Pediatric emergency medicine trisk 1693 1693
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CHAPTER 86 ■ CARDIAC EMERGENCIES
CASANDRA QUIñONES, BETH BUBOLZ
GOALS OF EMERGENCY THERAPY
Pediatric cardiac emergencies encompass a broad spectrum of disease states and
thus have a variety of presentations. Cardiac emergencies may be caused by
congenital heart disease (CHD), arrhythmias, acute heart failure syndromes
(AHFS), trauma, infection, ischemia, inflammation, and as sequelae of treatment.
The common denominators in cardiac emergencies ultimately distill down to
either abnormal pulmonary blood flow (PBF) or compromised cardiac output.
The special challenge for the emergency medicine (EM) provider is to identify
cardiac emergencies promptly even when the chief complaint is not cardiac in
nature. The clinician must consider heart disease when evaluating common
symptoms such as feeding difficulty, abdominal pain, wheezing, or respiratory
distress. An exhaustive knowledge of every anatomic variation of CHD is not
necessary. By simply maintaining a high index of suspicion for cardiac conditions
the provider can recognize cardiac disease by the presenting symptoms and
determine the correct approach to such complex patients.
KEY POINTS
CHD should be considered in any neonate presenting with acute
decompensation in the first 2 months of life.
CHD often presents with cyanosis or shock in the first 2 weeks of life,
coinciding with closure of the ductus arteriosus (DA).
CHD often presents with pulmonary overcirculation and poor feeding
around 2 months of life, coinciding with fall in pulmonary vascular
resistance (PVR).
Pediatric patients with AHFS often present with nonspecific, noncardiac
complaints on multiple visits before heart failure is recognized.
Incessant tachycardia may lead to heart failure at any age.
Children with implanted cardiac devices may present with
complications of implantation or device failure.
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