In patients with chronic systolic HF, RAVI is an independent predictor of adverse outcome with a threshold value of 29 ml/m(2).

Introduction:Adolescents with congenital heart disease are at increased risk for developingpsychological distress. Aim of the study: To assess the prevalence of depression and anxiety in adolescents withcongenital heart disease, and to identify the predictors related to thesedisorders. Methods:This is a cross-sectional case-control study. A total of 60 adolescents withCHD aged from 12-18 years and 30 apparently healthy adolescents were recruited.All participants were assessed using a designed questionnaire, the Children'sDepression Inventory (CDI), the Revised Children Manifest Anxiety Scale(RCMAS), and the Mini International Neuropsychiatric Interview for Children andAdolescents (MINI-Kid). Results:Prevalence of depression was higher in adolescents with CHD compared to healthycontrol (18.3% vs. 3.3%, p= 0.048). Moreover, 30% of adolescents with CHD hadanxiety compared to 10% of the control group (p= 0.03). Multivariate analysisof risk factors showed that level of education and symptomatic cardiacfunctional class were the significant predictors of depression in adolescentswith CHD. Likewise, presence of more than one cardiac defect and having morethan one cardiac catheterization were the significant predictors of anxiety inadolescents with CHD. Conclusion: Adolescentswith CHD are at increased risk of having depression and anxiety, especiallythose with low level of education, severe cardiac illness and having multiplecardiac catheterizations. Appropriate psychiatric assessment and earlyintervention can improve the quality of life of adolescents with CHD.

IntroductionAdolescents with congenital heart disease (CHD) are at an increased risk of developing psychological distress. Aim of the study The aim of this study was to assess the prevalence of depression and anxiety in adolescents with CHD, and to identify the predictors related to these disorders. Participants and methods This is a cross-sectional case-control study. A total of 60 adolescents with CHD aged between 12 and 18 years and 30 apparently healthy adolescents were recruited. All participants were assessed using a designed questionnaire, the Children's Depression Inventory (CDI), the Revised Children Manifest Anxiety Scale (RCMAS), and the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ResultsThe prevalence of depression was higher in adolescents with CHD compared with healthy controls (18.3 vs. 3.3%, P = 0.048). Moreover, 30% of adolescents with CHD had anxiety compared with 10% of the control group (P = 0.03). Multivariate analysis of risk factors showed that the level of education (being illiterate) and the symptomatic cardiac functional class were significant predictors of depression in adolescents with CHD. Likewise, the presence of more than one cardiac defect and having more than one cardiac catheterization were significant predictors of anxiety in adolescents with CHD. Conclusion Adolescents with CHD are at an increased risk of having depression and anxiety, especially those with a low level of education, severe cardiac illness, and multiple cardiac catheterizations. Appropriate psychiatric assessment and early intervention can improve the quality of life of adolescents with CHD.

The electrocardiogram (ECG) is the primary diagnostic tool in cardiovascular diseases. Hence its interpretation is a core competency in medicine, where obvious deficiencies have been reported among learners. The aim of this study was to introduce the fundamentals of ECG knowledge and interpretation through early clinical exposure (ECE) based on a six-step approach for preclinical students ( n = 110) and to study its influence on their knowledge and interpretation skills thereafter. The first step employed a blended learning format using didactic lectures on normal and pathological ECGs, each preceded by preinstructional videos. The second step focused on psychomotor skills and utilized laboratory exercises for ECG recording and interpretation. The third step focused on vertical integration, where the clinical relevance of the procedure was established with integrated lectures. The fourth step used the Moodle platform, where opportunities for peer interactions and clarifications by clinical faculty were made available. The fifth step incorporated clinical and diagnostic reasoning through cardiology ward visits and interpretation of patient ECGs. The sixth step was designed for critical thinking and problem solving through case-based discussions with peers and faculty. Students were assessed with multiple-choice questions and objective structured practical examination. Learner perceptions of the approach were evaluated with a feedback questionnaire and focus group discussion. Statistical analysis showed that ECE through a six-step approach significantly enhanced knowledge and interpretation of ECG as evidenced by the pre- and posttest scores. Analysis of the focus group data revealed that learner engagement and skills of critical thinking were enhanced along with diagnostic and clinical reasoning.

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