and can be helpful for patients with palpitations and a racing heartbeat, particularly in the short term.

However, due to patients’ lack of tolerance, and side effects such as fatigue and impacted concentration, medication is not an effective long-term treatment for most.

A very successful treatment for most heart rhythm conditions – particularly atrial fibrillation – is ablation. This is a minimally invasive, keyhole technique, during which electrodes are passed into the heart through a vein at the top of the leg. This allows the surgeon to either cauterise or freeze the areas of the heart that are triggering a change in heart rhythm. 

When the heart rhythm presents a potential danger to life, such as cardiac arrest, treatment options include an implanted device called an implantable cardioverter defibrillator (ICD). This small, battery-powered life-saving device checks the heartbeat, identifies rhythm irregularities and then delivers an electric shock to restore a regular pattern.