S Pediatric Heart Disease

C. James Corrall

Cardiovascular Physiology

Therapeutic,, Implications

Pharmacologic, Enhancement of, Cardiac, Output

Assessment of, Children,, Suspected, ofMaving, Heart Disease

HemodynamicaliyUnsiabie,, Patients

Hemodynamically Stable, Symptomatic Patients Hemodynamically,, Stable,, Asymptomatic, Patients

Congestive Heart, Failure Recognition

Physiologic , , Correlates, , ,of , Congestive,, HeartFaHure Differeniial, Diagnosis

Initial Stabilization

Dysrhythmia SloW^Cardiac,, Rates

Fast, CardiacRates

Congenital,, Lesions ,,that,Produce,,Syncope

Tetralogy ,,o,f,, Fallot

Critical,, AorticStenosis

Sick, ,S,inus,,SyinidMromie Hypertrophic,, Cardiomyopathy

Prolonged, QTSyndrome

Anticipating, Problems, inC.hi.l.d.re.n.W'rt^ Hypoxemic,, Spells

Surgical, ShuntDysfunction

PulmonaryHypertensive Crisis

DiureticCgmElications

DigoxinTox.icity

Anticoagulation.Problems

Aneimia,,and,,Polycythemia,,With,,Cya„n,otic,, Congenital, Heart, .Disease

ViralInlect.iop.s.with.C.ongenital Heart., Disease

Subacute, ,,Bacteria,l,, Endocarditis

Endocarditis Prophylaxis Priortg Procedures Evaluation of Feyer.in jnfants, with,,Heart,, Disease

Chapter,, References

Pediatric cardiovascular disorders are decidedly uncommon in emergency medicine. The incidence of congenital heart disease is only about eight cases per 1000 live births and contrasts sharply with the increasing prevalence of cardiovascular disease in adult populations. 1 Because of the relative unfamiliarity of such disorders, most emergency medicine physicians have encountered these disorders only in their initial training. The combination of the low incidence and the age-related differences in clinical presentation make timely recognition, stabilization, and appropriate tertiary referral a challenge for primary care physicians. In the emergency department, problems may range from an asymptomatic discovery of a murmur to the life-threatening presentation of a cyanotic infant in cardiogenic shock.

Congenital heart disease is usually classified based on physiology (presence or absence of cyanosis, with or without persistent fetal circulation) or on the nature of the anatomic defect (shunt, obstruction, transposition, or complex). Most pediatric heart disease is congenital, but acquired conditions also occur and include complications secondary to rheumatic fever, Kawasaki disease, and severe chronic anemias, as well as myocarditis, pericarditis, endocarditis, and the tachydysrrhythmias.

Pediatric heart disease can also be classified by clinical presentation. The six common clinical presentations to primary care physicians are cyanosis, congestive heart failure, pathologic murmur in asymptomatic patients, abnormal pulses, hypertension, and syncope. Ia.bJ.e..,1.1..5.:..1 lists the most common lesions in each category. While this is informative in the formation of a broad differential diagnosis in very ill pediatric patients, it is perhaps best to classify heart disease according to the clinical presentation in the emergency department. Most often, this presentation is in children with previously undiagnosed heart disease and to a lesser degree in those with previously diagnosed heart disease or reparative surgery for the same.

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