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Paeds Casescardiology

Paeds Cases · cardiology

Cardiomyopathies in children — structured clinical encounter

Structured encounter testing the approach to an adolescent who collapses during a race with a family history of sudden death: recognition of hypertrophic cardiomyopathy, the bedside and echocardiographic assessment, sudden-death risk stratification, the implantable defibrillator decision, and family cascade screening.

structured clinical encounter2 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 14-year-old competitive runner collapses briefly during a 1500-metre race and recovers fully in seconds. His father died suddenly at 38. A soft ejection systolic murmur at the left sternal border grows louder on standing. You are the paediatric registrar working through the diagnosis, the investigations, the sudden-death risk stratification, and the management and family-counselling plan.

Station brief (candidate)

You are the paediatric registrar in the emergency department. A 14-year-old competitive runner collapsed briefly during a 1500-metre race and recovered fully within seconds. His father died suddenly at 38 of an unspecified "heart attack". On examination he is well, with a soft ejection systolic murmur at the left sternal border that grows louder on standing. The team asks you to establish the diagnosis, order and interpret the investigations, perform the sudden-death risk stratification, and proceed to the management and family-counselling plan. You have 12 minutes with the team and 5 minutes for examiner discussion. [4] [6]

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References5ShowHide
  1. [4]Maron BJ Hypertrophic cardiomyopathy: a systematic review. JAMA, 2002.PMID 11886323
  2. [5]Maron BJ; Shen WK; Link MS; Epstein AE; Almquist AK; Daubert JP; et al Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med, 2000.PMID 10666426
  3. [6]Bagnall RD; Weintraub RG; Ingles J; Duflou J; Yeates L; Lam L; et al A Prospective Study of Sudden Cardiac Death among Children and Young Adults. N Engl J Med, 2016.PMID 27332903
  4. [8]Burkett EL; Hershberger RE Clinical and genetic issues in familial dilated cardiomyopathy. J Am Coll Cardiol, 2005.PMID 15808750
  5. [9]Alexander PMA; Nugent AW; Daubeney PEF; Lee KJ; Sleeper LA; Schuster T; et al Long-Term Outcomes of Hypertrophic Cardiomyopathy Diagnosed During Childhood: Results From a National Population-Based Study. Circulation, 2018.PMID 29490994
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