A thorough history is an essential part of virtually all medical encounters. With regard to the cardiovascular system, this can be performed at 2 levels: that which is part of the review of systems at all well-child and illness visits and a more comprehensive history performed when there is reason to suspect a cardiovascular disorder.
General Cardiovascular History
In infants and younger children, questions regarding feeding and respiration may point to a cardiovascular disorder. Rapid breathing or retractions while feeding or failure to gain weight may indicate cardiac disease. In older children, exercise intolerance, light-headedness, syncope, or chest pain may suggest an underlying cardiac abnormality. Each of these symptoms, however, is extremely common in the general population, and further history, physical examination, and laboratory tests are frequently necessary to determine the cause.
Comprehensive Cardiovascular History
If the patient’s presentation, screening history, or physical examination suggests a possible cardiovascular disorder, a more detailed cardiovascular history is warranted. Examples include the critically ill patient presenting in shock or respiratory distress, the preschool child or adolescent with a newly detected heart murmur, and the child complaining of chest pain, exercise intolerance, palpitations, or syncope. In these situations, a more detailed history is necessary. This should include a consideration of the pregnancy and neonatal period, growth and development during early childhood, and family history as well as the current complaint. See Table 481-1 for significant points of historical inquiry.
TABLE 481-1MEDICAL HISTORY POINTS RELEVANT TO CARDIOVASCULAR DISEASE |Favorite Table|Download (.pdf) TABLE 481-1MEDICAL HISTORY POINTS RELEVANT TO CARDIOVASCULAR DISEASE
|History ||Red Flags |
|Pregnancy || |
Systemic lupus erythematosus
|Neonatal || |
Need for oxygen supplementation
Prolonged hospitalization after birth
|Infancy || |
Failure to thrive
|Children and adolescents || |
|Family || |
Congenital heart defects
Early (< 40 years) sudden death or heart-related disability and/or surgeries
Inherited cardiovascular diseases (eg, hypertrophic cardiomyopathy)
With the advancements in our knowledge of genetic contributions to cardiovascular disease, the importance of a complete, accurate family history cannot be overstated. The majority of inherited cardiovascular conditions have an autosomal dominant mode of inheritance, so a child with an affected parent or sibling often has a 50% risk of having or developing the same disease. A combination of genetic testing and cardiovascular screening is required for a child with an abnormal family history.
If a child’s affected family member is available, then he or she is an ideal candidate to undergo genetic testing in order to find the specific gene mutation that causes the disease. The primary justification for genetic testing is the ability to distinguish those at high risk of disease who need close surveillance and management (ie, the child tests positive for the gene mutation in the family) from those at low risk who require limited to no cardiological follow-up ...