VSD: A Common Congenital Heart Defect

Posted on January 18, 2017July 8, 2020

Posted by Dr. Monica Wonnacott | January 18, 2017

A VSD, or ventricular septal defect, is a fancy medical term to describe a hole in the heart that isn’t supposed to be there. VSDs are relatively common and are one of the top 3 causes of heart murmurs that I see in my clinic. While VSDs can be part of other/bigger heart defects, they happen as isolated defects as well. I’m going to address only the isolated problems. Isolated VSDs make up about 20% of all congenital heart defects (which is a huge percentage considering all the possible heart problems). VSDs happen in 2-7% of all live births.

Where exactly is the hole in the heart?

As you probably already know, the heart is a muscle about the size of your fist. It has 4 chambers or compartments. Think of the heart like a box. The upper 2 boxes are “atria” and the lower 2 boxes are “ventricles.” The blood is supposed to flow between the atria and ventricles (through a little one-way valve), essentially up and down in the box analogy. The 2 compartments of atria have a big wall of muscle that separates them and prevents them from sharing blood. Again using the box analogy, it prevents side-to-side flow. The ventricles have a similar wall of muscles between their 2 chambers, preventing the ventricles from communicating. When there is a hole or defect in the wall separating the two ventricles (the lower half of the boxes in the heart), the ventricles can have blood flow back and forth. When the blood goes from ventricle to ventricle (a path it’s not supposed to go), the blood that is flowing the wrong way will usually make a sound or murmur.

Is it something to worry about?

Generally the answer is no. Many VSDs are relatively small and will close up on their own. The VSDs that cause worry are the ones that cause other associated symptoms (e.g., feeling tired, sweating-especially during feeds, poor weight gain, or fast breathing). These other symptoms indicate complications (e.g., congestive heart failure)

How are VSDs diagnosed?

Most of the time, a parent will be made aware of the problem when a pediatrician listens with a stethoscope to a child’s heart and discovers a murmur. The definitive diagnosis is then made by a test called an echocardiogram, or echo (which is essentially an ultrasound of the heart).

How it is treated?

Small VSDs are usually treated with “watchful waiting.” This is medical lingo for “do nothing, but keep an eye on it to make sure things don’t get worse.” Often, small VSDs will close on their own, so nothing needs to be done. Sometimes larger VSDs can lead to congestive heart failure (CHF) and will require medications to manage that. Severe cases (that involve the pulmonary blood flow) will need surgery.

Should I see a cardiologist (heart specialist)?

Simple VSDs that resolve on their own, do not always require the expertise of a specialist. However, if there is anything concerning sounding about the murmur or history that is concerning, it is prudent to seek the care of specialist. Your pediatrician will help guide you on if/when to see a cardiologist.

Will my child need surgery for it?

Most cases of children with VSDs do not need surgery. Only children who have moderate-to-large defects that are causing increased blood flow to the lungs usually require surgery.

Did I do something to cause my baby to have this?

The last thing a mother needs is to hear is that she is responsible for her baby’s birth defect. Mothers are already plagued with enough guilt. However, the truth is, some maternal conditions increase the risk of having a child with a heart defect. Maternal diabetes is a well-recognized risk factor for congenital heart defects. Maternal alcohol consumption has also been linked to babies that have VSDs (specifically, a certain subtype called muscular VSDs).

Are VSDs genetic?

The short answer is yes, sort of. The genetic transmission isn’t a direct line like some conditions, but having a family history of previous congenital heart defects (in either parents or siblings), greatly increases the risk (about 3 times) of subsequent children having congenital heart defects. There are also some genetic conditions that are associated with heart defects (e.g., Down syndrome).

Candy, Candy, Candy! What To Do With Halloween Candy

Posted on October 31, 2016August 18, 2020

Posted by Dr. Monica Wonnacott | October 31, 2016

I love candy. I loved it as a kid and still do. It’s my nutritional Achilles heel. But it’s not good for you or your kids. The problem is that there is an entire holiday surrounding it and what to do with it. So what should you do? My advice, come up with a plan. Know the recommendations, know the risks, then decide what’s best for you and your family.

Official recommendations on how much sugar

The American Heart Association (with the AAP supporting the guidelines) says that children should not have more than 6 teaspoons (25 gms) of sugar a day. That’s not much (think 16 candy corns, 5 suckers, 2.5 Reeses Peanut Butter cups, 1.5 Snickers, 0.5 bag of Skittles). The average kid consumes more than 3 times that amount (on regular days, not Halloween and the days following). It’s no secret that too much sugar can lead to obesity, elevated blood pressure, and type 2 diabetes. So despite my love for candy, it’s something I need to address (both for me and my kids) with a plan.

Halloween day plan

Eat dinner before trick or treating (fuller bellies will be less inclined to eat too much candy).
Only allow candy to be eaten at home (where you can monitor what and how much) not on the trick or treat trail.
Make your child walk, don’t chauffer them to houses. The exercise is good for them and will reduce the total number of houses your child can get to.
Limit your trick or treating to neighborhoods you know.
Set an ending time.
Make children trick or treat with someone else. (In our case, one parent takes the all the children…and being told “wait for your sister,” slows the process down so we end up with less candy).
Support the cause by giving out something other than candy (This year I’m giving out glow-in-the-dark bouncy balls and punch balloons that I got for a deal online).
Set a limit ahead of time on the total number of pieces of candy on Halloween day (I’ve done everywhere from 5-15 in years past).

What to do with the post Halloween haul

I’ve heard all sorts of good ideas over the years. Here’s a few you can choose from.

Daily limit. Slowly dole out the candy with a daily limit (e.g., the child is allowed to have 1-5 candies a day).
Donate extra candy. Depending on where you live, there are all sorts of different options. Some dentists have a donation or buy back program. Many shelters will take extra candy (you can have your children help separate them into little bags that make distributing it easier). I’ve also heard of programs that send candy to troops overseas.
Bake goodies. Many candies can be frozen and used later in cookies, brownies, and cake recipes.
Candy art. Have a family night competition where everyone gets to use the candy and toothpicks to make artistic creations (you could even chose a competition theme like best candy house, funniest monster, etc.).Give out awards. Take pics, then pitch the art (candy) later.
The Switch Witchery. I once read in Parents magazine an article about the “Switch Witch” (like a tooth fairy) who comes on her broom stick in the night and takes the entire bag candy, but leaves a toy or prizes in return. I’ve never tried it, but it sounds interesting. Apparently it works best when the child is prepped days in advance. In theory, the child is happy with the new toy and voila, the candy problem is gone.
Reuse the candy. I’m almost embarrassed to admit that I have used my kids Halloween candy to fill a piñata and grab bags for my son’s birthday (which happens to be just after Halloween). It solves two problems, I don’t have to buy more candy and it gets rids of all of the extra Halloween candy.
Parent Tax. Last, but not least, my self-serving favorite (did I mention I love candy), the parent tax. I use some lame reasoning like, “I bought your costume, paid for treats to hand out, and took you around,” so that entitles me to whatever candy of yours I want to eat at any time. I say it ‘tongue in cheek,’ my kids put up a fake fight, and they consent to sharing. It’s a win-win scenario.

Have a safe and healthy Halloween!

The Innocent Heart Murmur

Posted on April 5, 2016July 8, 2020

Posted by Dr. Monica Wonnacott | April 5, 2016

Hearing your pediatrician say, “Your child has a heart murmur,” can cause instantaneous anxiety. In six simple words your mind envisions heart surgery, failure, and death. It’s amazing how we as parents are programmed to worry whenever we hear that something could be wrong with our child’s heart. The most common heart scenario in childhood is that of the Still’s murmur.

There are tons of terms all used to describe the same type of murmur: stills, physiologic, benign, flow, vibratory, innocent, and functional. Don’t be thrown off if different doctors or people call them different things. They are all the same murmur. For ease, I’ll call them Still’s murmurs.

What are Still’s murmurs?

A murmur is nothing more than a sound heard between the first and second beat of the heart. Normally, there is no sound between the two beats. A Still’s murmur is just one type of murmur. However, if your kid is going to have a murmur, this is the one you want because they are completely benign heart murmurs. They are not associated with any heart disease or disorder. They are very common in childhood (with some sources quoting as many as 1 in 3 children having them at some point). They peak in the 2-7 year-old range, but can happen outside of those ages.

How are Still’s murmurs diagnosed?

Still’s murmurs are diagnosed by an experienced doctor listening with a stethoscope (the term is auscultation). All pediatricians should be well versed in diagnosing Still’s murmurs. The diagnosis does not require fancy electrocardiograms (ECG or EKG) or echocardiograms (echo)–that just causes unnecessary worry and cost. A child with a Still’s murmur shouldn’t need to see a pediatric cardiologist (or heart specialist) either as there isn’t anything wrong with the heart. The sound of the murmur is vibratory or musical in nature. A referral to a specialist or further testing would only be indicated if the sound was atypical in some manner and there was need to rule out something more serious. It is worth noting these benign murmurs are heard more often when kids are going through periods of rapid growth or are sick.

How are Still’s murmurs treated?

Because stills murmurs are nothing more than the heart making a reverberating sound when it is pumping the blood, and there is nothing wrong, there is no need for treatment. There are no medications, no limitations on activities, and no need to worry. The murmur will go away on its own with time (usually by mid-adolescence, if not sooner).

So the next time your doctor says your child has a heart murmur, take a deep breath. There is a good chance that it is no big deal.