Children's Heart Failure May Be Overlooked In ER

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CHILDREN HEART FAILURE
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Half of children with heart failure will die or need a heart transplant, an outcome that has prompted new guidelines for emergency room doctors to help recognize the problem.

The Canadian Cardiovascular Society released the guidelines Tuesday during its meeting in Toronto.

"Often children are brought to the emergency room with shortness of breath, and some cough and are thought to have asthma, when in fact they have very severe heart failure," said Dr. Paul Kantor, who chaired the guidelines and is head of pediatric cardiology at Stollery Children’s Hospital at the University of Alberta in Edmonton.

"The clues of a very unusually fast heart rate and low blood pressure are sometimes overlooked, and these children will be sent home with a 'puffer' for their breathing problems, which are actually due to heart failure," he added in a release.

The new guidelines provide a framework to help doctors recognize heart failure sooner and treat it with medications.

Early recognition is key for conditions such as:

- Cardiomyopathy or heart muscle disease, one of the main causes of heart failure in children that should be considered when a child has unexplained rapid heart rate or rapid breathing. It can be caused by gene abnormalities.

- Myocarditis, a viral infection of the heart muscle that may be present when children have abdominal pain and vomiting with signs of poor circulation.

Doctors need to order specialized tests called pediatric echocardiography to exclude heart failure, the group said.

Emergency room physicians need to know about the guidelines, agreed Tim Miller of Delaware, Ont., who lost a teenage son to heart failure in 2003.

At 17, his son Daniel had a high heart rate, but the classic sign wasn’t recognized and the case was considered the flu, his parents recalled.

On Monday, researchers at the conference presented a study suggesting 72 per cent of sudden cardiac deaths among those aged two to 40 occurred at home, even though the cases that grab attention are typically of young athletes who suddenly collapse and die.

Researcher Dr. Andrew Krahn of the University of British Columbia said it's important to have defibrillators in malls and workplaces as well as sporting venues, and that coaches and teachers should be aware of possible warning signs such as fainting.

In sudden cardiac death, the heart beats irregularly, which stops the organ from pumping blood.

The conference runs through Wednesday.