Caring for infants with congenital heart disease and their families.

Congenital heart defects are classified into two broad categories: acyanotic and cyanotic lesions. The most common acyanotic lesions are ventricular septal defect, atrial septal defect, atrioventricular canal, pulmonary stenosis, patent ductus arteriosus, aortic stenosis and coarctation of the aorta. Congestive heart failure is the primary concern in infants with acyanotic lesions. The most common cyanotic lesions are tetralogy of Fallot and transposition of the great arteries. In infants with cyanotic lesions, hypoxia is more of a problem than congestive heart failure. Suspicion of a congenital heart defect should be raised by the presence of feeding difficulties in association with tachypnea, sweating and subcostal recession, or severe growth impairment. Follow-up of infants with congenital heart disease should follow the schedule of routine care for healthy babies with some modifications, such as administration of influenza and pneumococcal vaccines. More frequent follow-up is required if congestive heart failure is present. Family psychosocial issues should also be addressed. One of the main roles for the family physician is to help the parents put the diagnosis in perspective by clarifying expectations and misconceptions, and answering specific questions.

Management of hypercholesterolemia.

As a major risk factor for coronary heart disease, hypercholesterolemia is responsible for a significant number of illnesses and deaths, and contributes considerably to health care costs. Lowering cholesterol levels reduces the risk of coronary heart disease and may halt or reverse atherosclerosis. Lifestyle modifications include dietary measures and aerobic exercise. Pharmacologic therapy can further decrease cholesterol levels. Family physicians need to recognize patients at risk for hypercholesterolemia (and thus coronary heart disease), institute appropriate therapy and counsel family members about disease prevention.