Pooja Gupta, MD, Editor

Richard Humes, MD, Editor

Most congenital heart diseases are evident in early life, presenting with cyanosis, heart murmur, congestive heart failure, or shock. Textbooks in pediatric cardiology are filled overwhelmingly with chapters on the various congenital heart lesions that are encountered, both rare and common. However, practicing pediatric cardiologists will be quick to point out that a significant number of referrals to their practice may be due to symptoms referred to the heart but the majority of them do not involve congenital heart problems. Many of these problems may be perplexing to the general pediatrician and create tremendous anxiety for the patients and families. Heart murmur, chest pain, syncope, and suspected rhythm problems constitute the top four reasons for new outpatient referral to any pediatric cardiology practice. Many of these problems present to the general pediatrician during the teen years and the numbers of referrals reflect the concern and uncertainty that pediatricians have in diagnosing and managing these problems. There are also rare congenital heart problems that can have a lethal outcome and must be addressed in a timely manner. Sudden death in young athletes, even though rare, often receives sensational press coverage.

Reviewing our own statistics at the Children’s Hospital of Michigan Cardiology Center for the past two years (2010–2012) reveals that outpatient visits for new patient consultations examined by age groups are as follows: less than 1 year of age, 11%; 1 to 5 years, 23%; 6 to 10 years, 21%; 11 to 18 years, 45%. Retrospective data collected from billing codes, as in this brief survey, may be imprecise. However, it does provide a snapshot of the usual referral problems encountered by pediatric cardiologists. In our practice, the most common overall reason for referral in all ages was “heart murmur,” constituting 26% of total referrals. The second most common were rhythm and rhythm-related problems (inclusive of palpitations, abnormal ECG, and diagnosed premature beats), which constituted 19% of the total.

In the age group of interest for this issue of 11 to 18 years, the most common presenting issues, were rhythm-related (23%) and chest pain (23%), followed by syncope or dizziness (19%), and heart murmur (12%). Congenital heart disease diagnoses encountered in the 11- to 18-year age group comprised only 6.5% of referrals within that age group. It is likely that many of these were not new diagnoses (with a few exceptions), but rather represented transfers to our practice.

Our own outpatient clinical experience reveals that the majority of outpatients referred by pediatricians for pediatric cardiology evaluation are between the ages of 11 and 18. We decided to devote this text to defining the spectrum of cardiac issues and problems commonly encountered during adolescence by pediatricians and other primary caregivers. We have asked the authors to emphasize the role of the pediatrician/primary caregiver in diagnosing and managing these issues, as well as defining when appropriate referral is needed.