Park’s Pediatric Cardiology for Practitioners

PARK’S PEDIATRIC CARDIOLOGY FOR PRACTITIONERS
Copyright
Dedication
PREFACE
FREQUENTLY USED ABBREVIATIONS
1 - History Taking
	GESTATIONAL AND NATAL HISTORY
		Infections
		Medications, Alcohol, and Smoking
		Maternal Conditions
		Birth Weight
	POSTNATAL HISTORY
		Weight Gain, Development, and Feeding Pattern
		Cyanosis, “Cyanotic Spells,” and Squatting
		Tachypnea, Dyspnea, and Puffy Eyelids
		Frequency of Respiratory Infections
		Exercise Intolerance
		Heart Murmur
		Chest Pain
		Syncope
		Palpitation
		Joint Symptoms
		Neurologic Symptoms
		Medications
	FAMILY HISTORY
		Hereditary Disease
		Congenital Heart Disease
		Rheumatic Fever
		Hypertension and Atherosclerosis
2 - Physical Examination
	GROWTH PATTERN
	INSPECTION
		General Appearance and Nutritional State
		Chromosomal Syndromes
		Hereditary and Nonhereditary Syndromes and Other Systems Malformations
		Color
		Clubbing
		Respiratory Rate, Dyspnea, and Retraction
		Sweat on the Forehead
		Acanthosis Nigricans
		Inspection of the Chest
	PALPATION
		Peripheral Pulses
		Chest
			Apical Impulse
			Point of Maximal Impulse
			Hyperactive Precordium
			Thrills
	BLOOD PRESSURE MEASUREMENT
	AUSCULTATION
		Heart Sounds
			First Heart Sound
			Second Heart Sound
				Splitting of the S2. In every normal child, with the exception of occasional newborns, two components of the S2 should be audibl...
				Normal Splitting of the S2. The degree of splitting of the S2 varies with respiration, increasing with inspiration and decreasin...
				Abnormal Splitting of the S2. Abnormal splitting may be in the form of wide splitting, narrow splitting, a single S2, or paradox...
				Intensity of the P2. The relative intensity of the P2 compared with the A2 must be assessed in every child. In the pulmonary are...
			Third Heart Sound
			Fourth Heart Sound or Atrial Sound
		Gallop Rhythm
		Systolic and Diastolic Sounds
		Extracardiac Sounds
		Heart Murmurs
			Intensity
		Classification of Heart Murmurs
		Systolic Murmurs
		Types of Systolic Murmurs
		Location of Systolic Murmurs
		Transmission of Systolic Murmurs
		Quality of Systolic Murmurs
		Differential Diagnosis of Systolic Murmurs at Various Locations
		Diastolic Murmurs
		Continuous Murmurs
		Innocent Heart Murmurs
			Classic Vibratory Murmur
			Pulmonary Ejection Murmur (Pulmonary Flow Murmur) of Childhood
			Pulmonary Flow Murmur of Newborns
			Venous Hum
			Carotid Bruit (or Supraclavicular Systolic Murmur)
	SOME SPECIAL FEATURES OF THE CARDIAC EXAMINATION OF NEONATES
		Normal Physical Findings of Neonates
		Abnormal Physical Findings in Neonates
		Role of Pulse Oximetry in Newborn Examination
3 -
Electrocardiography
	Hexaxial Reference System
		Horizontal Reference System
		Information Available on the 12-Lead Scalar Electrocardiogram
	COMPARISON OF PEDIATRIC AND ADULT ELECTROCARDIOGRAMS
	BASIC MEASUREMENTS AND THEIR NORMAL AND ABNORMAL VALUES
		Rhythm
		Heart Rate
		QRS Axis, T Axis, and QRS-T Angle
			QRS Axis
			Successive Approximation Method
				Normal QRS axis. Normal ranges of QRS axis vary with age. Newborns normally have RAD compared with the adult standard. By 3 year...
				Abnormal QRS axis. The QRS axis outside normal ranges signifies abnormalities in the ventricular depolarization ­process
				T axis. The T axis is determined by the same methods used to determine the QRS axis. In normal children, including newborns, the...
				QRS-T angle. The QRS-T angle is formed by the QRS axis and the T axis. A QRS-T angle of greater than 60 degrees is unusual, and ...
		Intervals
		PR Interval
		QRS Duration
		QT Interval
		The JT Interval
		P-Wave Duration and Amplitude
		QRS Amplitude, R/S Ratio, and Abnormal Q Waves
			The QRS Amplitude and R/S Ratio
			Q Waves
		ST Segment and T Waves
	ATRIAL HYPERTROPHY
		Right Atrial Hypertrophy
		Left Atrial Hypertrophy
		Biatrial Hypertrophy
	VENTRICULAR HYPERTROPHY
		General Changes
		Criteria for Right Ventricular Hypertrophy
		Criteria for Left Ventricular Hypertrophy
		Criteria for Biventricular Hypertrophy
	VENTRICULAR CONDUCTION DISTURBANCES
		Right Bundle Branch Block
		Criteria for Right Bundle Branch Block
		Incomplete Right Bundle Branch Block
		Left Bundle Branch Block
		Intraventricular Block
		Wolff-Parkinson-White Preexcitation
		Criteria for Wolff-Parkinson-White Syndrome
		Ventricular Hypertrophy versus Ventricular Conduction Disturbances
	ST-SEGMENT AND T-WAVE CHANGES
		ST-Segment Shift
		Nonpathologic ST-Segment Shift
			J-depression
			Early Repolarization
		Pathologic ST-Segment Shift
		T-Wave Changes
			Pericarditis
			Myocardial Infarction
		Electrolyte Disturbances
			Calcium
			Potassium
4 - Chest Radiography
	HEART SIZE AND SILHOUETTE
		Heart Size
		Normal Cardiac Silhouette
		Abnormal Cardiac Silhouette
	EVALUATION OF THE CARDIAC CHAMBERS AND GREAT ARTERIES
		Individual Chamber Enlargement
			Left Atrial Enlargement
			Left Ventricular Enlargement
			Right Atrial Enlargement
			Right Ventricular Enlargement
		Size of the Great Arteries
			Prominent Main Pulmonary Artery Segment
			Hypoplasia of the Pulmonary Artery
			Dilatation of the Aorta
	PULMONARY VASCULAR MARKINGS
		Increased Pulmonary Blood Flow
		Decreased Pulmonary Blood Flow
		Pulmonary Venous Congestion
		Normal Pulmonary Vasculature
	SYSTEMATIC APPROACH
		Location of the Liver and Stomach Gas Bubble
		Skeletal Aspect of Chest Radiographic Film
		Identification of the Aorta
		Upper Mediastinum
		Pulmonary Parenchyma
5 - Noninvasive Imaging Tools
	ECHOCARDIOGRAPHY
		Two-Dimensional Echocardiography
			The Parasternal Views
			Parasternal Long-Axis Views
			Parasternal Short-Axis Views
			The Apical Views
			Apical Four-Chamber View
			Apical Long-Axis Views
			The Subcostal Views
			Subcostal Views of the Abdomen
			The Suprasternal Views
			The Subclavicular Views
		Quantitative Values Derived from Two-Dimensional Echocardiography
	M-MODE ECHOCARDIOGRAPHY
		Normal M-Mode Echo Values
			Cardiac Chamber Dimensions
			Left Ventricular Systolic Function
			Fractional Shortening
			Ejection Fraction
	DOPPLER ECHOCARDIOGRAPHY
		Measurement of Pressure Gradients
		Prediction of Intracardiac or Intravascular Pressures
		Measurement of Cardiac Output or Blood Flow
		Diastolic Function
	COLOR-FLOW MAPPING
	CONTRAST ECHOCARDIOGRAPHY
	OTHER ECHOCARDIOGRAPHIC TECHNIQUES
		Fetal Echocardiography
		Transesophageal Echocardiography
		Intravascular Echocardiography
		Tissue Doppler Echocardiography
		Magnetic Resonance Imaging
		Computed Tomography
		Choice of Imaging Modalities
6 - Other Noninvasive Investigation Tools
	STRESS TESTING
		Cardiovascular Response in Normal Subjects
		Cardiovascular Response in Cardiac Patients
		Exercise Stress Testing
		Monitoring During Exercise Stress Testing
		Safety of Exercise Testing
		Indications
		Contraindications
		Termination of Exercise Testing
	ALTERNATIVE STRESS TESTING PROTOCOLS
		Six-Minute Walk Test
		Pharmacologic Stress Protocols
		Exercise-Induced Bronchospasm Provocation
	LONG-TERM ECG RECORDING
		Holter Recording
			Indications
			Interpretations
			Holter Findings in Normal Children
			Premature or Low-Birth-Weight Infants
			Full-Term Neonates
			Children
			Adolescent Boys
		Event Recorders
		Implantable Loop Recorder and Insertable Cardiac Monitor
		Patch Electrocardiogram Recording Devices
	AMBULATORY BLOOD PRESSURE MONITORING
		Indications
		Procedure
		Standard Calculations
		Ambulatory Blood Pressure Monitoring Standards
		Staging of Ambulatory Blood Pressure Monitoring Levels
7 -
Invasive Procedures
	CARDIAC CATHETERIZATION AND ANGIOCARDIOGRAPHY
		Normal Hemodynamic Values
			Routine Hemodynamic Calculations
		Selective Angiocardiography
			Risk
			Indications
			Sedation
			Preparation and Monitoring
	CATHETER INTERVENTION PROCEDURES
		Balloon and Blade Atrial Septostomy
		Balloon Valvuloplasty
			Pulmonary Valve Stenosis
			Aortic Valve Stenosis
			Mitral Stenosis
			Stenosis of Prosthetic Conduits and Valves within Conduits
		Balloon Angioplasty
			Recoarctation of the Aorta
			Native (or Unoperated) Coarctation of the Aorta
			Branch Pulmonary Artery Stenosis
			Systemic Venous Stenosis
		Closure Techniques
			Atrial Septal Defect
			Ventricular Septal Defect
			Patent Ductus Arteriosus
			Occlusion of Collaterals and Other Vessels
		Percutaneous Valve Replacement
8 - Fetal and Perinatal Circulation
	FETAL CIRCULATION
		Course of Fetal Circulation
		Dimensions of Cardiac Chambers
		Fetal Cardiac Output
	CHANGES IN CIRCULATION AFTER BIRTH
		Pulmonary Vascular Resistance
		Closure of the Ductus Arteriosus
			Oxygen and the Ductus
			Prostaglandin E and the Ductus
			Reopening of a Constricted Ductus
			Responses of Pulmonary Artery and Ductus Arteriosus to Various Stimuli
	PREMATURE NEWBORNS
9 - Pathophysiology of Left-to-Right Shunt Lesions
	ATRIAL SEPTAL DEFECT
	VENTRICULAR SEPTAL DEFECT
	PATENT DUCTUS ARTERIOSUS
	ENDOCARDIAL CUSHION DEFECT
10 -
Pathophysiology of Obstructive and Valvular Regurgitant Lesions
	OBSTRUCTION TO VENTRICULAR OUTPUT
		Aortic and Pulmonary Valve Stenoses
		Coarctation of the Aorta
	STENOSIS OF ATRIOVENTRICULAR VALVES
		Mitral Stenosis
		Tricuspid Stenosis
	VALVULAR REGURGITANT LESIONS
		Mitral Regurgitation
		Tricuspid Regurgitation
		Aortic Regurgitation
		Pulmonary Regurgitation
11 -
Pathophysiology of Cyanotic Congenital Heart Defects
	CLINICAL CYANOSIS
		Detection of Cyanosis
		Influence of Hemoglobin Level on Cyanosis
		Role of Pulse Oximetry in Detection of Hypoxemia
		Causes of Cyanosis
		Cyanosis of Cardiac versus Pulmonary Origin
		Consequences and Complications
	COMMON CYANOTIC HEART DEFECTS
		Complete Transposition of the Great Arteries
		Persistent Truncus Arteriosus and Single Ventricle
		Tetralogy of Fallot
			Hypoxic Spell
			Mechanism of Hypoxic Spell
			Clinical Features of Hypoxic Spell
			Treatment of Hypoxic Spells
			Squatting
		Tricuspid Atresia
		Pulmonary Atresia
		Total Anomalous Pulmonary Venous Return
12 - Left-to-Right Shunt Lesions
	ATRIAL SEPTAL DEFECT
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 12.2)
			Electrocardiography (Fig. 12.3)
			Radiographic Studies (Fig. 12.4)
			Echocardiography
		Natural History
		Management
			Medical
			Nonsurgical Closure
				Post–Device Closure Follow-up. The patients are prescribed aspirin (3–5 mg/kg/day; maximum, 81 mg/day) for 6 months. Postprocedu...
			Surgical Closure
				Indications and Timing. Surgical closure is indicated only when device closure is not considered appropriate. Therefore, most pa...
				Procedure. For secundum ASD, the defect is traditionally repaired through a midsternal incision under cardiopulmonary bypass by ...
				Mortality. Fewer than 0.5% of patients die; however, there is a greater risk for small infants and those with increased PVR
				Complications. Cerebrovascular accident and postoperative arrhythmias may develop in the immediate postoperative period
			Postoperative Follow-up
	VENTRICULAR SEPTAL DEFECT
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Figs. 12.8 and 12.9)
			Electrocardiography
			Radiography (Fig. 12.11)
			Echocardiography
		Natural History
		Management
			Medical
			Nonsurgical Device Closure
			Surgical
				Indications and Timing
				Procedure
				Mortality. The surgical mortality rate is 0.5%. The mortality rate is higher for small infants younger than 2 months of age, inf...
				Complications
				Surgical Approaches for Special Situations
				Postoperative Follow-up
	PATENT DUCTUS ARTERIOSUS
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 12.14)
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Differential Diagnosis
		Management
			Medical
			Nonsurgical Closure
				Indications. The following are indications and contraindications for device closure of PDA (Feltes et al. 2011)
				Procedure. Small PDAs smaller than 3 mm in diameter are closed by various kinds of coils and larger ones with the Amplatzer PDA ...
			Surgical Closure
				Indications and Timing. Surgical closure is reserved for patients in whom a nonsurgical closure technique is not considered appl...
				Procedure
				Mortality. The surgical mortality rate is 0% to 1% for both techniques
				Complications. Complications are rare. Injury to the recurrent laryngeal nerve (hoarseness), the left phrenic nerve (paralysis o...
	PATENT DUCTUS ARTERIOSUS IN PRETERM NEONATES
		Prevalence
		Pathophysiology
		Clinical Manifestations
		Management
			Medical
			Surgical
	COMPLETE ENDOCARDIAL CUSHION DEFECT
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 12.18)
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Management
			Medical
			Surgical
				Indications. The presence of complete ECD indicates the need for surgery because an important hemodynamic derangement is usually...
				Timing. Although timing varies among institutions and with the hemodynamics of the defect, most centers perform the repair at 2 ...
				Procedures. Palliative. Banding of the PA in early infancy is no longer recommended unless other associated abnormalities make c...
				Mortality. The mortality rate is about 2.5%. The survival rate is the same for patients with and without Down syndrome. Factors ...
				Complications
				Special Situations
				Postoperative Follow-up
	PARTIAL ENDOCARDIAL CUSHION DEFECT
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Management
			Medical
			Surgical
				Indications and Timing. The presence of a partial AV canal (or primum ASD) is an indication for surgical repair. Elective surger...
				Procedure. Under cardiopulmonary bypass, the primum ASD is closed and the cleft mitral and tricuspid valves are reconstructed. S...
				Mortality. The surgical mortality rate is approximately 2.5%. Risk factors include the presence of CHF or cyanosis, failure to t...
				Complications
				Postoperative Follow-up
	PARTIAL ANOMALOUS PULMONARY VENOUS RETURN
		Prevalence
		Pathology
		Pathophysiology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
				Cardiac Magnetic Resonance Imaging. Cardiac magnetic resonance imaging can make correct diagnosis of partial anomalous pulmonary...
		Natural History
		Management
			Medical
			Surgical
				Indications and Timing. Indications for surgery include a significant left-to-right shunt with a Qp/Qs ratio of greater than 2:1...
				Procedures. Surgical correction is carried out under cardiopulmonary bypass. The procedure to be performed depends on the site o...
				Mortality. Surgical mortality occurs less than 1% of the time
				Complications
				Postoperative Follow-up
13 -
Obstructive Lesions
	PULMONARY STENOSIS
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 13.2)
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Management
			Medical and Balloon Valvuloplasty
			Surgical
				Procedure
				Mortality. Surgical mortality occurs in fewer than 1% of older children. The rate is about 10% in critically ill infants
	AORTIC STENOSIS
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 13.6)
			Electrocardiography
			Radiography
			Echocardiography
				Subvalvular Aortic Stenosis
				Supravalvular Aortic Stenosis. Supravalvular AS is seen as a narrowing of the ascending aorta in the parasternal long-axis and a...
			Magnetic Resonance Imaging
		Natural History
		Management
			Medical
			Balloon Valvuloplasty
				Results of Valvuloplasty. Although the results of aortic balloon valvuloplasty are promising, they are not as good as those for ...
			Surgical
			Procedures and Mortality
				Postballoon and Postoperative Follow-up
	COARCTATION OF THE AORTA
		Prevalence
		Pathology
			Symptomatic Infants-Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
			Other Imaging
		Natural History
		Management
			Medical
			Nonsurgical
			Surgical
				Indications and Timing
				Procedures. The choice of surgical procedures varies greatly from institution to institution, but the following procedures are p...
				Mortality. The mortality rate for COA surgery is less than 1.5%. The mortality rate for repair of COA and VSD at the same time i...
				Complications
				Postoperative Follow-up
			Asymptomatic Infants and Children-Clinical Manifestations
			Physical Examination (Fig. 13.16)
			Electrocardiography
			Radiography
			Echocardiography
			Other Imaging
		Natural History
		Management
			Medical
				Nonsurgical
			Surgical
				Indications and Timing
				Procedures
				Mortality. The mortality rate is less than 1% in older children
				Complications
				Postoperative Follow-up
		Management Algorithm
	INTERRUPTED AORTIC ARCH
		Prevalence
		Pathology
		Clinical Manifestations
		Management
14 - Cyanotic Congenital Heart Defects
	NEONATAL PULSE OXIMETRY SCREEN
		Usefulness of Pulse Oximetry
		Neonatal Pulse Oximetry Screen Algorithm
			Test Results
			What To Do with the Screen Results
	TRADITIONAL TOOLS IN DIFFERENTIATION OF CENTRAL CYANOSIS
		Initial Evaluation
		Hyperoxia Test
		Arterial Po2 in Preductal and Postductal Arteries
	COMPLETE TRANSPOSITION OF THE GREAT ARTERIES
		Prevalence
			Pathophysiology
			Clinical Manifestations
				History
				Physical Examination
				Laboratory Studies
				Electrocardiography (Fig. 14.2)
				Radiography
				Echocardiography
				Other Studies
			Natural History
			Management
				Medical
				Surgical
					Procedures
					Postoperative Follow-up After Arterial Switch Operation. Although the complication rate is much lower for arterial switch than f...
	CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
			Other Studies
		Natural History
		Management
			Medical
			Surgical
				Definitive Procedures. There are two major approaches to surgical management of L-TGA, classic repair and anatomic repair. Patie...
				Postoperative Follow-up
		TETRALOGY OF FALLOT
			Prevalence
			Pathology
			Clinical Manifestations
				History
				Physical Examination (Fig. 14.18)
				Electrocardiography
				Radiography
					Acyanotic Tetralogy of Fallot. Radiographic findings of acyanotic TOF are indistinguishable from those of a small to moderate VS...
				Echocardiography
				Other Studies
			Natural History
			Hypoxic Spell
			Management
				Medical
				Surgical
					Complete Repair Surgery. Timing of this operation varies from institution to institution, but early surgery is generally preferr...
					Postoperative Follow-up
	TETRALOGY OF FALLOT WITH PULMONARY ATRESIA (PULMONARY ATRESIA AND VENTRICULAR SEPTAL DEFECT)
		Prevalence
			Pathology
			Clinical Manifestations
			Natural History
			Management
				Medical
				Surgical
					Postoperative Follow-up
	TETRALOGY OF FALLOT WITH ABSENT PULMONARY VALVE
		Prevalence
			Pathology and Pathophysiology
			Clinical Manifestations
			Natural History
			Management
				Medical
				Surgical
					Primary Repair. Complete primary repair is the procedure of choice. VSD is closed either through right ventriculotomy (across th...
	TOTAL ANOMALOUS PULMONARY VENOUS RETURN
		Prevalence
			Pathology and Pathophysiology
			Clinical Manifestations
			Without Pulmonary Venous Obstruction
				History
				Physical Examination
				Electrocardiography
				Radiography
			With Pulmonary Venous Obstruction
				History
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
					1. Features common to all types
				Other Studies
			Natural History
			Management
				Medical
				Surgical
					Procedures. Although procedures vary with the site of the anomalous drainage, all procedures are intended to redirect the pulmon...
					Mortality. The surgical mortality rate is between 5% and 10% for infants with the unobstructed type. This rate can be much highe...
					Complications
					Postoperative Follow-up
		TRICUSPID ATRESIA
			Prevalence
			Pathology
			Clinical Manifestations
				History
				Physical Examination (Fig. 14.35)
				Electrocardiography
				Radiography
				Echocardiography
				Other Studies
			Natural History
			Management
				Initial Medical Management
				Surgical
					Stage 1. The most frequently done first-stage operation is the BT shunt. Under special circumstances, other procedure (e.g., Dam...
					Stage 2. As a stage 2 operation, either a bidirectional Glenn shunt or rarely the hemi-Fontan operation is performed in preparat...
					Stage 3. A modified Fontan operation is the definitive procedure for patients with tricuspid atresia. The whole premise of the F...
					Results of Fontan Operation. Currently, the operative mortality rate of the Fontan procedure is less than 3%. Mean PA pressure o...
					Postoperative Medical Follow-up
					Evolution of the Fontan-Type Operation. The Fontan-type operation applies to many complex CHDs, most of which are otherwise unco...
	PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
		Prevalence
			Pathology
			Clinical Manifestations
				History
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
				Cardiac Catheterization
			Natural History
			Management
				Medical
				Surgical
				Procedures
					1. Staged two-ventricular repair: For the two-ventricular repair, the initial procedure consists of establishing a connection be...
					Postoperative Follow-up. Most patients require close follow-up because none of the surgical procedures available are curative
		HYPOPLASTIC LEFT HEART SYNDROME
			Prevalence
			Pathology
			Pathophysiology
			Clinical Manifestations
			Natural History
			Management
				Presurgical Medical Management
				Surgical
					Staged Surgical Approach. The first-stage (Norwood) operation is performed initially followed by the bidirectional Glenn or the ...
				Hybrid Approach
				Other Surgical Approaches
					Postsurgical Follow-up Plan. After the second-stage operation and the final Fontan operation, the follow-up plans are similar to...
		EBSTEIN’S ANOMALY
			Prevalence
			Pathology
			Clinical Manifestations
				History
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
				Other Studies
			Natural History
			Management
				Medical
				Surgical
					Procedures. Controversy exists concerning the type and timing of surgical procedures
				Complications
				Postoperative Follow-up
		PERSISTENT TRUNCUS ARTERIOSUS
			Prevalence
			Pathology
			Clinical Manifestations
				History
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
				Other Studies
			Natural History
			Management
				Medical
				Surgical
					Definitive Procedure
				Postoperative Follow-up
		SINGLE VENTRICLE
			Prevalence
			Pathology
			Pathophysiology
			Clinical Manifestations
				History
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
				Other Studies
			Natural History
			Management
				Initial Medical Management
				Surgical
				Postoperative Follow-up
		DOUBLE-OUTLET RIGHT VENTRICLE
			Prevalence
			Pathology
			Pathophysiology and Clinical Manifestations
				Echocardiography
				Other Studies
			Natural History
			Management
				Medical
				Surgical
				Definitive Surgeries
					Postoperative Follow-up
		HETEROTAXIA (ATRIAL ISOMERISM, SPLENIC SYNDROMES)
		ASPLENIA SYNDROME
			Prevalence
			Pathology
			Pathophysiology
			Clinical Manifestations
				Physical Examination
				Electrocardiography
				Radiography
				Echocardiography
				Other Imaging Modalities
				Laboratory Studies
			Natural History
			Management
				Medical
				Surgical
		POLYSPLENIA SYNDROME
			Prevalence
			Pathology
			Pathophysiology
			Clinical Manifestations
				Physical Examination
				Electrocardiography (see Fig. 14.68)
				Radiography
				Laboratory Studies
				Echocardiography
				Other Imaging Modalities
			Natural History
			Management
				Medical
				Surgical
					Postoperative Follow-up
	PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN
		Prevalence
			Pathology and Pathophysiology
			Clinical Manifestations
			Management
			Prognosis
15 - Miscellaneous Congenital Cardiac Conditions
	ANEURYSM OF THE SINUS OF VALSALVA
		Management
			Palliative Surgery
			Definitive Surgery
			Intrapulmonary Tunnel Operation (Takeuchi Repair). Intrapulmonary tunnel operation is the most popular among two-coronary repair...
			Left Coronary Artery Implantation. Left coronary artery implantation, with direct transfer of the anomalous left coronary artery...
			Tashiro Repair. Tashiro and colleagues (1993) reported a repair technique that was performed in adult patients. In this procedur...
			Subclavian–to–Left Coronary Artery Anastomosis. In subclavian–to–left coronary artery anastomosis, the end of the left subclavia...
	AORTOPULMONARY SEPTAL DEFECT
	ARTERIOVENOUS FISTULA, CORONARY
	ARTERIOVENOUS FISTULA, PULMONARY
	ARTERIOVENOUS FISTULA, SYSTEMIC
	ATRIAL SEPTAL ANEURYSM
	CERVICAL AORTIC ARCH
	CLEFT MITRAL VALVE
	COMMON ATRIUM (OR SINGLE ATRIUM)
	COR TRIATRIATUM
	DOUBLE-CHAMBERED RIGHT VENTRICLE
	ECTOPIA CORDIS
	HEMITRUNCUS ARTERIOSUS
	IDIOPATHIC DILATATION OF THE PULMONARY ARTERY
	KARTAGENER SYNDROME
	PARACHUTE MITRAL OVALE
	PATENT FORAMEN OVALE
		Patent Foramen Ovale Versus Strokes in Adults
	PERICARDIAL DEFECT, CONGENITAL
	PSEUDOCOARCTATION OF THE AORTA
	PULMONARY ARTERY STENOSIS
		Incidence
		Pathology
		Clinical Manifestation
		Management
	PULMONARY VEIN STENOSIS
		Congenital (“Primary”) Pulmonary Vein Stenosis
			Diagnosis
			Treatment and Prognosis
		Acquired Pulmonary Vein Stenosis
	SCIMITAR SYNDROME
		Infants
		Older Children and Adults
	SYSTEMIC VENOUS ANOMALIES
		Anomalies of the Superior Vena Cava
		Persistent Left Superior Vena Cava Draining Into the Right Atrium
		Persistent Left Superior Vena Cava Draining Into the Left Atrium
		Anomalies of the Inferior Vena Cava
		Interrupted Inferior Vena Cava with Azygos Continuation
		Inferior Vena Cava Connecting to the Left Atrium
16 -
Vascular Ring
	PATHOLOGY
	CLINICAL MANIFESTATIONS
		History
		Physical Examination
		Electrocardiography
	DIAGNOSIS
	MANAGEMENT
		Medical
		Surgical
			Indications and Timing
		Procedures and Mortality
		Complications
	VARIANTS OF AORTIC ARCH BRANCHING
17 -
Chamber Localization and Cardiac Malposition
	Localization of the Atria
		Chest Radiography
			Electrocardiography
			Two-Dimensional Echocardiography and Other Methods
	Localization of the Ventricles
		Electrocardiography
			Two-Dimensional Echocardiography
			Magnetic Resonance Imaging or Ventriculography
		Localization of the Great Arteries
		Segmental Expression
	DEXTROCARDIA AND MESOCARDIA
18 - Primary Myocardial Disease
	HYPERTROPHIC CARDIOMYOPATHY
		Pathology and Pathophysiology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Management
			General Management
			Patients with Symptoms (Dyspnea, Chest Discomfort, Disability)
			Asymptomatic Patients
			Drug-Refractory Patients with Obstruction
			Implantable Cardioverter–Defibrillators
			Mitral Valve Replacement
	INFANTS OF MOTHERS WITH DIABETES
		Prevalence
		Pathology
		Clinical Manifestations
		Management
	OTHER RARE FORMS OF HYPERTROPHIC CARDIOMYOPATHIES
	DILATED CARDIOMYOPATHY
		Prevalence
		Cause
		Pathology and Pathophysiology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
			Other Laboratory Tests
			Cardiac Catheterization
		Natural History
		Management
		Prognosis
	ENDOCARDIAL FIBROELASTOSIS
		Prevalence
		Pathology
		Clinical Manifestations
		Management
		Prognosis
	DOXORUBICIN CARDIOMYOPATHY
		Prevalence
		Cause
		Pathology and Pathophysiology
		Clinical Manifestations
		Management
		Prognosis
	CARNITINE DEFICIENCY
		Treatment
	BARTH SYNDROME
	RESTRICTIVE CARDIOMYOPATHY
		Prevalence and Cause
		Pathology and Pathophysiology
		Clinical Manifestations
		Management
	ARRHYTHMOGENIC CARDIOMYOPATHY
		Cause
		Pathology
		Clinical Manifestations
		Management
	NONCOMPACTION CARDIOMYOPATHY
		Clinical Manifestations
		Treatment
19 - Cardiovascular Infections
	INFECTIVE ENDOCARDITIS
		Prevalence
		Pathogenesis
		Pathology
		Microbiology
		Clinical Manifestations
			History
			Physical Examination
			Laboratory Studies
			Echocardiography
		Diagnosis
		Management
			Prognosis
			Prevention
				Special Situations
	MYOCARDITIS
		Prevalence
		Pathology
		Cause
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Radiography
			Echocardiography
				Laboratory Studies
		Natural History
		Management
	PERICARDITIS
		Cause
		Pathology
		Pathophysiology
		Clinical Manifestations
			History
			Physical Examination
			Electrocardiography
			Chest Radiography
			Echocardiography
		Management
	CONSTRICTIVE PERICARDITIS
	KAWASAKI’S DISEASE
		Cause and Epidemiology
		Pathology
		Clinical Manifestations
			Acute Phase (First 10 Days)
			Subacute Phase (11 to 25 Days After Onset)
			Convalescent Phase
		Diagnosis
		Differential Diagnosis
		Management
			Initial Treatment
			Special Situations in the Treatment of Kawasaki’s Disease
		Natural History
		Long-Term Follow-up
	LYME CARDITIS
		Prevalence
		Cause and Pathology
		Clinical Manifestations
		Diagnosis
		Management
	POSTPERICARDIOTOMY SYNDROME
		Clinical Manifestations
		Management
20 - Acute Rheumatic Fever
	PREVALENCE
	CAUSE
	PATHOLOGY
	CLINICAL MANIFESTATIONS
		History
		Major Manifestations
			Carditis
				Concept of Subclinical Carditis. In the past, clinical evidence of carditis was based solely on the presence of heart murmur of ...
			Arthritis
			Sydenham’s Chorea
			Subcutaneous Nodules
			Erythema Marginatum
		Minor Manifestations
			Other Clinical Features
		Evidence of Antecedent Group A Streptococcal Infection
	DIAGNOSIS
	DIFFERENTIAL DIAGNOSIS
	CLINICAL COURSE
	MANAGEMENT
	PROGNOSIS
	PREVENTION
		Primary Prevention
		Secondary Prevention
21 - Valvular Heart Disease
	MITRAL STENOSIS
		Prevalence
		Pathology and Pathophysiology
		Clinical Manifestations
			History
			Physical Examination (Fig. 21.1)
			Electrocardiography
			Chest Radiography
			Echocardiography
		Natural History
		Management
			For Congenital Mitral Stenosis
			For Rheumatic Mitral Stenosis
			Postintervention Follow-up
	MITRAL REGURGITATION
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 21.2)
			Electrocardiography
			Radiography (Fig. 21.3)
			Echocardiography
		Natural History
		Management
			Medical
			Surgical
			Procedures and Mortality
			Postoperative Follow-up
	AORTIC REGURGITATION
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 21.4)
			Electrocardiography
			Radiography
			Echocardiography
		Natural History
		Management
			Medical
			Surgical
				Indications. A major clinical decision in AR is the timing of aortic valve replacement (AVR). Ideally, it should be performed be...
				Procedure and Mortality. Aortic valve repair is favored over valve replacement whenever possible. Valve replacement does not inc...
				Complications. 1. Postoperative acute cardiac failure is the most common cause of death
				Postoperative Follow-up. 1. Regular follow-up of valve function should be done every 6 to 12 months by echo and Doppler studies
	MITRAL VALVE PROLAPSE
		Prevalence
		Pathology
		Clinical Manifestations
			History
			Physical Examination (Fig. 21.5)
			Electrocardiography
			Chest Radiography
			Echocardiography
		Natural History
		Management
22 -
Cardiac Tumors
	PREVALENCE
	PATHOLOGY
		Types and Frequency of Tumors
		Pathology of Individual Cardiac Tumors
			Rhabdomyoma
			Fibroma
	Myxoma
		Teratoma
			Cardiac Angioma
		Clinical Manifestations
		Diagnostic Procedures
		Management
23 -
Cardiovascular Involvement in Systemic Diseases
	ACUTE GLOMERULONEPHRITIS
	DIGEORGE SYNDROME
		Clinical Manifestations
		Management
		Prognosis
	FRIEDREICH ATAXIA
	HYPERTHYROIDISM: CONGENITAL AND ACQUIRED
	HYPOTHYROIDISM: CONGENITAL AND ACQUIRED
	MARFAN SYNDROME
	MUCOPOLYSACCHARIDOSES
	MUSCULAR DYSTROPHY
	MYOTONIC DYSTROPHY
	NOONAN SYNDROME
		Management
	RHEUMATOID ARTHRITIS
	SICKLE CELL ANEMIA
	SYSTEMIC LUPUS ERYTHEMATOSUS
	TURNER SYNDROME
	WILLIAMS SYNDROME
24 - Cardiac Arrhythmias
	TACHYCARDIA VERSUS BRADYCARDIA
	RHYTHMS ORIGINATING IN THE SINUS NODE
		Regular Sinus Rhythm
			Description
			Significance
			Management
		Sinus Tachycardia
			Description
			Causes
			Significance
			Management
		Sinus Bradycardia
			Description
			Causes
			Significance
			Management
		Sinus Arrhythmia
			Description
			Causes
			Significance
			Management
		Sinus Pause
			Description
			Causes
			Significance
			Management
		Sinoatrial Exit Block
			Description
			Causes
			Significance
			Management
		Sinus Node Dysfunction (Sick Sinus Syndrome)
			Description
			Causes
			Significance
			Management
	RHYTHMS ORIGINATING IN THE ATRIUM
		Premature Atrial Contraction
			Description
			Causes
			Significance
			Management
		Wandering Atrial Pacemaker
			Description
			Causes
			Significance
			Management
		Ectopic (or Autonomic) Atrial Tachycardia
			Description
			Causes
			Significance
			Management
		Chaotic (or Multifocal) Atrial Tachycardia
			Description
			Causes
			Significance
			Management
		Atrial Flutter
			Description
			Causes
			Significance
			Management
		Atrial Fibrillation
			Description
			Causes
			Significance
			Management
		Supraventricular Tachycardia
			Description
			Reentry (Reciprocating) Type of Supraventricular Tachycardia
			Automatic Type of Supraventricular Tachycardia
			Causes
			Significance
			Management
				Prevention of Recurrence of Supraventricular Tachycardia
	RHYTHMS ORIGINATING IN THE ATRIOVENTRICULAR NODE
		Junctional (or Nodal) Premature Beats
			Description
			Causes
			Significance
			Management
		Junctional (or Nodal) Escape Beats
			Description
			Causes
			Significance
			Management
		Nodal (or Junctional) Rhythm
			Description
			Causes
			Significance
			Management
		Accelerated Nodal Rhythm
			Description
			Causes
			Significance
			Management
		Junctional Ectopic Tachycardia (Nodal Tachycardia)
			Description
			Causes
			Significance
			Management
	RHYTHMS ORIGINATING IN THE VENTRICLE
		Premature Ventricular Contraction
			Description
				Interrelationship
			Coupling Interval
			Aberration
			Causes
			Significance
			Management
		Accelerated Ventricular Rhythm
			Description
			Causes
			Significance
			Management
		Ventricular Tachycardia
			Description
			Causes
			Significance
			Management
		Ventricular Arrhythmias in Children with Normal Hearts
		Ventricular Fibrillation
			Description
			Causes
			Significance
			Management
		Long QT Syndrome
			Causes
			Pathophysiology
			Clinical Manifestations
			Diagnosis
			Management
			Prognosis
		Short QT Syndrome
		Brugada Syndrome
25 -
Disturbances of Atrioventricular Conduction
	FIRST-DEGREE ATRIOVENTRICULAR BLOCK
		Description
			Causes
			Significance
			Management
	SECOND-DEGREE ATRIOVENTRICULAR BLOCK
		Mobitz Type I (Wenckebach)
			Description
			Causes
			Significance
			Management
		Mobitz Type II
			Description
				Causes
				Significance
				Management
			Two-to-One (or Higher) Atrioventricular Block
				Description
				Causes
				Significance
				Management
	THIRD-DEGREE ATRIOVENTRICULAR BLOCK (COMPLETE HEART BLOCK)
		Description
			Causes
				Acquired Type. Cardiac surgery is the most common cause of acquired complete heart block in children. Other rare causes include ...
			Significance
			Management
	ATRIOVENTRICULAR DISSOCIATION
26 - Cardiac Pacemakers and Implantable Cardioverter–Defibrillators in Children
	ELECTROCARDIOGRAMS OF ARTIFICIAL CARDIAC PACEMAKERS
		Ventricular Pacemaker (Ventricular Sensing and Pacing)
		Atrial Pacemaker (Atrial Sensing and Pacing)
		P-Wave Triggered Ventricular Pacemaker (Atrial Sensing, Ventricular Pacing)
	PACEMAKER THERAPY IN CHILDREN
		Indications
		Types of Pacing Devices
		Selection of Pacing Mode
		Battery, Leads, and Route
	IMPLANTABLE CARDIOVERTER–DEFIBRILLATOR THERAPY
		Indications
		Living with a Pacemaker or Implantable Cardioverter–Defibrillator
		Follow-up for Pacemaker and Implantable Cardioverter–Defibrillator
27 - Congestive Heart Failure
	CAUSES
		Congenital Heart Disease
		Acquired Heart Disease
		Miscellaneous Causes
	PATHOPHYSIOLOGY
		Preload
		Afterload
		Compensatory Mechanisms
	DIAGNOSIS
		History
		Physical Examination
		Radiography
		Electrocardiography
		Echocardiography
		Tissue Diagnosis
		Cardiac Biomarkers
	MANAGEMENT
		Treatment of Underlying Causes or Contributing Factors
		General Measures
		Drug Therapy
			Diuretics
				Side Effects of Diuretic Therapy. Diuretic therapy alters the serum electrolytes and acid–base equilibrium
			Rapidly Acting Inotropic Agents
			Digitalis Glycosides
				Dosage of Digoxin. The total digitalizing dose and maintenance dosage of digoxin in treating CHF by oral and intravenous routes ...
				How to Digitalize. Loading doses of the total digitalizing dose are given over 12 to 18 hours followed by maintenance doses. Thi...
				Monitoring for Digitalis Toxicity by Electrocardiography. Digitalis toxicity is best detected by monitoring with ECGs, not serum...
				Serum Digoxin Levels. Therapeutic ranges of serum digoxin levels for treating patients with CHF are 0.8 to 2 ng/mL. Levels obtai...
				Digitalis Toxicity. Digitalis toxicity may result during treatment with digoxin or from an accidental overdose of digoxin. With ...
			Afterload-Reducing Agents
			Other Drugs
				Carnitine. Carnitine, which is an essential cofactor for transport of long-chain fatty acids into mitochondria for oxidation, ha...
	SURGICAL MANAGEMENT
28 -
Systemic Hypertension
	DEFINITION
	WHICH NORMATIVE BLOOD PRESSURE STANDARDS?
	WHAT ABOUT OTHER MEANS OF BLOOD PRESSURE MEASUREMENT?
		Cause
		Diagnosis and Workup
			Steps to Confirm the Diagnosis
		History
			Past and Present History
			Family History
			Physical Examination
			Initial Investigation
		Specialized Studies
			Echocardiography
			Images for Renovascular Disease
			Specialized Chemistries
		Nonpharmacologic Intervention
		Pharmacologic Intervention
		Indications for Drug Therapy
			End-Organ Damage
			The Choice of Drug
		Classes of Antihypertensive Drugs
			Diuretics
			Adrenergic Inhibitors
			Angiotensin-Converting Enzyme Inhibitors
			Angiotensin Receptor Blockers
			Calcium Channel Blockers
			Vasodilators
		Follow-up Evaluation of Patients with Chronic Hypertension
			White-Coat Hypertension
			Secondary Hypertension
			Renovascular Hypertension
				Pathogenesis of Renovascular Hypertension. The renin–angiotensin–aldosterone system (RAAS) is involved in the pathogenesis of re...
			Causes
			Clinical Manifestations
			Diagnostic Workup
			Management
			Pheochromocytoma
			Management of Other Forms of Secondary Hypertension
				Cardiovascular Causes. Hypertension caused by mild coarctation is treated with beta-blockers. Surgical or catheter interventiona...
				Renal Parenchymal Disease. In nephritis, medical management should be instituted to lower BP in the same manner as has been disc...
				Renovascular Disease. Renovascular disease may be cured by successful renal artery balloon angioplasty or surgery, such as recon...
				Adrenal Glands. Hyperaldosteronism caused by bilateral adrenal hyperplasia is treated with a mineralocorticoid antagonist, such ...
29 - Pulmonary Hypertension
	DEFINITION
	CAUSES
	PHYSIOLOGY OF THE PULMONARY CIRCULATION
	PATHOGENESIS OF PULMONARY HYPERTENSION
		Hyperkinetic Pulmonary Hypertension
		Alveolar Hypoxia
		Pulmonary Venous Hypertension
		Primary Pulmonary Hypertension
		Other Disease States
	PATHOLOGY OF PULMONARY HYPERTENSION
	PATHOPHYSIOLOGY
	CLINICAL MANIFESTATIONS
		History
		Physical Examination
		Electrocardiography
		Radiographic Studies
		Echocardiography
		Exercise Testing
	DIAGNOSIS
	NATURAL HISTORY
	MANAGEMENT
		Treating Underlying Causes
		General Measures
		Anticoagulation
		Pharmacologic Treatment of Chronic Pulmonary Hypertension
		For “Acute Responders”
		For “Nonresponders”
30 - The Child with Chest Pain
	CAUSE AND PREVALENCE
	CLINICAL MANIFESTATIONS
		Idiopathic Chest Pain
		Noncardiac Causes of Chest Pain
			Costochondritis
			Musculoskeletal
			Respiratory
			Exercise-Induced Asthma
			Gastrointestinal
			Psychogenic
		Miscellaneous
		Cardiovascular Causes of Chest Pain
		Ischemic Myocardial Dysfunction
			Congenital Heart Defects
			Mitral Valve Prolapse
			Cardiomyopathy
			Coronary Artery Disease
			Cocaine Abuse
			Aortic Dissection or Aortic Aneurysm
		Pericardial or Myocardial Disease
			Pericarditis
			Myocarditis
		Arrhythmias
	DIAGNOSTIC APPROACH
		History of Present Illness
		Past and Family Histories
		Physical Examination
		Other Investigations
		Referral to Cardiologists
	MANAGEMENT
31 - Syncope
	PREVALENCE
	DEFINITION
	CAUSES
	NONCARDIAC CAUSES OF SYNCOPE
		Vasovagal Syncope
		Orthostatic Hypotension (Dysautonomia)
		Postural Orthostatic Tachycardia Syndrome
		Exercise-Related Syncope
		Rare Causes of Syncope
	CARDIAC CAUSES OF SYNCOPE
		Obstructive Lesions
		Myocardial Dysfunction
		Arrhythmias
			No Identifiable Structural Defects
			Structural Heart Defects
	EVALUATION OF A CHILD WITH SYNCOPE
		History
		Physical Examination
		Diagnostic Studies
			Head-up Tilt Table Test
	TREATMENT
		Cardiac Arrhythmias
	DIFFERENTIAL DIAGNOSIS
		Epilepsy
		Hypoglycemia
		Hyperventilation
		Hysteria
32 - Palpitation
	DEFINITION
		Causes
	EVALUATION
		History
		Physical Examination
		Recording of Electrocardiogram Rhythm
		Echocardiography
		Laboratory Studies
	MANAGEMENT
33 -
Dyslipidemia and Other Cardiovascular Risk Factors
	REVIEW OF LIPID BIOCHEMISTRY
		Lipids and Lipoproteins
			Small, Dense Low-Density Lipoprotein
		Lipid and Lipoprotein Metabolism
			Exogenous Pathway
			Endogenous Pathway
	DIAGNOSIS OF DYSLIPIDEMIA
		Measurement of Lipid and Lipoproteins
		Normal Levels of Lipids and Lipoproteins
	CLASSIFICATION OF DYSLIPIDEMIA
		Secondary Dyslipidemia
		Selected Primary Dyslipidemias
			Familial Hypercholesterolemia
			Familial Combined Hyperlipidemia
			Familial Hypertriglyceridemia
			Dysbetalipoproteinemia (Type III Hyperlipoproteinemia)
			Familial Hypoalphalipoproteinemia (Low High-Density Lipoprotein Syndrome)
	MANAGEMENT OF HYPERCHOLESTEROLEMIA
		Dietary Management of Hypercholesterolemia
		Indications for Drug Therapy
		Lipid-Lowering Drugs
		The “Statins”
			Adverse Effects of Statins
			Dosages of the “Statins”
	HYPERTRIGLYCERIDEMIA
		Management of Hypertriglyceridemia
	LOW HIGH-DENSITY LIPOPROTEIN LEVEL
	ELEVATED TRIGLYCERIDE AND LOW HIGH-DENSITY LIPOPROTEIN
34 - Pediatric Preventive Cardiology
	CHILDHOOD ONSET OF CORONARY ARTERY DISEASE
	CARDIOVASCULAR RISK FACTORS
		Metabolic Syndrome
		Lipid Screening for Dyslipidemia
			Current Recommendations
			What To Do with the Results of the Screening
			Management Plans
		Obesity
			Definition and Classification
		Prevalence
		Pathogenesis
			Concept of Energy Balance
			High Glycemic Index Food as a Cause of Obesity and Increased Cardiovascular Risks
				Glycemic Index. The glycemic index, first described by Dr. David J. Jenkins of the University of Toronto and his colleagues in 1...
				Glycemic Load. One criticism of the GI is that it tells only how rapidly 50 g of CHO in a particular food turns into blood sugar...
				How may high-GI food contribute to weight gain and increase CV risk? Figure 34.2 shows the data reported by Dr. David S. Ludwig ...
				Why is low-GI food good for your health?. Consumption of low-GI food has been shown to have the following benefits, opposite to ...
		Health Consequences of Obesity
		Evaluation of Obese Children
		Management
			Dietary Component
			Physical Activity
			Behavior Modification
			Early Intervention and Family Involvement
		Cigarette Smoking
			Prevalence
				Pathophysiologic Effects of Smoking. The following are some pathophysiologic effects of smoking on the CV system (Lu et al, 2004...
				Psychosociology of Smoking. Physicians should be aware of the psychosociology of initiating smoking to help prevent smoking in c...
			Management
				Pharmacologic Approach. Currently, there is insufficient evidence for the effectiveness of pharmacologic treatments with youth s...
		Practice of Preventive Cardiology
35 - Athletes with Cardiac Problems
	SUDDEN UNEXPECTED DEATH IN YOUNG ATHLETES
	PREPARTICIPATION SCREENING
		History and Physical Examination
			Personal History
			Family History
			Physical Examination
		Electrocardiography
		Echocardiography
	CLASSIFICATION OF SPORTS
	ELIGIBILITY DETERMINATION OF ATHLETES WITH CARDIOVASCULAR DISEASES
		Acyanotic Congenital Heart Defects
		Cyanotic Congenital Heart Defects
		Other Miscellaneous Cardiac Conditions
		Valvular Heart Diseases
		Cardiomyopathy, Pericarditis, and Other Myocardial Diseases
	ATHLETES WITH ARRHYTHMIAS AND CONDUCTION DISTURBANCES
		Diagnostic Workup
			History
				Physical Examination. Physical examination may reveal irregularity of heart rate but regular heart rate on examination does not ...
				Recording of Electrocardiogram. Normal ambulatory ECG monitor does not provide absolute safety or absence of arrhythmias because...
				Exercise Stress Test. An EST is often needed to document appearance or disappearance of arrhythmias with exercise. Arrhythmias t...
			Eligibility Recommendations for Cardiac Arrhythmias
			Eligibility Recommendations for Atrioventricular Block and Intraventricular Blocks
	ATHLETES WITH SYSTEMIC HYPERTENSION
36 -
Cardiac Transplantation
	INDICATIONS
	SELECTION OF THE RECIPIENT
	EVALUATION AND MANAGEMENT OF THE CARDIAC DONOR
	INFORMED CONSENT FROM THE FAMILY AND RECIPIENT
	OPERATIVE TECHNIQUE
	POSTTRANSPLANT MANAGEMENT
		Frequency of Clinic Visits and Investigations
	OVERVIEW OF IMMUNOSUPPRESSIVE THERAPY
		Calcineurin Inhibitors
			Cyclosporine
			Tacrolimus
		Corticosteroids
		Antiproliferative Agents
			Azathioprine
			Mycophenolate Mofetil
	EARLY POSTTRANSPLANTATION FOLLOW-UP
		Acute Rejection
			Identification
			Treatment
			Infection
		Late Posttransplantation Follow-up
		Rejection
		Allograft Coronary Artery Disease
		Side Effects of Immunosuppression
	PHYSIOLOGY OF THE TRANSPLANTED HEART
	PROGNOSIS
A - Miscellaneous
B- Blood Pressure Values
C - Cardiovascular Risk Factors
D - Normal Echocardiographic Values
E - Drugs Used in Pediatric Cardiology