Sudden Collapse of a Preschool-Aged Child on the Playground.
OBJECTIVE
Primary cardiac events are rare in children. There is little information in the literature regarding the most appropriate emergency department (ED) management of this type of pediatric patient, especially with regard to medication use.


CONCLUSIONS
This case highlights the pediatric ED evaluation and treatment of sudden collapse in a child with an ultimate diagnosis of hypertrophic cardiomyopathy. Cardiac disorders represent 2% to 6% of cases of pediatric syncope presenting to EDs, particularly if there are previous prodromal symptoms and/or a history of exertion. Evaluation should include electrocardiogram, chest radiograph, and echocardiogram if available. Management should focus on decreasing the potential for a recurring arrhythmia while maintaining cardiac preload, which can be worsened with certain medication use.


CONCLUSIONS
Although primary cardiac events in children are rare, a high index of suspicion should be maintained especially with a history of prodromal symptoms or collapse during exertion. If cardiac etiology is suspected, deliberate management should be used to exclude a treatment that could be detrimental. This case report provides an initial assessment and recommendations for management of these patients.
From the Divisions of *Emergency Medicine, †Pharmacy, and ‡Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
RoseAnn L
RL
Scheller
Laurie H
LH
Johnson
Michelle C
MC
Caruso
Angela
A
Lorts
D024741:Cardiomyopathy, Hypertrophic, Familial / Q000150:complications* / Q000175:diagnosis* / Q000235:genetics; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009154:Mutation; D012518:Sarcomeres / Q000235:genetics; D013318:Stroke Volume; D013575:Syncope / Q000209:etiology*; D000099163:Myosin Binding Protein C
D002352:Carrier Proteins; D000099163:Myosin Binding Protein C