Guest editorial

Managing children’s heart disease: a basic guide to wizardry

Rik De Decker, MSc, MB ChB, DCH, FCPaeds (SA), Cert Med Genetics (Paeds)

Senior specialist paediatric cardiologist, Division of Critical Care and Children’s Heart Diseases, Red Cross War Memorial Children’s Hospital, Cape Town

Rik is a paediatric cardiologist at Red Cross Children’s hospital with special interests in the genetic control of heart development and interventional cardiac catheterisation. He panics when in big flat spaces.

Correspondence to: Rik De Decker (

Few things are as worrisome as a sick child, and when that child’s malaise seems to spring from a defective heart, most medics pale. Differential cyanosis, mid-diastolic murmur, dextrocardia and ejection click: the legion of terms from the lexicon of cardiogenic symptoms and signs seem to be suffused with an aura of daunting complexity. Only after some people - mumbling incoherently around a flashing echo screen in a darkened room - have probed the patient, or a pontificating highbrow has deciphered those hideous hieroglyphics on long paper strips, may cracks appear to throw some light on the child’s true diagnosis. Then you pass your patient on through a series of hoops into the hands of worried anaesthetists asking awkward questions before allowing a coldly competent craftsman to ‘correct the defect’.

When, some weeks later, your patient returns, tattooed by the craftsman and perhaps a little less blue, smartly labelled in a cryptic discharge letter as an ‘AVSD/Tet post RMBTS’ or ‘bilateral Glenn’, or even more esoterically a ‘left isomerism after a DKS with a PPM set at VVIR’ the gloom descends once again, like a dementor onto Harry Potter.

However, no special wizard-like magic is required to help these desperate children. In your hands now is a scenario-based hands-on no-nonsense review of childhood cardiac problems that may help and hopefully convince you that the dizzying complexity can readily be dispelled by following a basic approach and using the toolbox of simple clinical skills that all of us possess.

This edition of CME is aimed at looking at the common but serious cardiac conditions that befall children, from babies to teenagers, and how to approach and manage them effectively and safely. These articles are not intended to be academic treatises on paediatric cardiology, but rather a series of reminders and pointers on how to make sense of a child’s heart disease in various contexts, with a few illustrative pitfalls gleaned from the authors - most gained by bitter experience.

Crucially, the early recognition of a child with heart disease is made at the coalface, teased out in a bustling emergency room from among the many other babies and children with similar presenting complaints. The hard work is done at the point of first contact, where the exact diagnosis is often (and usually) not essential, yet an understanding of the probable pathology and its urgent management may well be critical to the child’s survival. We hope that this issue of CME will not remain stashed on your bookshelf, but be at hand to sharpen your awareness and recognition of paediatric heart disease and dispel that voodoo aura that is often its unnecessary companion.

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