{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:34:57Z","timestamp":1791329697817,"version":"4.3.1"},"reference-count":125,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Missed or delayed heart disease diagnoses pose a major challenge in pediatric primary care. Many cardiac conditions present with subtle or nonspecific symptoms that resemble benign childhood illnesses, making their prompt recognition difficult. This review describes congenital and acquired heart diseases prone to diagnostic delays, including critical congenital heart disease, coarctation of the aorta, atrial and ventricular septal defects, myocarditis, Kawasaki disease, heart failure, and pulmonary arterial hypertension. The atypical presentations of these disorders and the associated diagnostic pitfalls are emphasized. Furthermore, the importance of alarming symptoms and signs, such as chest pain, palpitations, syncope, and abnormal heart murmurs, is underscored. A structured approach to these red flags is presented to assist primary care pediatricians in identifying children at risk, initiating appropriate management, and referring them for specialized evaluation. The importance of preparticipation screening for athletes is also discussed, highlighting how it can be applied to all children during routine health visits to identify those with heart disease. Appropriate training is essential to increase pediatricians\u2019 ability to recognize and manage cardiac patients.<\/jats:p>","DOI":"10.3390\/children12030366","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T07:49:57Z","timestamp":1742197797000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Missed or Delayed Diagnosis of Heart Disease by the General Pediatrician"],"prefix":"10.3390","volume":"12","author":[{"given":"Ageliki A.","family":"Karatza","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7617-9076","authenticated-orcid":false,"given":"Sotirios","family":"Fouzas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1421-0813","authenticated-orcid":false,"given":"Despoina","family":"Gkentzi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-7537","authenticated-orcid":false,"given":"Eirini","family":"Kostopoulou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Loukopoulou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7929-1573","authenticated-orcid":false,"given":"Gabriel","family":"Dimitriou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0878-0668","authenticated-orcid":false,"given":"Xenophon","family":"Sinopidis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20593","DOI":"10.1097\/MD.0000000000020593","article-title":"Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990\u20132017","volume":"99","author":"Wu","year":"2020","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0140-6736(09)61922-X","article-title":"20-year survival of children born with congenital anomalies: A population-based study","volume":"375","author":"Tennant","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.pop.2017.10.005","article-title":"Heart disease in children","volume":"45","author":"Garcia","year":"2018","journal-title":"Prim. 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