PHYSICAL EXAMINATION
Although many forms are not seen in adult patients, cardiologists often do see simple clues to the diagnosis of certain forms of congenital heart disease (CHD), usually acyanotic or cyanotic and postoperative. Any child with or suspected with CHD should be seen by a pediatric cardiologist at an institution with interventional pediatric cardiologists and cardiac surgeons. Adult patients with CHD should be seen and advised by a pediatric cardiologist or adult cardiologist (prefer ably both) at a surgical center with experts in congenital heart surgery and percutaneous procedures. Many adult patients present with arrhythmias, heart failure, or failure of the original childhood surgery. Occasionally, older patients or patients with anomalous coronary artery disease present with ischemic heart disease symptoms.
Although the history generally does not
provide major clues to the diagnosis, the family history of CHD raises awareness
that the offspring of these patients may also have a congenital abnormality. Diagnostic
clues in the adolescent or adult patient are based on simple physical examination
and electrocardiographic (ECG) and chest radiographic findings characteristic of
CHD (see Plate 5-1).
