Cardiac testing in adolescents

Diagnostic testing in adolescents and young adults with known or suspected heart disease typically involves the use of electrocardiography, various imaging modalities such as echocardiography, and laboratory investigations. Authors discuss common tests that may be requested by the generalist or cardiologist to evaluate the heart. The emphasis is on indications for ordering a specific test, understanding their strengths and weaknesses, and basic interpretation of the results. Heart disease in adolescents primarily includes previously diagnosed congenital lesions, undiagnosed defects such as atrial septal defect (ASD) or aortic valve abnormalities that are often asymptomatic in childhood, inherited latent conditions that may first become mainfest during the teen years, such as hypertrophic cardiomyopathy (HCM), and acquired disease such as myocarditis. Signs and symptoms of possible heart disease, when present, may include a pathological murmur or heart sound(s), chest pain and shortness of breath, especially when associated with exercise, other signs of heart failure, palpitations or syncope. An electrocardiogram is often ordered by the generalist or specialist to evaluate symptoms of possible heart disease. Most imaging studies, including echocardiography, are ordered or performed by the cardiologist to diagnose specific defects conditions, and catheterizations are increasingly done primarily for intervention purposes.