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Congenital Heart Disease Tips

Signs Your Kid is Suffering from Congenital Heart Disease!

Dr. Avinash Vilas Wankhede 89% (1502 ratings)
Clinical Cardiology, MD - Consultant Physician
Cardiologist, Surat
Signs Your Kid is Suffering from Congenital Heart Disease!

Most families refer to their newborn baby as their 'bundle of joy'. The news of a child being born brings immense joy to the entire family. However, due to various reasons, a child could be born with some medical abnormalities, which would be known as congenital abnormalities.

If your child has a congenital heart defect, it means that your child was born with a problem in the structure of his or her heart. Some congenital heart defects in children are simple and don't need treatment. Other congenital heart defects in children are more complex and may require several surgeries performed over a period of several years.

There are several different types of heart defects that can be congenital. These usually manifest themselves either immediately after birth or in the early years of life. In some cases, the abnormality could be detected on prenatal ultrasounds. In others, it may not be and the family could be caught off guard about the condition. This causes a lot of stress, both for the child, who does not receive regular postnatal care and for the parents immediately after the delivery process.

If the baby has the following symptoms within the first few hours of life, there could be a serious underlying condition, which requires medical attention. The presence and severity of the symptoms would depend on the actual abnormality.

  1. The skin is pale gray or blue in color due to excessive venous flow in the system
  2. Excessive sweating
  3. The child is exerting to breathe regularly
  4. Rapid breathing causes added load on the heart accompanied by a grunting noise
  5. Flared nostrils i.e. the baby attempts to take in more oxygen with each breath causes flared nostrils
  6. Swollen legs, eyes, and abdomen: Fluid retention in the legs and abdomen is quite common, and this could be characteristic of newborns with congenital heart disease
  7. Shortness of breath, even during feeding
  8. Clubbed fingernails
  9. Lethargy and low energy, even with feeding, therefore very poor feeding pattern
  10. Chest pain, which may cause the newborn to cry incessantly
  11. Low weight gain, as they feed less

In some children, symptoms manifest only during the teenage years or early adulthood. These conditions are not very severe and the symptoms include:

  1. Swelling of the hands, feet, and ankles due to fluid accumulation
  2. Lowered energy levels, leading to easy fatigue
  3. Shortness of breath with even minimal physical activity
  4. Inability to exercise
  5. Developmental delays and changes in growth milestones
  6. Recurrent respiratory tract infections including sinus infections, bronchitis, and pneumonia
  7. Endocarditis
  8. Pulmonary hypertension
  9. Heart failure, where the heart is not able to effectively function and pump blood to all parts of the body.

Some or more of these symptoms should trigger a warning to get the child tested for congenital heart disease. While some would just require a monitoring until severe symptoms develop, severe conditions like holes, abnormal valves, narrowed arteries, and blood vessel abnormalities might require immediate intervention. Serious congenital heart defects are often diagnosed before or soon after your child is born. If you notice that your baby has any of the signs or symptoms above, call your child's doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4227 people found this helpful

What To Do When Your Kid Is Suffering From Congenital Heart Disease?

Dr. Vikas Chopra 85% (10 ratings)
MBBS, MD - General Medicine, DM - Cardiology
Cardiologist, Delhi
What To Do When Your Kid Is Suffering From Congenital Heart Disease?

Most families refer to their newborn baby as their 'bundle of joy'. The news of a child being born brings immense joy to the entire family. However, due to various reasons, a child could be born with some medical abnormalities, which would be known as congenital abnormalities. There are several different types of heart defects that can be congenital. These usually manifest themselves either immediately after birth or in the early years of life. In some cases, the abnormality could be detected on prenatal ultrasounds. In others, it may not be and the family could be caught off guard about the condition. This causes a lot of stress, both for the child, who does not receive regular postnatal care and for the parents immediately after the delivery process.

If the baby has the following symptoms within the first few hours of life, there could be a serious underlying condition, which requires medical attention. The presence and severity of the symptoms would depend on the actual abnormality.

  1. The skin is pale gray or blue in color due to excessive venous flow in the system
  2. Excessive sweating
  3. The child is exerting to breathe regularly
  4. Rapid breathing causes added load on the heart accompanied by a grunting noise
  5. Flared nostrils i.e. the baby attempts to take in more oxygen with each breath causes flared nostrils
  6. Swollen legs, eyes, and abdomen: Fluid retention in the legs and abdomen is quite common, and this could be characteristic of newborns with congenital heart disease
  7. Shortness of breath, even during feeding
  8. Clubbed fingernails
  9. Lethargy and low energy, even with feeding, therefore very poor feeding pattern
  10. Chest pain, which may cause the newborn to cry incessantly
  11. Low weight gain, as they feed less

In some children, symptoms manifest only during the teenage years or early adulthood. These conditions are not very severe and the symptoms include:

  1. Swelling of the hands, feet, and ankles due to fluid accumulation
  2. Lowered energy levels, leading to easy fatigue
  3. Shortness of breath with even minimal physical activity
  4. Inability to exercise
  5. Developmental delays and changes in growth milestones
  6. Recurrent respiratory tract infections including sinus infections, bronchitis, and pneumonia
  7. Endocarditis
  8. Pulmonary hypertension
  9. Heart failure, where the heart is not able to effectively function and pump blood to all parts of the body.

Some or more of these symptoms should trigger a warning to get the child tested for congenital heart disease. While some would just require a monitoring until severe symptoms develop, severe conditions like holes, abnormal valves, narrowed arteries, and blood vessel abnormalities might require immediate intervention.

1758 people found this helpful

Congenital Heart Disease - Factors That Can Lead To It!

Dr. Smita Mishra 85% (10 ratings)
FDNB, MD, MBBS
Cardiologist, Noida
Congenital Heart Disease - Factors That Can Lead To It!

Congenital Heart Disease refers to a problem in the structure of heart that is present at birth. It is one of the most common types of birth defect. The defects can arise at the walls of the heart, the valves of the heart and could also take place at the arteries and veins close to the heart. The disease causes great impact in changing the normal flow of blood through the heart.There are many different types of congenital heart defects, ranging from simple ones having no symptoms to complex defects, which are severe and life-threatening symptoms.

Symptoms

  • Congenital heart defect generally is detected in women at the time of ultrasound during pregnancy. In case the doctor comes across abnormal heartbeat, he may further investigate by conducting certain tests in the form of echocardiogram, chest X-ray or MRI scan.
  • This problem might be seen even in newborn babies, due to which they might experience:
    • Skin, fingers, lips and toes which are bluish in colour
    • Experience problem breathing
    • Low weight at the time of birth
    • Chest Pain

There might be other symptoms as well, which may not develop till many years after birth. The symptoms are:

  • Abnormal heart rate
  • Dizziness
  • Frequesnt dizziness
  • Swelling might be seen at certain parts of the body

Causes behind congenital heart disease

Developmental problem in the heart’s structure at an early stage is usually the reason behind congenital heart disease. This defect acts a hindrance to the normal flow of blood through the heart, thus affecting people’s breathing to some extent. Though there is no surety as to why there is a problem in the development of heart, some of the suspected causes are:

  • Any of the family members might be having heart problems.
  • Some prescribed drugs at the time of pregnancy tend to put a child at a higher risk for developing this problem of congenital heart disease.
  • Consumption of alcohol or if you take drugs which are not prescribed by doctor during pregnancy, can lead to an increase in the risk of a child getting diagnosed with a heart defect.
  • Women who have had viral infection during the first three months of pregnancy are more susceptible towards giving birth to children having heart defects.

How to treat congenital heart disease?

Like any other heart disease, treatment for congenital heart disease also depends on the type and extent of the defect.

  • There are certain medicines which allow the heart for function more efficiently, while others can be used to prevent blood clots from forming and also put a check on irregular heartbeat.
  • Implantable heart devices like implantable cardioverter defibrillators can prevent this particular defect by regularising an abnormal heart rate.
  • Catheter procedure followed by doctors where they insert a thin tube into a vein in the leg and move up to the heart, then use small tool by threading through the catheter to rectify the defect.
  • Some rare cases, when the heart disease is too complex to fix, doctor may form heart transplant surgery.
2563 people found this helpful

Congenital Heart Disease - Signs Your Kid is Suffering from It!

Dr. Balaji Ramagiri 92% (204 ratings)
MBBS, DM - Cardiology, MD
Cardiologist, Hyderabad
Congenital Heart Disease - Signs Your Kid is Suffering from It!

Most families refer to their newborn baby as their 'bundle of joy'. The news of a child being born brings immense joy to the entire family. However, due to various reasons, a child could be born with some medical abnormalities, which would be known as congenital abnormalities. There are several different types of heart defects that can be congenital. These usually manifest themselves either immediately after birth or in the early years of life. In some cases, the abnormality could be detected on prenatal ultrasounds. In others, it may not be and the family could be caught off guard about the condition. This causes a lot of stress, both for the child, who does not receive regular postnatal care and for the parents immediately after the delivery process.

If the baby has the following symptoms within the first few hours of life, there could be a serious underlying condition, which requires medical attention. The presence and severity of the symptoms would depend on the actual abnormality.

  1. The skin is pale gray or blue in color due to excessive venous flow in the system
  2. Excessive sweating
  3. The child is exerting to breathe regularly
  4. Rapid breathing causes added load on the heart accompanied by a grunting noise
  5. Flared nostrils i.e. the baby attempts to take in more oxygen with each breath causes flared nostrils
  6. Swollen legs, eyes, and abdomen: Fluid retention in the legs and abdomen is quite common, and this could be characteristic of newborns with congenital heart disease
  7. Shortness of breath, even during feeding
  8. Clubbed fingernails
  9. Lethargy and low energy, even with feeding, therefore very poor feeding pattern
  10. Chest pain, which may cause the newborn to cry incessantly
  11. Low weight gain, as they feed less

In some children, symptoms manifest only during the teenage years or early adulthood. These conditions are not very severe and the symptoms include:

  1. Swelling of the hands, feet, and ankles due to fluid accumulation
  2. Lowered energy levels, leading to easy fatigue
  3. Shortness of breath with even minimal physical activity
  4. Inability to exercise
  5. Developmental delays and changes in growth milestones
  6. Recurrent respiratory tract infections including sinus infections, bronchitis, and pneumonia
  7. Endocarditis
  8. Pulmonary hypertension
  9. Heart failure, where the heart is not able to effectively function and pump blood to all parts of the body.

Some or more of these symptoms should trigger a warning to get the child tested for congenital heart disease. While some would just require a monitoring until severe symptoms develop, severe conditions like holes, abnormal valves, narrowed arteries, and blood vessel abnormalities might require immediate intervention. If you wish to discuss about any specific problem, you can consult a cardiologist.

3325 people found this helpful

Congenital Heart Defects: Symptoms Your Child Might Be Suffering From It!

Dr. Viveka Kumar 91% (112 ratings)
DM - Cardiology -, MD - General Medicine - , MBBS, FSCAI, MHRS, FACC, FESC , Fellowship in Interventional Cardiology & EP, Interventional Cardiology & EP and Devices, Senior Specialist( Interventional Cardiology), Fellow of southeast Asian Interventional Cardiology Society, International Award of Excellence in Cardiology
Cardiologist, Delhi
Congenital Heart Defects: Symptoms Your Child Might Be Suffering From It!

Most families refer to their newborn baby as their 'bundle of joy'. The news of a child being born brings immense joy to the entire family. However, due to various reasons, a child could be born with some medical abnormalities, which would be known as congenital abnormalities. There are several different types of heart defects that can be congenital. These usually manifest themselves either immediately after birth or in the early years of life. In some cases, the abnormality could be detected on prenatal ultrasounds. In others, it may not be and the family could be caught off guard about the condition. This causes a lot of stress, both for the child, who does not receive regular postnatal care and for the parents immediately after the delivery process.

If the baby has the following symptoms within the first few hours of life, there could be a serious underlying condition, which requires medical attention. The presence and severity of the symptoms would depend on the actual abnormality.

  1. The skin is pale gray or blue in color due to excessive venous flow in the system
  2. Excessive sweating
  3. The child is exerting to breathe regularly
  4. Rapid breathing causes added load on the heart accompanied by a grunting noise
  5. Flared nostrils i.e. the baby attempts to take in more oxygen with each breath causes flared nostrils
  6. Swollen legs, eyes, and abdomen: Fluid retention in the legs and abdomen is quite common, and this could be characteristic of newborns with congenital heart disease
  7. Shortness of breath, even during feeding
  8. Clubbed fingernails
  9. Lethargy and low energy, even with feeding, therefore very poor feeding pattern
  10. Chest pain, which may cause the newborn to cry incessantly
  11. Low weight gain, as they feed less

In some children, symptoms manifest only during the teenage years or early adulthood. These conditions are not very severe and the symptoms include:

  1. Swelling of the hands, feet, and ankles due to fluid accumulation
  2. Lowered energy levels, leading to easy fatigue
  3. Shortness of breath with even minimal physical activity
  4. Inability to exercise
  5. Developmental delays and changes in growth milestones
  6. Recurrent respiratory tract infections including sinus infections, bronchitis, and pneumonia
  7. Endocarditis
  8. Pulmonary hypertension
  9. Heart failure, where the heart is not able to effectively function and pump blood to all parts of the body.

Some or more of these symptoms should trigger a warning to get the child tested for congenital heart disease. While some would just require a monitoring until severe symptoms develop, severe conditions like holes, abnormal valves, narrowed arteries, and blood vessel abnormalities might require immediate intervention. If you wish to discuss about any specific problem, you can consult a cardiologist.

3354 people found this helpful

Congenital Heart Defects In Children - Symptoms and Causes!

Dr. Pramod Kumar Sharma 93% (121 ratings)
MBBS, MS (Gen. Surgery), M.Ch - Cardio Thoracic & Vascular Surgery, DNB (CTS)
Cardiologist, Noida
Congenital Heart Defects In Children - Symptoms and Causes!

Most families refer to their newborn baby as their 'bundle of joy'. The news of a child being born brings immense joy to the entire family. However, due to various reasons, a child could be born with some medical abnormalities, which would be known as congenital abnormalities.

If your child has a congenital heart defect, it means that your child was born with a problem in the structure of his or her heart. Some congenital heart defects in children are simple and don't need treatment. Other congenital heart defects in children are more complex and may require several surgeries performed over a period of several years.

There are several different types of heart defects that can be congenital. These usually manifest themselves either immediately after birth or in the early years of life. In some cases, the abnormality could be detected on prenatal ultrasounds. In others, it may not be and the family could be caught off guard about the condition. This causes a lot of stress, both for the child, who does not receive regular postnatal care and for the parents immediately after the delivery process.

If the baby has the following symptoms within the first few hours of life, there could be a serious underlying condition, which requires medical attention. The presence and severity of the symptoms would depend on the actual abnormality.

  1. The skin is pale gray or blue in color due to excessive venous flow in the system
  2. Excessive sweating
  3. The child is exerting to breathe regularly
  4. Rapid breathing causes added load on the heart accompanied by a grunting noise
  5. Flared nostrils i.e. the baby attempts to take in more oxygen with each breath causes flared nostrils
  6. Swollen legs, eyes, and abdomen: Fluid retention in the legs and abdomen is quite common, and this could be characteristic of newborns with congenital heart disease
  7. Shortness of breath, even during feeding
  8. Clubbed fingernails
  9. Lethargy and low energy, even with feeding, therefore very poor feeding pattern
  10. Chest pain, which may cause the newborn to cry incessantly
  11. Low weight gain, as they feed less

In some children, symptoms manifest only during the teenage years or early adulthood. These conditions are not very severe and the symptoms include:

  1. Swelling of the hands, feet, and ankles due to fluid accumulation
  2. Lowered energy levels, leading to easy fatigue
  3. Shortness of breath with even minimal physical activity
  4. Inability to exercise
  5. Developmental delays and changes in growth milestones
  6. Recurrent respiratory tract infections including sinus infections, bronchitis, and pneumonia
  7. Endocarditis
  8. Pulmonary hypertension
  9. Heart failure, where the heart is not able to effectively function and pump blood to all parts of the body.

Some or more of these symptoms should trigger a warning to get the child tested for congenital heart disease. While some would just require a monitoring until severe symptoms develop, severe conditions like holes, abnormal valves, narrowed arteries, and blood vessel abnormalities might require immediate intervention. If you wish to discuss about any specific problem, you can consult a cardiologist.When to see a doctor

Serious congenital heart defects are often diagnosed before or soon after your child is born. If you notice that your baby has any of the signs or symptoms above, call your child's doctor.

If your child has any of the signs or symptoms of less serious heart defects as he or she grows, call your child's doctor. Your child's doctor can let you know if your child's symptoms are due to a heart defect or another medical condition.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1884 people found this helpful

All About Congenital Hypothyroidism!

Dr. Richa Arora Agarwal 88% (43 ratings)
Visiting Consultant - Rajiv Gandhi Cancer Hospital, Saroj Super Speciality Hospital, D.N.B. PEDIATRICS, MD - Paediatrics, MBBS, Bhagwati Hospital, Rainbow Hospital- Panipat
Pediatrician, Delhi
All About Congenital Hypothyroidism!

What is congenital hypothyroidism?
Newborn babies who are unable to make enough thyroid hormone have congenital hypothyroidism, meaning they are born with an underactive or absent thyroid gland.  If the condition is not found and treated, children can have mental retardation and growth failure. But the good news is that early diagnosis and proper treatment can prevent these problems. In most cases, the condition is permanent and your child will need lifelong treatment. 

What causes congenital hypothyroidism?
 The most common causes are

  1. An underdeveloped thyroid gland
  2. A thyroid gland that’s not located where it should be (in the neck below the voice box or larynx)  
  3. A missing thyroid gland

 Other possible causes include

  1. Defective production of thyroid hormone (an inherited condition)
  2. Problems with the pituitary gland (located at the base of the brain), which tells the thyroid to make thyroid hormone
  3. Less commonly, a mother’s thyroid disease or medicines taken during pregnancy can cause congenital hypothyroidism.

What are the signs and symptoms of congenital hypothyroidism?

Many babies with congenital hypothyroidism appear normal at birth or for several months after birth.  But others may have these signs and symptoms:

  • Jaundice (yellowing of the skin and eyes)
  • Constipation
  • Poor muscle tone
  • Sluggishness
  • A hoarse cry
  • They might also have
  • Feeding problems
  • A thick, large tongue
  • A puffy-looking face
  • A swollen abdomen, sometimes with “outpouching” of the belly button
  • Large soft spots of the skull

Thyroid hormone deficiency can also occur in older babies or young children, even if test results at birth were normal.

Treatment
Early diagnosis is very important. Most of the effects of hypothyroidism are easy to reverse. For this reason, doctors always ask to get screening for hypothyroidism of your newborn.

Thyroxine is usually given to treat hypothyroidism. Once the child starts taking this medicine, blood tests are regularly done to make sure thyroid hormone levels are in a normal range.

When to Contact a Medical Professional
Call your health care provider if:

  • You feel your infant shows signs or symptoms of hypothyroidism
  • You are pregnant and have been exposed to antithyroid drugs or procedures

Prevention
If a pregnant woman takes radioactive iodine for thyroid cancer, the thyroid gland may be destroyed in the developing fetus. Infants whose mothers have taken such medicines should be observed carefully after birth for signs of hypothyroidism. Also, pregnant women should not avoid iodine-supplemented salt. If you wish to discuss about any specific problem, you can consult an endocrinologist.

2682 people found this helpful

Congenital Nephrotic Syndrome - Is Your Child Suffering From It?

Dr. Deepak Sharma 90% (753 ratings)
FIMSA, MD-Nephrology, DM - Nephrology, MD-Medcine, MBBS
Nephrologist, Delhi
Congenital Nephrotic Syndrome - Is Your Child Suffering From It?

As the name suggests, congenital nephrotic syndrome affects the kidneys of newborn babies. Though congenital means the disease must be present from birth, babies who develop nephrotic syndrome in the first three months are also said to suffer from this condition. This is a rare genetic disorder that is passed down from parents to their children. Boys are at a higher risk of suffering from this disorder than girls. The congenital nephrotic syndrome causes the kidneys to leak large amounts of protein into the baby’s urine. This can lead to swelling of the body tissues and a weakened immune system.

Some of the common symptoms of this disease include

  1. Low birth weight
  2. Lack of appetite
  3. Swelling of the body
  4. Foamy or frothy urine
  5. Lowered urine production
  6. Cough

Pregnant women are usually screened for this condition before the baby is born. The doctor will be looking for a placenta that is larger than normal in an ultrasound and high levels of alpha fetoprotein in amniotic fluid samples. If found; the doctor might ask for a genetic test to confirm the diagnosis.

Once the baby is born, he or she will show signs of fluid retention as the body begins to swell. Other signs your doctor will look out for are high blood pressure, signs of malnutrition and abnormal sounds from the heart and lungs. A urine analysis will also show high levels of protein in the urine though the overall protein levels in the body may be low. The doctor may also ask for a kidney biopsy in some cases to confirm the diagnosis.


Aggressive forms of treatment in the early stages of this disease can help control it. This may include antibiotics, blood pressure medication, ACE inhibitors and angiotensin receptor blockers to reduce protein leakage and diuretics to manage excess fluid build-up. Nonsteroidal anti-inflammatory drugs may also help reduce the amount of protein leaking into the urine. In addition, the doctor may advise you to limit fluid the baby’s fluid intake to control the swelling. As a last resort, the kidneys may need to be removed to prevent protein loss. This will be followed by dialysis or a kidney transplant.

If left unchecked, this disorder can lead to a number of complications including acute kidney failure, blood clots, infections and diseases related to malnutrition. It can also lead to the death of a baby in the first year of catching the infection or before his or her fifth birthday.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2773 people found this helpful

Prevent Heart Disease And Blockage

Dr. Dhananjay 89% (32 ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS), PG Diploma in Emergency Medicine, pg diploma in clinical research and pharmacovigilance
Dietitian/Nutritionist, Pimpri-Chinchwad
Prevent Heart Disease And Blockage

Heart disease refers to a group of conditions that decrease the health and functionality of the heart muscle.

Cardiovascular disease is an umbrella term used to denote diseases of the blood vessels, arrhythmias, coronary artery disease, and congenital defects that affect cardiovascular efficacy.

The major blood vessels which supply the heart muscle with blood are called coronary arteries. Coronary artery disease is diagnosed when the coronary arteries become damaged or weakened.

The most prevalent cause of coronary artery disease is the accumulation of arterial plaque deposits along the linings of the blood vessels and the heart muscle. This has been linked to high LDL cholesterol levels as well as oxidation of blood lipids.

Arterial plaque is comprised by cholesterol, waste from cells, fatty substances like triglycerides, calcium and a clotting agent called fibrin. When plaque deposits increasingly constrict arterial flow over time, the heart has to work harder to get blood delivered throughout the circulatory system.

 

4 people found this helpful

Depression And Heart Diseases: Things You Must Know

Dr. Garima Sharma 90% (447 ratings)
MBBS
General Physician, Fatehabad
Depression And Heart Diseases: Things You Must Know

Heart disease is a serious medical condition, and so is depression. Together, they can be harmful for the people suffering from them. It is seen that 33% of heart attack patients also suffer from depression. Interestingly enough, many patients having depression also have coronary artery disease (CHD) or adult congenital heart disease (ACHD).  

Patients with heart disease (acquired or congenital) - are more likely to suffer from depression because heart problems directly and adversely impact the patient’s attitude and mood, confidence regarding the future, and confidence in the ability to fulfill his or her life roles. CHD and ACHD also create a sense of guilt and feelings of embarrassment, regarding the patient’s ability to carry out physical activities - these factors trigger depression.  

Heart disease also causes stress in patients, which triggers the brain to produce higher levels of cortisol and glucose, both of which cause depression.  

While both diseases can overwhelm the patients, they can be managed with a combination of antidepressants and lifestyle changes which include: cardiac rehabilitation, social support, and psychological and psychiatric counseling.  

Cardiac rehabilitation is important because many studies have shown that physical exercise and proper nutrition can improve overall heart health and mental function. The reason being that both cause the brain to produce higher levels of dopamine which heals the heart and the brain.

Many heart disease patients may require professional psychological, and/or psychiatric counseling because such professionals are trained to treat patients with various forms of depression and can work with such individuals to formulate a plan involving medications or various activities and actions derived through counseling to help them recover mentally. Additionally, these patients can learn valuable life lessons and tips regarding managing a heart disease, which they can apply to their lives to heal faster.  

While heart diseases and depression can be a fatal combination however, they are not untreatable. Given proper guidance through exercising, and mental healing tools and therapy, it is possible for even those patients with the most severe forms of heart diseases and depression to manage their condition and heal themselves.

6 people found this helpful
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