Cardiology

A primer for pediatricians on how to approach hypertension in children and adolescents.

Over the last few years, the incidence of hypertension (HTN) in children has risen, noted Beth Vogt, MD, of Rainbow Babies and Children’s Hospital in Cleveland, as she spoke in Boston to a packed room of concerned pediatricians. In addition to a rise in HTN, the average blood pressure (BP) of American children is also increasing. Several studies have shown that elevated blood pressure is under-recognized; the increase in HTN may also be associated with the childhood obesity. The recommendations below offer some insight in how to identify the child with elevated BP, and how to approach treatment.

An otherwise healthy female infant presented at birth with a lesion on the left side of the face that involved the frontotemporal scalp, periocular area, nose, and upper lip (A). She was born at term via spontaneous vaginal delivery after an uncomplicated gestation. The initial clinical impression was that of a port-wine stain associated with Sturge-Weber syndrome.

These links offer information on treatment, diagnosis, and help in communicating information on pediatric cardiac ailments to parents.

A 2-year-old girl was seen by her pediatrician because of a 3-day history of runny nose, cough, congestion, and low-grade fevers. A viral upper respiratory tract infection was diagnosed and supportive care was recommended. The child returned 2 days later with persistent cough, mild tachypnea, and an episode of vomiting. The cough and tachypnea prompted the pediatrician to order a chest film, which revealed an enlarged cardiac silhouette.

A report released in June at the 17th Annual Scientific Sessions of the American Society of Echocardiography in Baltimore, Md., describes how ultrasonography of the heart can identify pulmonary hypertension in children who are obese and experience sleep apnea. The finding was an outcome of a study of the prevalence of pulmonary hypertension in children who have systemic hypertension.

Chest pain in children evokes anxiety in patients and their parents--and prompts frequent visits to the pediatrician's office, urgent care facility, or emergency department (ED). In a prospective study, Selbst and colleagues reported that chest pain accounted for 6 in 1000 visits to an urban pediatric ED.

High blood pressure in an infant can be the presenting sign of serious illness. Here’s a road map for how to proceed-from making the diagnosis to finding and treating the cause.

When you are presented with a child who has a murmur, chest pain, or syncope, what findings on history and physical exam point to cardiac pathology? When should you refer?

When you are presented with a child who has a murmur, chest pain, or syncope, what findings on history and physical exam point to cardiac pathology? When should you refer?