Wayne H Franklin

Adult-type pulmonary function tests in infants without respiratory disease.

A new method that permits the measurement of adult‐type maximal expiratory flow‐volume curves and fractional lung volumes in sedated infants was recently described. The purpose of this study was to define the normal range for these new measures of pulmonary function in infants and young children. Measurements of forced expiratory flows and fractional lung volume were made on 35 occasions in 22 children (ages 3–120 weeks) without respiratory disease. Maximal expiratory flow‐volume curves were measured by the raised lung volume, thoracoabdominal compression technique. Functional residual capacity (FRC) was measured plethysmographically.

Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs: A Statement for Healthcare Professionals From the Committee on Congenital Cardiac Defects, Council on Cardiovascular Disease in the Young, American Heart Association

Reports of sudden deaths of children and adolescents treated with psychotropic medications have raised concerns regarding the appropriateness of this therapy, as well as the advisability of baseline and periodic electrocardiographic (ECG) monitoring of such patients.1 2 3 4 What follows is a review of the drug effects on the ECG, cardiovascular effects of the commonly used psychotropic medications in children and adolescents, a summary of potentially dangerous drug interactions, and recommendations for cardiovascular monitoring.nnAlthough medications can potentially cause sudden, unexpected death by a variety of mechanisms (eg, seizures, central nervous system depression, or coronary artery spasm), cardiac arrhythmias are the most frequent cause. In particular, a unique form of ventricular tachycardia termed torsade de pointes has been recognized as the arrhythmia responsible for the so-called proarrhythmic effect of several antiarrhythmia drugs, and recent evidence has pointed to a similar mechanism in syncope and deaths related to other medications5 and in the familial long-QT syndromes.6 The common feature of these conditions is delayed repolarization of the myocardium (related to abnormal sodium or potassium currents) with resultant prolongation of the QT interval of the ECG. This appears to leave the myocardium vulnerable to ventricular tachycardia, primarily in the setting of bradycardia but occasionally in association with exercise.nnOther ECG abnormalities, such as sinus node depression, …

Acute pulmonary toxicity in an infant from intravenous amiodarone

Intravenous amiodarone is an effective treatment for supraventricular and ventricular tachyarrhythmias. We report a case of acute pulmonary toxicity in an infant from intravenous amiodarone and describe the clinical evaluation and laboratory studies leading to the diagnosis.

COMMON CARDIAC DISEASES IN ADOLESCENTS

Adolescent patients frequently present with symptoms potentially referable to the cardiovascular system; however, patients rarely have true cardiovascular disease. In many patients, the history is the key to determining whether additional testing or referral is necessary. Even though the history, physical examination, and preliminary laboratory data may indicate a benign cause, occasionally a referral to a cardiologist is necessary because of patient or parental anxiety. Patients with true cardiac pathology should be followed by a cardiologist in conjunction with the primary care physician.