Cardiac Emergencies in Children

Abstract

Cardiac emergencies in children are infrequent, and unlike the adult population, they are rarely due to coronary disease. There are a myriad of pediatric cardiac emergencies that are etiology related and age related. These include structural heart disease (eg, undiagnosed congenital heart disease or postoperative complications from cardiac surgery), arrhythmias, and acquired heart disease (eg, Kawasaki disease or myocardiopathy). Physicians taking care of pediatric cardiac emergencies ought to recognize the different clinical presentations to deliver swift therapy and/or referral because a late or missed diagnosis could have devastating consequences. The book, Cardiac Emergencies in Children, is edited by Drs Sarnaik, Ross, Lipshultz, and Walters, all of whom are respected authorities in pediatric critical care. The background of the authors includes cardiology, intensive care, and cardiac surgery. The anesthesiologist’s perspective is not included, and the cardiac surgery contribution is brief. The goal of this book is to be a practical handbook for quick consultation, diagnosis, and treatment. Its targeted readership is a wide variety of clinicians and trainees not specialized in pediatric heart disease who occasionally are faced with caring for critically ill children with life-threatening cardiac emergencies. The book is currently available in hardcover and as an eBook (EPUB and PDF formats). The digital version allows for quick access to search, bookmark, and provide notation functions, but it does not add any additional content. It also lacks extra digital features such as hyperlinks, didactic teaching tools, and self-evaluation questionnaire. These educational resources should be considered in future editions. The 394-page book is divided into 21 chapters that include general knowledge (eg, emergency presentation of heart disease, heart failure in the emergency department, cardiac pharmacology, etc), and other chapters are focused on specific aspects of pediatric cardiology (eg, radiographic evaluation of the child with heart disease or point-of-care cardiac ultrasound in the emergency department). Finally, there are chapters that review specific pathology (eg, pulmonary hypertension, infective endocarditis, inflammatory heart disease, etc) or advanced technology (eg, pediatric mechanical circulatory support or emergency interventional cardiology). The majority of the book chapters are formatted as case-based scenarios with or without board review questions. It seems that the chapters have been written completely independently, with a lack of editorial cohesiveness and no cross-reference among them. For example, the closing book chapter is a straightforward one, “Evaluation and Management of Pediatric Chest Pain, Syncope, and Murmur in the ED,” which should have been one of the first chapters. Other chapters are beyond the scope of the book and are geared to a very targeted readership (eg, pediatric mechanical circulatory support or emergency interventional cardiology in children). The quality of the content of the chapters is variable. The majority of the chapters are well written, and the authors’ opinion is supported by the available literature. In some cases, this information is outdated. In selected chapters, the content is either incomplete or there is repetition (eg, chapter 5 repeats information about hypoplastic left and right heart syndrome). The quality of the figures is highly variable and could be improved in some cases (eg, both electrocardiographs and chest radiographs are shown with poor contrast and resolution). In addition, some of the illustrations are not original and have been taken from the web (eg, pediatric mechanical circulatory support). In an attempt to be practical, the book presents several diagnostic and treatment algorithms that typically are not useful because the final recommendation is “cardiology consultation.” Overall, the book, Cardiac Emergencies in Children, addresses most of the topics superficially, and although the case-oriented format makes it readable, the shortcoming is that it limits comprehensiveness. There are better and more comprehensive books for the pediatric anesthesiologist such as Critical Care of Children with Heart Disease.1 The approach of this book is oriented to the operating room instead of the emergency department, and there are frequent contributions by anesthesiologists, which make it more appealing for the anesthesia provider. We think that the book, Cardiac Emergencies in Children, is better suited for the general pediatrician, family physician, or emergency doctor, and its format is not practical for the practicing anesthesiologist. The pediatric cardiovascular anesthesiologist who is faced to deal with cardiac emergencies around the perioperative period should be considered as a reader for this book, but such a reader is not addressed. Antonio Perez-Ferrer, MD, PhD, MBADepartment of AnesthesiologyHospital Universitario Infanta SofíaMadrid, Spain[email protected] Pablo Motta, MD, FAAPDepartment of AnesthesiologyPerioperative and Pain MedicineBaylor College of MedicineTexas Children’s HospitalHouston, Texas