CHAPTER 86 ■ CARDIAC EMERGENCIES CASANDRA QUIñONES, BETH BUBOLZ GOALS OF EMERGENCY THERAPY Pediatric cardiac emergencies encompass a broad spectrum of disease states and thus have a variety of presentations Cardiac emergencies may be caused by congenital heart disease (CHD), arrhythmias, acute heart failure syndromes (AHFS), trauma, infection, ischemia, inflammation, and as sequelae of treatment The common denominators in cardiac emergencies ultimately distill down to either abnormal pulmonary blood flow (PBF) or compromised cardiac output The special challenge for the emergency medicine (EM) provider is to identify cardiac emergencies promptly even when the chief complaint is not cardiac in nature The clinician must consider heart disease when evaluating common symptoms such as feeding difficulty, abdominal pain, wheezing, or respiratory distress An exhaustive knowledge of every anatomic variation of CHD is not necessary By simply maintaining a high index of suspicion for cardiac conditions the provider can recognize cardiac disease by the presenting symptoms and determine the correct approach to such complex patients KEY POINTS CHD should be considered in any neonate presenting with acute decompensation in the first months of life CHD often presents with cyanosis or shock in the first weeks of life, coinciding with closure of the ductus arteriosus (DA) CHD often presents with pulmonary overcirculation and poor feeding around months of life, coinciding with fall in pulmonary vascular resistance (PVR) Pediatric patients with AHFS often present with nonspecific, noncardiac complaints on multiple visits before heart failure is recognized Incessant tachycardia may lead to heart failure at any age Children with implanted cardiac devices may present with complications of implantation or device failure RELATED CHAPTERS