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[Adults with congenital heart disease presenting to the emergency department : Potential pitfalls]

J Mair1, G-P Diller2, H Geiger3

  • 1Universitätsklinik für Innere Medizin III - Kardiologie und Angiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich. Johannes.Mair@i-med.ac.at.

Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|October 26, 2020
PubMed

Insights

Adults with congenital heart disease (ACHD) face unique emergencies, often due to arrhythmias or heart failure. Prompt recognition and management, including contacting specialized centers, are crucial for unstable ACHD patients.

Area of Science:

  • Cardiology
  • Adult Congenital Heart Disease (ACHD) Management

Background:

  • The population of adults with congenital heart disease (ACHD) now surpasses that of children with ACHD in industrialized nations.
  • ACHD patients frequently present with complex anatomical and physiological challenges, even post-cardiac surgery.
  • Sudden deterioration and instability can occur in ACHD patients, irrespective of prior symptom status.

Purpose of the Study:

  • To provide guidance for managing emergency situations in adults with congenital heart disease (ACHD).

Main Methods:

  • This is a review article guiding emergency management.
  • Key emergency presentations in ACHD patients were identified and analyzed.
  • Management strategies for common and critical ACHD emergencies were discussed.

Main Results:

  • Arrhythmias and acute heart failure account for approximately two-thirds of ACHD emergency admissions.
  • Sustained arrhythmias can lead to rapid cardiac decompensation, necessitating electrical cardioversion in unstable cases.
  • Acute right heart failure is a common cause of acute heart failure in ACHD; other emergencies include infections, syncope, thromboembolic events, and aortic dissection.

Conclusions:

  • Early consultation with the patient's tertiary care center is strongly recommended for emergency room presentations of ACHD patients.
  • Management of ACHD emergencies requires specialized knowledge due to complex patient profiles.
  • Prompt interventions, such as cardioversion or pacemaker implantation, are vital for hemodynamically unstable ACHD patients.

Keywords:
AdultArrhythmiaCongenital heart diseaseEmergencyHeart failure

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