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A wide range of cardiovascular signs and symptoms present to the pediatrician’s office, and clinician knowledge of key “red flags” alerting them to a higher likelihood of significant pathology or more urgent need for subspecialty referral is paramount.
A wide range of cardiovascular signs and symptoms present to the pediatrician’s office, and clinician knowledge of key “red flags” alerting them to a higher likelihood of significant pathology or more urgent need for subspecialty referral is paramount. These symptoms were highlighted by Timothy Slesnick, MD, in his presentation “Five Critical Cardiac Problems Commonly Missed in Office Practice.” Cases included:
Timothy Slesnick, MD, FAAP, is a pediatric cardiologist in Atlanta, Georgia.
At the recent AAP meeting, Timothy Slesnick, MD, reviewed the “red flags” that every provider of primary pediatric care must take into account in order to identify cardiac disease. Slesnick reminds us that we must harken to the principles we learned as we began our medical careers: Take a good clinical history, pay careful attention to family history, and perform a focused physical examination. By following these foundational principles, the vast majority of cases of congenital heart disease, cardiomyopathies, and arrhythmias will be detected before clinical deterioration develops. These principles apply irrespective of whether we are caring for the newborn or the young adult. In fact, there is little difference in the application of this model of care as compared with that required for taking an effective preparticipation athletic screening history and physical examination (Maron, et al. Circulation. 2007;115(12):1643-1655).
We are greatly assisted in early detection of CCHD by the recent AAP policy statement regarding newborn pulse oximetry screening (Mahle, et al. Pediatrics. 2012;129(1):190-192). Nevertheless, the burden remains squarely on the shoulders of the primary provider: Maintain a working knowledge of the spectrum of pediatric cardiac disease and remain prepared to implement a thorough evaluation in order to ascertain disorders that will prompt expeditious referral for pediatric cardiac specialty care.
Mark B. Lewin, MD, is professor and chief, Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle, and co-director, Heart Center, Seattle Children’s Hospital.