Cardiovascular emergencies

Abstract

The spectrum of cardiovascular disease in children is very different from that of adults. It comprises almost exclusively congenital disorders and their complications. Ischaemic heart disease is extremely rare in this age group, although myocardial ischaemic damage is occasionally seen in the newborn following severe hypoxia. As rheumatic fever is now uncommon in Britain acquired heart disease has become a relatively minor problem. The incidence of congenital heart disorders is high at 8–10 per 1000 births. They cover a wide range of severity. Some disorders present acutely in the neopatal period or infancy whilst others have a more chronic presentation and may be detected in asymtomatic children on hearing a heart murmur. Infants and babies with severe heart disease develop cyanosis, heart failure or a combination of these. The age of the child is helpful in assessing the most likely underlying cause (Figure 1). The commonest cardiac lesions presenting in the first week of life are listed in Table 1.