Cardiovascular emergencies in the pediatric patient

Children who have heart disease may present to the emergency department (ED) in many stages of life with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. They can present with congenital heart disease, after a temporizing procedure has been performed or after their definitive repair. Children can also present with fever, weakness, dyspnea, syncope, or chest pain; alternatively, children may present to the ED with active dysrhythmia, pulmonary edema, or cardiogenic shock . These symptoms and presentations may result from Kawasaki disease,hypertrophic cardiomyopathy, or arrhythmia; therefore, emergency physicians must also be comfortable with the most common types of heart disease associated with these symptoms and presentations. The purpose of this article is to describe the physiology and presentation of undiagnosed congenital heart disease, to describe the complications that can occur after a staged or definitive repair,and to discuss acquired heart disease in children.