Source: medimoon.com
Heart problems in Orthopaedic Conditions
What comes to your mind when you come across the word ‘Orthopaedics’? Let me guess, fractured bones? Elderly people with knee pain? Or perhaps diabetic patients with amputated limbs? Well, it is more than that.
The word Orthopaedics is a combination of 2 Greek words – ‘Ortho’ which means ‘straight’ and ‘Paedeia’ which means child, literally it means ‘straightening a child’. In definition, it is a branch of surgery concerning human skeletal system including bones, muscles, joints and ligaments.
However, Orthopaedic doctors need to equip themselves with more than that. There are instances when we get referrals regarding Orthopaedic conditions that have associated heart problems especially from our Paediatrics and Medical colleagues. These includes conditions such as Congenital Talipes Equino Varus (CTEV) or Clubfoot, Spina bifida, Scoliosis, Developmental dysplasia of the hip and Torticolis. Syndromic babies with Orthopaedic problems may also have associated heart abnormality. These include Turner syndrome, Marfan syndrome and most commonly, Down syndrome.
Down Syndrome
Down’s syndrome is the most common genetic condition characterised by an extra 21st chromosome. These babies usually have typical features – reduced muscle tone, small stature, single palmar crease and upwards slanted eyes. They are usually referred to Orthopaedic team for ligamentous laxity, a shortened and occasionally bent fingers and subluxated joints.
Source: medimoon.com
About half of all babies with Down syndrome have congenital heart defects. These defects include atroventricular heart defect, ventricular septal defect (VSD), Persistent Ductus Arteriosus (PDA) and Tetralogy of Fallot, commonly termed hole in the heart by laymen.
Clubfoot
Clubfoot is one of the commonest birth defect in an otherwise healthy baby encountered by the Orthopaedic team. In these babies, the foot and ankle rotates inwards and resembles the shape of a golf club. Although majority of clubfoot cases referred to us are simple cases, ie it is not accompanied with other abnormality, there are cases where there it is associated heart problems. In babies with TARP syndrome for example, the clubfoot is accompanied with an Arterial Septal Defect (a defect at the heart’s atrial septum/wall).
Scoliosis
Scoliosis is defined as a 3 dimensional deformity of the spine. There are many types of scoliosis such as Congenital Scoliosis (presence at birth), Idiopathic Scoliosis (unknown cause), De Novo Scoliosis (degenerative) and Neuromuscular Scoliosis. Scoliosis can also be associated with other conditions such as Cerebral palsy, Neurofibromatosis and Marfan Syndrome.
Besides Scoliosis that is caused by degenerative process (De Novo Scoliosis) and Idiopathic Scoliosis, in patients presented with other type of scoliosis, the doctors need to always bear in mind the possibility of accompanying pathology. Patients with Marfan syndrome for example, which are characterized by having scoliosis, tall stature, long arm span and thin fingers and toes may have associated defect in the heart’s valves and aorta which can eventually lead to death.
Conclusion
For a doctor, it is therefore very important to have a holistic approach and to look at the condition entirely and not just focusing on a specific discipline. As for patients or parents, knowing the disease is paramount in participating in managing the problems. It is important to be aware that the condition may be accompanied by other disease manifestations as well and these need to be addressed accordingly. And for you my beloved readers, don’t be surprised if your Orthopaedic doctors talk about heart conditions as we, the doctors, are always reminded since our first day in our medical career – “Always treat your patient as a whole!”
Dr. Ahmad Mahyuddin is an orthopedic surgeon working in Pahang. Know more about him in The Team page.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]