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Self-Assessment Questions

Pediatric Medicine

Answer 5
  1. Exertional chest pain not affected by movement. The incidence of sudden cardiac death in infants through adolescents ranges from 1.3 to 8.5 per 100,000 patient-years. Males are more likely to experience sudden cardiac death compared with females,8 and the etiology may be either cardiac or noncardiac. Sudden cardiac death in children younger than 1 year of age is most often related to ductal- dependent complex cyanotic congenital heart disease. In older children (aged = 1 yr) and adolescents, the possible diagnoses are more variable and include congenital heart disease, anomalies of the coronary arteries, myocardial disease, arrhythmia, or high-risk behaviors (eg, illicit drug use). Evaluation of patients presenting with unexplained syncope should focus on warning signs associated with a higher risk of sudden cardiac death, including the presence of exertional chest pain, dyspnea at rest or with minimal exertion, lightheadedness, palpitations, or an irregular heart beat.9 Prior cardiac history, such as infectious complications (eg, rheumatic heart disease, myocarditis) or prior cardiac surgeries, should be explored. Careful examination of the patient’s family history is essential. The presence of late-onset atherosclerotic coronary artery disease in family members does not predict sudden death, although this may be important so that the likelihood of developing atherosclerotic disease is addressed. Identifying a family history of sudden death is important given the known genetic predisposition and patterns of inheritance for certain cardiac syndromes, such as Brugada syndrome, long QT syndrome, hypertrophic cardiomyopathy, or Marfan syndrome. A history of classic neurocardiogenic syncope does not place an individual at higher risk for sudden death. In the absence of other findings, orthostatic hypotension is not associated with sudden death. An isolated T-wave inversion present in lead V1 is a normal finding on an electrocardiogram.

    Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med 1996;334:1039-44.

    9. Berger S, Utech L, Fran Hazinski M. Sudden death in children and adolescents. Pediatr Clin North Am 2004;51:1653-77.

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