Critical CareEmergency MedicinePaediatricsSMACCUndiagnosed Paediatric Emergency Cardiac Disease

Undiagnosed Paediatric Emergency Cardiac Disease by Michele Domico

Most people think it is easy to spot the paediatric emergency – and this usually holds true. However, this is not so in undiagnosed paediatric emergency cardiac disease, as Michele Domico explains.

She delves into the practical points on recognising children over one month of age with life threatening cardiac disease. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of paediatric heart disease in the differential diagnosis.

This talk will review the most commonly missed cardiac “zebras”. Cardiac emergencies can masquerade as anything – fatigue, emesis, tachypnoea, septic shock, failure to thrive and abdominal pain could all point to a cardiac aetiology!

Recognition is the key.

Michele present five cases of paediatric cardiac emergencies to highlight the subtleties that can exist. Each case provides its own lesion and clinical pearl.

A 7-year-old presents with abdominal pain and fatigue. This teaches us that a persistently tired child is not normal.

Furthermore, a 5-month-old with respiratory symptoms highlights that when things do not add up, keep looking!

Moreover, a 4-month-old with tachypnoea since birth couple with peri-oral cyanosis teaches us that if something is abnormal, it is abnormal. It is important not to be falsely reassured by parents or health care providers.

Further, a 3-month-old with tachypnoea and poor oral intake is a lesson in being aware of the quiet tachypneic!

Finally, a 7-week-old with feeding problems shows us that failure to thrive is not always a gut problem. Do not wear blinders when working these patients up.

This presentation provides you with some helpful hints for when it is time to stray from the straight path and start entertaining a cardiac diagnosis in a sea of children complaining of respiratory, gastrointestinal, and other symptoms.

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Michele Domico

Dr. Domico is board certified in both pediatrics and pediatric critical care medicine. Dr. Domico worked in London at the world-renowned Great Ormond Street Hospital for Children as a senior fellow in pediatric cardiac intensive care/ECMO. She completed her pediatric critical care fellowship at Harbor-UCLA Medical Center and CHOC Hospital in Orange. She received additional fellowship training in pediatric cardiology at the University of Florida Health Science Center. Dr. Domico attended medical school and completed her internship and residency at University of Texas Health Science Center in San Antonio.