To determine the frequency of significant complications of exercise testing in children, we reviewed 1,730 studies performed over a 9-year period, 1973 to 1982. The protocol used a graded, continuous test to maximal effort on a cycle ergometer. The overall incidence of complications was 1.79%, similar to the 1.7% previously reported by Freed [4]. No deaths occurred. Complications were classified into 4 groups with their frequency of occurrence as follows: chest pain (0.69%), dizziness or syncope (0.29%), decreased blood pressure (0.35%), hazardous arrhythmias (0.46%). These data confirm that exercise testing in children has low morbidity and mortality. We believe that the safety of stress testing should encourage physicians to expand its use in the assessment of functional ability.

Adolescent↗

PubMedDate not supplied

Abnormalities in lymphocyte populations in infants with neural crest cardiovascular defects.

The DiGeorge syndrome has been associated with various immune deficits. Embryologically, defects of the neural crest are associated with conotruncal and aortic arch abnormalities. The objective of this study was to determine if children with neural crest congenital heart defects can have subtle but significant immunodeficiencies. Complete blood counts with differential counts and a standard lymphocyte immunophenotyping panel of selected monoclonal antibodies were performed on peripheral blood from 20 children with neural crest cardiac disease and 34 normal newborns. The children with cardiac disease were grouped as survivors and nonsurvivors. The mean total white blood cell count was similar for all groups, but the percent lymphocytes was significantly less in the nonsurvivors than in the survivors and normal newborns (p < 0. 02). The lymphocyte subsets affected were CD2, CD3, and CD4. When the cardiac patients were compared to the normal newborns, again differences in lymphocyte subsets CD2, CD3, and CD4 were seen. When comparing nonsurvivors with survivors, the mean percentages of the CD2, CD3, and CD4 T lymphocyte markers, as well as the mean lymphocyte, B cell (CD20), and natural killer cell (CD16) percentages were all lower in the nonsurvivors. It was concluded that abnormalities in specific lymphocyte populations and their subsets may be predictors of infants at greatest risk for immunodeficiency complications. Therefore children with neural crest cardiac defects should have evaluations of lymphocyte subsets at birth and be treated as if potentially immunodeficient.

Antibodies, Monoclonal↗

PubMedDate not supplied

Introduction: pediatric cardiology exercise testing.

Explore the source record for details and available documents.

Child↗

PubMedDate not supplied

A novel use of Amplatzer duct occluder.

This report describes the use of the Amplatzer patent ductus arteriosus occluder to close a left ventricle to descending aorta conduit. The patient was a 10-year-old male who was born with critical aortic stenosis and left ventricular outflow tract obstruction. After initial valvotomy, he underwent left ventricular to descending aorta conduit placement. At the age of 10, he had a Konno procedure to enlarge the left ventricular outflow tract and 21-mm St. Jude aortic valve placement. Closure of the conduit was not addressed because it was inaccessable from median sternotomy. Postoperatively, echocardiogram revealed significant flow through the conduit with a wide pulse pressure. Cardiac catheterization was performed with the premise to close the conduit with an Amplatzer patent ductus arteriosus occluder device.

Aortic Valve Stenosis↗

PubMedDate not supplied

Electrocardiographic abnormalities in pediatric neuromuscular disease: a review.

Cardiac abnormalities, often heralded by electrocardiographic alterations, at times may become a serious problem in patients with neuromuscular disorders and occasionally lead to death. Electrocardiographic monitoring can identify patients whose conduction defects will benefit from the use of demand pacemakers.

Arrhythmias, Cardiac↗

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Racial differences in hemodynamic responses to the cold face stimulus in children and adults.

The prevalence of essential hypertension is higher among blacks than whites. One reason for this difference may be that blacks are more reactive to stressors that produce vasoconstrictive responses. Two studies were conducted to test this hypothesis, one with 10- to 14-year-old males (20 whites, 20 blacks) and one with young adult males (10 whites, 10 blacks). Subjects had blood pressure, heart rate, cardiac output, and total peripheral resistance measured before, during, and after exposure to forehead cold stimulation. In both studies, blacks exhibited greater increases in diastolic blood pressure and total peripheral resistance to the stressor than whites. The findings are discussed in relation to blacks' greater pressor reactivity to stress, which appears to be mediated by changes in total peripheral resistance.

Adolescent↗

PubMedDate not supplied

Ethnicity, family history of hypertension and patterns of hemodynamic reactivity in boys.

This study compared blood pressure, heart rate, stroke volume, vascular resistance, and cardiac output responses to a video game challenge and forehead cold stressor in 6- to 15-year-old males who varied in ethnicity and family history of essential hypertension. Controlling for age, significant baseline differences were obtained with black boys exhibiting higher systolic and diastolic pressures than their white cohorts. Positive family history children were found to have higher cardiac outputs and stroke volumes indexed by body surface area during baseline. Controlling for baseline hemodynamic responses and age, positive family history children exhibited greater increases in systemic vascular resistance and systolic and diastolic pressure and greater decreases in heart rate to the cold stressor. The positive family history children exhibited greater decreases in cardiac index during both the video game and cold stressor phases. Implications of the findings and directions for future research are discussed.

Arousal↗

PubMedDate not supplied

Acute effects of transcendental meditation on hemodynamic functioning in middle-aged adults.

OBJECTIVE: Increased peripheral vasoconstriction (ie, total peripheral resistance, or TPR) has been implicated as playing an important role in the early development of essential hypertension. Some studies have demonstrated that Transcendental Meditation (TM) reduces high blood pressure, but the hemodynamic adjustments behind these blood pressure reductions have not been elucidated. The aim of this study was to provide a preliminary investigation of the acute effects of TM on TPR. METHODS: Subjects were 32 healthy adults (16 women and 16 men; 30 white and two African American; mean age, 46.4 +/- 3.9 years). Subjects were divided into a TM group of long-term TM practitioners (eight white women, nine white men, and one African American man; mean years of twice-daily TM practice, 22.4 +/- 6.7) and a control group (eight white women, five white men, and one African American man). Hemodynamic functioning was assessed immediately before and during three conditions: 20 minutes of rest with eyes open (all subjects), 20 minutes of TM (TM group), and 20 minutes of eyes-closed relaxation (control group). RESULTS: During eyes-open rest, the TM group had decreases in systolic blood pressure (SBP) and TPR, compared with increases in the control group (SBP: -2.5 vs. +2.4 mm Hg, p < .01; TPR: -0.7 vs. +0.5 mm Hg/liter per minute, p < .004). During TM, there was a greater decrease in SBP due to a concomitantly greater decrease in TPR compared with the control group during eyes-closed relaxation (SBP: -3.0 vs. +2.1 mm Hg, p < .04; TPR: -1.0 vs. +0.3 mm Hg/liter per minute, p < .03). CONCLUSIONS: TPR decreased significantly during TM. Decreases in vasoconstrictive tone during TM may be the hemodynamic mechanism responsible for reduction of high blood pressure over time. The results of this study provide a preliminary contribution to the understanding of the underlying hemodynamic mechanisms responsible for the beneficial influence of TM on cardiovascular risk factors.

Adult↗

PubMedDate not supplied

The effects of life events on cardiovascular reactivity to behavioral stressors as a function of socioeconomic status, ethnicity, and sex.

OBJECTIVE: The purposes of this study were 1) to examine the effects of stressful life events on cardiovascular reactivity to acute laboratory stressors in youth and 2) to determine whether these effects varied as a function of socioeconomic status, ethnicity, and/or sex. METHODS: Four hundred eighty-three youths (mean age = 16.7 years; 249 Caucasian Americans [126 males, 123 females] and 234 African Americans [109 males, 125 females]) completed the Adolescent Resources Challenge Scale (ARCS), a measure of stressful life events, and underwent two laboratory stressors (a car-driving simulation and the Social Competence Interview) during which blood pressure, heart rate, cardiac output, and total peripheral resistance were assessed. RESULTS: Youths who reported high levels of stressful life events showed smaller increases in blood pressure (both systolic and diastolic) and heart rate to the car-driving simulation but larger increases in cardiac output in response to the Social Competence Interview than did youths who reported low levels of stressful life events. The effect of stressful life events on cardiovascular reactivity was not moderated by sex, ethnicity, or socioeconomic status. Higher family socioeconomic status was associated with greater blood pressure, heart rate, and cardiac output increases in response to the Social Competence Interview. CONCLUSIONS: The attenuating effects of stressful life events on cardiovascular reactivity in response to car-driving simulation in youths are consistent with an inoculation effect, whereas the potentiating impact of stressful life events on reactivity observed during the social stressor interview is compatible with a possible cost of coping effect.

Adaptation, Psychological↗

PubMedDate not supplied

The uniqueness of the young athlete: medical considerations.

The common acute and chronic illnesses that may influence a youths' participation in sports are discussed. Conditions discussed include fever, upper and lower respiratory infection, infectious mononucleosis, and dermatoses (viral, fungal, bacterial and parasitic, and traumatic). The chronic diseases presented include asthma, epilepsy, diabetes, and cardiovascular problems, especially congenital and rheumatic lesions as well as arrhythmias and hypertension. The cardiovascular evaluation of the young athlete is detailed because, along with the orthopaedic examination, it probably is the area to yield the most abnormal or questionable findings.

Adolescent↗

PubMedDate not supplied

Preparticipation health screening of young athletes. Results of 1268 examinations.

The major purpose of the preparticipation physical examination of athletes is to screen for conditions that could predispose the athlete to injury or death. However, this examinations offered to many of the athletes in this country fail to adequately accomplish this. This study analyzed the preparticipation health exams of prospective sports participants from all public schools in Richmond County, Georgia for two consecutive years. We sought to identify the components of a preparticipation exam which most accurately identified athletes who were at risk of sustaining injury. The most frequently reported problems on the health history were previous injuries, previous hospitalizations, and joint problems. These were consistent over the two years. The problems recorded most frequently on the physical exam involved the lower extremities, mouth, teeth, heart, eyes, and genitalia. However the prevalence of abnormalities found during the first year of the study was significantly lower than that identified in the second study. Analysis of the findings resulted in a more standardized approach to the examination and in an improved examination form.

Adolescent↗