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Emergency Presentation Of Congenital Heart Disease In Children

May 2008

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Abstract

Though the field of antenatal ultrasound and echocardiography has advanced considerably in the last decade, many children with congenital heart disease (CHD) are not diagnosed before birth and do not manifest symptoms until after discharge from the newborn nursery.1-7 Frequently, when symptoms develop, they are first brought to the attention of an emergency medicine physician. These infants and children are particularly challenging patients, often appearing markedly distressed with non-specific signs and symptoms that resemble more common pediatric diagnoses such as sepsis, respiratory infection, or reactive airway disease. Unfortunately, therapy for these diagnoses may worsen the clinical course of a child with heart disease, emphasizing the need for a high index of suspicion in order to promptly identify patients with CHD.

This issue of Pediatric Emergency Medicine Practice addresses the evaluation and management of pediatric patients with CHD in the context of the evidence available from the medical literature. A comprehensive understanding of the pathophysiology as it relates to clinical manifestations is crucial for appropriate triage and treatment. Patients with nown uncorrected CHD and those who have undergone palliation procedures are increasingly encountered in emergency departments for illnesses that may or may not be related to their pre-existing conditions.

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