Search

Each year nearly 7,000 children, adolescents, and young adults in the United States as well as tens of thousands worldwide die unexpectedly. Nearly 50% of these deaths occur with little or no warning. This discussion reviews the epidemiology, presentation, diagnosis, and management of sudden cardiac death (SCD). SCD is predominantly due to previously unrecognized structural abnormalities of the heart and underlying or acquired conditions that predispose persons, especially when involved in exercise, to sudden death. Topics considered include SCD presenting signs, symptoms, diagnoses, and when applicable, management of common conditions associated with SCD. [ABSTRACT FROM AUTHOR]

Pediatric thromboembolism is an uncommon, but potentially life-threatening and occasionally fatal event in pediatric individuals. This discussion reflects on recent advances in thrombolytic therapy that have been in the adult populations and are applied to the pediatric population. After a historical refection, this discussion reviews various thrombolytics with the main emphasis on tissue plasminogen activator (tpa). Absolute and relative contraindications to thrombolysis are considered as well as general precautions for patients undergoing thrombolysis. Various medications used for the management of adult thromboembolic disease are noted that include rivaroxaban, dabigatran, apixaban, and edoxaban. [ABSTRACT FROM AUTHOR]

Pulmonary embolism occurs when thrombus forms in the venous vasculature and propagates to the pulmonary vasculature. These clots, often asymptomatic prior to migration, are an increasing problem in the adult and pediatric population. Mortality and morbidity from acute pulmonary embolism is high. After a review of the historical context of venous thromboembolism (VTE), this discussion details the recent increase, risk factors and other contributing causes of VTE in children. Presenting symptoms, physical examination, and diagnostic strategies are also reviewed. In addition, VTE management is presented that includes unfractionated heparin (UFH), low molecular weight heparins (LMWH: enoxaparin, dalteparin, fondaparinux), warfarin and the potential impact of the novel anti-coagulants (i.e., rivaroxaban, dabigatran, apixaban, edoxaban). This discussion concludes with a review of the applicable inherited thrombophilias and their impact on both the presentation and long-term management of venous thromboembolism in children. [ABSTRACT FROM AUTHOR]

Myocarditis, an acute inflammatory condition of the heart that affects all age groups, is an increasingly recognized cause of morbidity and mortality in all age groups. Presenting symptoms can range from mild gastrointestinal complaints (i.e., vomiting, diarrhea) to overt cardiogenic shock with dysrhythmia and death. Most cases of myocarditis are either infectious or autoimmune in origin, though it also may be idiopathic in origin. The outcome can be improved in selected patients with prompt recognition of the clinical syndrome and when necessary, initiation of cardiovascular support including inotropic, ventilatory, and anti-arrhythmic measures; however, long-term morbidity and mortality are common. This discussion reviews the epidemiology, presentation, diagnosis, and management of myocarditis in children and adolescents. [ABSTRACT FROM AUTHOR]

Each year nearly 7,000 children, adolescents, and young adults in the United States as well as tens of thousands worldwide die unexpectedly. Nearly 50% of these deaths occur with little or no warning. This discussion reviews the epidemiology, presentation, diagnosis, and management of sudden cardiac death (SCD). SCD is predominantly due to previously unrecognized structural abnormalities of the heart and underlying or acquired conditions that predispose persons, especially when involved in exercise, to sudden death. Topics considered include SCD presenting signs, symptoms, diagnoses, and when applicable, management of common conditions associated with SCD. [ABSTRACT FROM AUTHOR]

Acute abdominal pain in the college student can be due to many causes, some of which are considered in this discussion. The key to an accurate diagnosis is a meticulous medical history, careful physical examination repeated over time, and judicious use of laboratory and/or imaging studies. The medical history may present red flags that alert the astute clinician to which causes are benign and which ones indicate serious pathology. Particularly important is the location of the pain and how it may change over time. The challenging features presented by acute abdominal pain in the college student include findings such as guarding or rigidity signifying acute appendicitis or peritonitis versus negative palpatory findings that are non-specific with minimal clinical value. Appropriate follow-up over time is a valued tool in the clinician's armamentarium in the evaluation and management of acute abdominal pain. [ABSTRACT FROM AUTHOR]