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Congenital Heart Disease In Pediatric Patients: Recognizing The Undiagnosed And Managing Complications In The Emergency Department
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Congenital Heart Disease in Pediatric Patients: Recognizing the Undiagnosed and Managing Complications in the Emergency Department (Pharmacology CME) - $49.00

Publication Date: May 2016 (Volume 13, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 5/1/2019

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional approval.

Pavan Judge, MD
Pediatric Emergency Medicine Fellow, University of British Columbia, BC Children’s Hospital, Vancouver, BC, Canada
Garth Meckler, MD, MSHS
Associate Professor of Pediatrics, University of British Columbia; Division Head, Pediatric Emergency Medicine, BC Children’s Hospital, Vancouver, BC, Canada
Peer Reviewers:
Ilene Claudius, MD
Associate Professor of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
Jennifer E. Sanders, MD
Clinical Instructor, Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY


Congenital heart disease is the most common form of all congenital malformations and, despite advances in prenatal and newborn screening, it may present undiagnosed to the emergency department. Signs and symptoms of congenital heart disease are variable and often nonspecific, making recognition and treatment challenging. Patient presentations can range from life-threatening shock or cyanosis in a neonate to respiratory distress or failure to thrive in infants. Advances in surgical techniques have improved short- and long-term survival of infants and children with congenital heart disease, but these children are at risk for a variety of complications related to the underlying or surgical anatomy and physiology. This review focuses on the recognition and initial management of patients with undiagnosed congenital heart disease presenting to the ED and touches on considerations for postoperative infants and children with complex congenital heart disease.

Excerpt From This Issue:

Congenital heart disease (CHD) includes a spectrum of anatomic malformations of the heart and great vessels that occur during embryologic development of the fetus and can cause a wide range of physiologic perturbations and physical signs and symptoms. While many defects are identified prenatally through fetal ultrasound (including approximately 33% of all CHD and 57%-83% of critical lesions)1 or diagnosed in the newborn period prior to discharge from the hospital, some CHD may go unrecognized and present without previous diagnosis to the emergency department (ED). The emergency clinician must maintain a high index of suspicion in these rare cases, as the clinical picture of undiagnosed CHD can be nonspecific, can mimic other common and benign childhood disease, or can present with a child in extremis. Infants and children with partially or fully corrected or palliated CHD may also present to the ED with complications related to the structural heart disease, the surgical repair, or as a result of concurrent illness in the setting of limited physiologic reserves. This review focuses primarily on the presentation, evaluation, and stabilization of undiagnosed CHD presenting to the ED, but will also touch on common emergencies in the patient with known heart defects.

Product Reviews
anonymous - 11/21/2016
This was the most cogent presentation of CHD that I've ever seen. It was an excellent review and explanation of the physiology.
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