THE CRASHING PATIENT WITH CONGENITAL HEART DISEASE - DR. RICHARDSON

Congenital heart disease is common, and with advances in pediatric surgical care, many patients are surviving to adulthood and transitioning out of dedicated pediatric centers to receive care in general Emergency Department settings.

The range of possible conditions is broad, but most patients with congenital heart disease have essentially normal physiology. They are still at early risk for heart failure, pulmonary hypertension, dysrhythmias (especially atrial tachycardias and sinus node dysfunction), and valvular stenosis or insufficiency – but, you can manage these problems much like you would a patient without CHD history, at least until specialist backup is available.

However, there are two conditions that produce very different physiologies, especially in a true emergency or resuscitation situation: