Pediatric emergency medicine trisk 1719 1719
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (101.46 KB, 1 trang )
carefully evaluated with these issues in mind when presenting to the ED for any
reason.
Following a careful physical examination, B-type natriuretic peptide (BNP),
chemistry, CBC, blood cultures, viral studies, CXR, EKG, and echocardiogram
may aid diagnosis and treatment. Prompt consultation with the cardiac transplant
service is recommended when these patients present to the ED.
For more information on complications specific to particular lesions or
complications specific to particular procedures/surgical repairs, refer to Table
86.6 .
Adults With Congenital Heart Disease
Due to advances in surgical and medical treatment, about 85% of patients born
today with CHD will survive into adulthood. There are an estimated 1 million
adults living with CHD in the United States of America and this population will
continue to increase. With relatively few adult congenital heart disease (ACHD)
specialty centers, there is a gap in the healthcare delivery system for these
patients which is often filled by the ED. The most common reason ACHD
patients seek care in the ED is for noncardiac conditions, followed by nonspecific
chest pain (in simple ACHD) and respiratory complaints (in complex ACHD).
Urgent hospital admissions in ACHD are most often for arrhythmias (53%), CHF
(19%), and infections (6%).
As this population ages, they become increasingly complex with more
cardiovascular risk factors and comorbidities. These include hypertension,
diabetes mellitus, smoking, obesity, chronic kidney disease, and vascular disease.
Pulmonary hypertension is increasingly reported.
History should elicit information about diagnosis, baseline cardiac function,
concurrent medical history, medication, and previous problems encountered.
Perhaps the most common arrhythmia presenting to the ED is intra-atrial reentrant tachycardia (IART). This variation of atrial flutter is caused by scarring in
the atrium from previous surgeries. Often the rate of IART is relatively slow and
the amplitude of the P waves is low, making this arrhythmia hard to detect. The
heart rate in IART may be 80 to 86 BPM and may look like sinus rhythm, but it is
usually not well tolerated even at this slow rate. Adenosine blocks AV conduction
transiently but usually does not terminate tachycardia. Due to the low amplitude
of the P waves, continuation of IART during adenosine administration is often
missed. Synchronized cardioversion is typically the treatment of choice. Care
must be taken to consider the risk of stroke from a blood clot in the left atrium
associated with IART, similar to atrial fibrillation.
