Preface
Heart disease in infants and children can impact their growth and development and significantly increase the challenges of raising them. My interest in this topic grew out of personal experience with a congenital heart defect in a family member. We are grateful for the health care team that made a prompt diagnosis, a successful surgical repair, and a good outcome possible.
This edition of FP Essentials provides updates on several key aspects of pediatric heart disease. Section One addresses the evaluation of murmurs, which can be present in up to 5% of newborns. Section Two covers the cardiac preparticipation examination, where we strive to identify young athletes who are at risk for sudden cardiac death and help to reduce that risk. Section Three addresses important dysrhythmias in children, including supraventricular tachycardias, long QT syndrome, and others. Section Four focuses on two inflammatory syndromes that can affect the heart: Kawasaki disease and the multisystem inflammatory syndrome in children that is associated with COVID-19 disease.
I hope you find this edition of FP Essentials helpful for your practice. When you have finished studying it and are ready to submit your posttest answers, please tell us what was most useful and what we can do to improve. We look forward to hearing your ideas for topics you would like covered in future editions.
Karl T. Rew, MD, Associate Medical Editor
Clinical Associate Professor, Departments of Family Medicine and Urology
University of Michigan Medical School, Ann Arbor
Craig Barstow, MD, FAAFP, is an adult and pediatric hospitalist with FirstHealth of the Carolinas in Pinehurst, North Carolina. He was the founding director of the Hospital Medicine Fellowship for the US Army at Fort Liberty, North Carolina. Dr. Barstow is a frequent writer and lecturer on cardiology issues of interest to family physicians.
Ryan Flanagan, MD, is a pediatric cardiologist and active-duty officer in the US Army. He serves as a pediatric and fetal cardiologist and department chair of pediatrics at Landstuhl Regional Medical Center in Germany. He previously served as Pediatric Residency program director at Tripler Army Medical Center in Honolulu, Hawaii.
Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.
- Diagnose the characteristics of pathologic murmurs in newborns, infants, children, and adolescents.
- Recommend appropriate imaging and subspecialty consultation for children with murmurs.
- Screen young athletes for risk of sudden cardiac death.
- Determine when electrocardiography and other tests may be helpful in evaluating young athletes.
- Summarize the types and causes of pediatric cardiac dysrhythmias.
- Avoid using drugs that can further prolong the QT interval in patients with long QT syndrome.
- Summarize the principal clinical features of Kawasaki disease.
- Explain the approach for evaluation of patients with suspected multisystem inflammatory syndrome in children.
Key Practice Recommendations
Sections
Heart Murmurs
Heart murmurs are common in childhood. Any murmur associated with cardiac signs or symptoms should be referred to a pediatric cardiologist for further evaluation. A benign murmur typically can be differentiated from a pathologic murmur based on its characteristics. Between 1…
Cardiac Preparticipation Evaluation
The purpose of the cardiac portion of the preparticipation physical evaluation is to identify potential health risks in young athletes, particularly sudden cardiac death. The preparticipation evaluation begins with a detailed screening questionnaire. Sudden cardiac death in…
Cardiac Dysrhythmias
Cardiac dysrhythmias in children can be due to a structural abnormality or an intrinsic defect in the electrical conduction system of the heart. In a child with a structurally normal heart, the mechanisms for dysrhythmias are the same as in adults, although the incidence and…
Inflammatory Syndromes
Kawasaki disease is an acute vasculitis of unknown etiology that primarily affects children younger than 5 years, although it can affect older children. Cardiac complications are the major cause of morbidity and mortality in Kawasaki disease and can include myocarditis. Long…