Enlarged heart, a mystery baby killer

A young couple from Khanna were in for a shock when they went for an X-ray of their four-month-old baby after he had been experiencing shortness of breath and constant cough.

The doctor suggested a test called echo (echocardiography) for the child, as his heart appeared to be larger than normal. On April 20, they reached a laboratory in Sector 24, Chandigarh, for the same test that had been performed a week before the baby was born. While the old reports were normal, the new reports showed a lot of complications. The child failed to survive the exertion of the day and died in the hospital.

While the couple didn’t know what caused it, the doctors assured them nothing could have been done to save his life. “Cardiomyopathy, heart muscle disease literally, is not common among children,” said Dr Harinder Singh Bedi, pediatric cardiologist at Christian Medical College, Ludhiana. The poorly understood dilated cardiomyopathy (DCM) (enlarged heart) is its most prevalent form.

Every year, cases of congenital heart disease (present at birth) are registered in hospitals, while the cases of acquired disease (which develops post-fetally) are increasing. Dr Manoj Kumar Rohit, cardiologist at the Post Graduate Institute of Medical Education and Research (PGIMER), says that nearly 50 cases of DCM were registered at the institute in the last decade, and even if the chances of acquiring the disease are lesser in children, there is greater mortality. “In children, DCM pursues a heterogeneous course with a high mortality rate,” he said.

In a study at Cardiothoracic Centre of the AIIMS, record of 82 children (below the age of 12) with DCM (including 50 males) was compared. On an average, 11.5% patients died in 25.09 months. Jalandhar cardiac surgeon Dr Balram Bhopal says adult patients include certain who have survived with only 10% of the heart functioning, while in some cases, it is fatal.

What is DCM?

Dilated cardiomyopathy, in which the heart muscle weakens and becomes enlarged because of which the lower chambers of the heart are unable to pump blood efficiently. The lungs become congested, causing heart failure. As the heart becomes sicker, not only the systolic action (contraction) is impaired but also the ability of the heart to relax suffers.

Symptoms

Pale skin
Heartbeat faster than normal
Abnormal, life-threatening heart rhythms
Shortness of breath after small exertion
Sweating
Poor appetite, decline in growth rate
Fainting
Problem in breathing while lying down.

Causes

Unknown, generally, though one might be a viral infection that results in the inflammation of the heart, but it affects only a few and not all. Routine cardiac evaluation is necessary to detect this decline in heart function, since symptoms may develop later. Unlike HCM (hypertrophic cardiomyopathy, in which the heart muscle or myocardium becomes abnormally thick), in the case of DCM, only a few cases are genetic.

Alike diseases that can be cured

There are diseases that might mimic DCM, like narrowing of the aorta, aortic valve, ALCAPA (anomalous origin of the left coronary artery arising from the pulmonary artery) and PSVT (paroxysmal supraventricular tachycardia, or episodes of rapid heart rate that start in a part of the heart above the ventricles). While DCM is not curable, all diseases that mimic it can be cured permanently.

Treatments

At an earlier stage, when this disease is termed as myocarditis, it can be treated through therapy and medicines. However, once it takes the shape of DCM, it is not curable. Research is on for a possible cure.