Informed Consent for Cardiac Screening, and the Law of Unintended Consequences
- Mon, 11/8/10 - 10:52am
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The last several years have seen increased concern about the phenomenon of sudden unexpected death in young people, particularly athletes. Nearly all such tragedies garner significant media attention, and lead to recurring understandable questions as to how such terrible events might be prevented. Presuming that such cases result from cardiac conditions that might be detectable through the use of non-invasive tests, it seems obvious to some that we should make a major effort to identify young athletes at risk through screening, allowing one to (presumably) prevent a subsequent catastrophe. The topic of cardiac screening is, in fact, quite controversial. Viewed from the point of view of the grieving parent, pre-participation screening seems to be an obviously beneficial measure. From a public health point of view, however, it is not as clear.
The Fourth Door
- Wed, 8/11/10 - 12:17pm
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It is Friday, my regularly scheduled outpatient clinic day. As what sometimes happens, the last patient of the day and her mother are crying. This is how it unfolded. I look down and see written on the referral sheet: 16-year-old girl with QT prolongation and syncope. Sounds simple — diagnose her with long QT syndrome, take away her alarm clock, swimsuit and running shoes, start a beta blocker, print out a sheet on QT-prolonging medications, and send her on her way. Well, it is never that simple. In fact, it is always complicated. This girl’s corrected QT interval is 469, she has normal appearing T-waves, and now it gets dicey. As she tells the story, it becomes less clear whether she actually fainted. Syncope has been replaced by extreme dizziness that brought her to her knees, but she swears consciousness never left her. There is no family history of sudden cardiac death, but her 19-year-old sister had a single seizure at 8 years of age while waking up to her alarm.
ICDs in the Young: A Challenge for Physicians, and an Even Greater Challenge for Patients and Families
- Thu, 7/1/10 - 1:34pm
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By Ian Law, MD, Jean Gingerich, RN, BSN and Nicholas Von Bergen, MD
For those who have had the privilege of caring for children and young adults with life-threatening heart disease requiring ICD implantation, you are well aware that much of the emotional impact of the ICD occurs after device placement.
Child Neurologists and Pediatric Electrophysiologists
- Thu, 3/11/10 - 11:58am
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- 2006 reads
In medical school, I had a professor who talked about the “TWUD” factor, i.e., “Time Wasted in Useless Discussion.” As he defined it, TWUD is the mathematical quotient of the time spent discussing a particular diagnosis on rounds, divided by the number of times it is actually encountered. As an example of a high-TWUD factor condition, the entity “arrhythmogenic epilepsy” was cited, whereas “bronchopneumonia” has a low value.
Pediatric Electrophysiology: Venturing Into a World of Off-Label Products
- Mon, 2/8/10 - 1:55pm
- 2 Comments
- 2437 reads
The other day I was changing a light bulb in my stairwell and found that I was unable to reach the light fixture without venturing onto the forbidden top step of the ladder. After a quick glance at the bright yellow disclaimer, I cautiously climbed up, changed the bulb, and went on my way. Was that a smart choice on my part? My wife would say no, but
then again, she is happy with the results. Such is the life of a pediatric electrophysiologist. The list of FDA-approved medications, ablation catheters and equipment, and rhythm management devices is prohibitively limited, and yet care continues to be provided.
Overview of the 5th Charleston Symposium on Pediatric Electrophysiology: Focus on Clinical Management
- Mon, 1/11/10 - 4:14pm
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As part of our first Pediatric EP blog, it is timely to be able to report on the recent 5th Charleston Symposium on Pediatric Electrophysiology, which took place December 13-15, 2009, in Charleston, South Carolina. Based on feedback from prior years and an interest in keeping the course updated over time, this year’s program was somewhat different by focusing primarily on how to make decisions on care rather than the technical aspects of delivering care. To that end, most of the talks were preceded by a case report that demonstrated the complexity of decision making in the relevant topic and posed a set of questions for the speaker. Apparently, our brochure “sold” this concept well, because of the 100 or so attendees, over half were a mix of non-electrophysiologists, including pediatric cardiologists, adult cardiologists and nurse practitioners. Attendees came from all over the U.S., as well as Japan and five countries in Europe.
