הגישה לאבחנה של מומי לב בילדים

The development of diagnostic technology in Pediatric Cardiology has advanced rapidly in the last 30 years and continues to advance till today. The most apparent and important advancement has been with Ultra Sound and Doppler Technology. Although these are very important central tools with the ability to answer most questions in the field, false negatives give a dangerous complacency to hinder the appropriate continued search for important pathology and false positives bring about further unnecessary testing and most important- familial worry, the major cause of “Cardiac Non Disease” and its documented morbidity. Till today the most appropriate test to evaluate the healthy child with murmur, chest pain or dizziness- syncope is a thorough history and physical exam including expert auscultation in an appropriately quiet environment.
The first years of my practice witnessed the building of a clinically based, evidence based approach to population screening in a wide spread population within a major Medical Service Organization. This was a tiered approach with appropriate centralization when questions came up needing echocardiogram or catheter evaluation and then catheter or surgical treatment. Because of mostly non medical external reasons, this was not sustainable even though financially and medically was far and away the best answer for this platforms’ needs.
I plan on changing this model as I move to a new geography – a large city based platform. As such I will be centrally located and will start developing a strategy to teach the local primary care physicians in the art/science of pediatric cardiac auscultation and through this method, screen the population most efficiently. This should also increase dramatically the physicians’ professional satisfaction as the acquiring of new knowledge and skills and their practical application are quite enjoyable.