Korean Circ J.  2010 Jan;40(1):36-41. 10.4070/kcj.2010.40.1.36.

Pediatric Emergency Room Presentation of Congenital Heart Disease

• Lee YS
• Baek JS
• Kwon BS
• Kim GB
• Bae EJ
• Noh CI
• Choi JY
• Yun YS

• KMID: 1776304
• DOI: http://doi.org/10.4070/kcj.2010.40.1.36

Abstract

BACKGROUND AND OBJECTIVES
Only a few studies have specifically investigated the reasons for emergency room (ER) visits in patients with congenital heart disease (CHD). The aim of this study was to identify the major reasons for ER presentation among patients with CHD that were acutely and seriously ill at a tertiary medical center in Korea. SUBJECTS AND METHODS: All 368 admissions of patients with CHD via the ER from 2003 to 2008 were enrolled. We conducted a retrospective study with review of the medical records. RESULTS: Eighty two patients were newly diagnosed as having CHD. Their major presentations were: symptoms of heart failure (41.5%), murmur (31.7%), and cyanosis (18.3%). There were 286 visits that were cases with known CHD. Their major presentations were respiratory tract infection (24.1%, 2.7+/-4.1 years of age), dysrhythmia (16.4%, 16.7+/-9.5 years), symptoms of heart failure (14.3%, 7.6+/-9.4 years), aggravated cyanosis (5.6%, 0.8+/-1.4 years), protein-losing enteropathy (4.9%), hemoptysis (4.5%), drug side effects (4.1%), and infective endocarditis (3.0%). There were significant correlations between the age distributions and major modes of presentation. Surgical treatments were required within 1 month in 38%, and 2.7% of all patients died during hospitalization. The patient group with respiratory infections and CHD showed the highest mortality (5.8%). Atrial flutter was the most frequent arrhythmia (70.2%) and 70% of these patients were post-Fontan surgery condition. The causes of heart failure in the patients with previous surgical repair were: pulmonary hypertension, myocardial dysfunction, valve regurgitation, and uncorrected lesions. CONCLUSION: Improved understanding of the common problems in the ER can help prepare clinicians to manage patients that present with CHD.

Keyword

Congenital heart; Emergencies

MeSH Terms

Age Distribution
Arrhythmias, Cardiac
Atrial Flutter
Cyanosis
Emergencies
Endocarditis
Heart
Heart Diseases
Heart Failure
Hemoptysis
Hospitalization
Humans
Hypertension, Pulmonary
Korea
Medical Records
Protein-Losing Enteropathies
Respiratory Tract Infections
Retrospective Studies

Figure

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  Fig. 1 A: patterns of presentation at the PER of newly diagnosed congenital heart disease (Group 1). Heart failure, cardiac murmur and cyanosis were the dominant symptoms. B: patterns of presentation at the PER of patients with known congenital heart disease (Group 2). Respiratory tract infection, dysrhythmia, heart failure and cyanosis were the main causes for the ER visits. PER: pediatric emergency room, ER: emergency room.

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  Fig. 2 Comparison of the age distribution of each subgroup in Group 2: The patients with respiratory tract infection or cyanosis were younger than the patients with dysrhythmia Horizontal bars represent mean±SD.

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