Most physicians entering the field of pediatric cardiology are drawn to it by an interest in the wide variety of congenital heart defects which present at various ages. Most congenital heart disease will be evident in early life, presenting with cyanosis, heart murmur, congestive heart failure or shock. Textbooks in pediatric cardiology are filled overwhelmingly with chapters on the various congenital heart lesions which are encountered, both rare and common. However, practicing pediatric cardiologists will be quick to point out that a significant number of referrals to any practice do not involve congenital heart problems. Reviewing our own statistics at the Childrenâs Hospital of Michigan Cardiology Center for the past two years (2010-2012) reveals that outpatient visits for new patient consultations examined by age groups are: less than 1 year of age - 11%; 1-5 years - 23%; 6-10 years - 21%; 11-18 years - 45%. Retrospective data collected from billing codes, as in this brief survey, may imprecise. However, it does provide a snapshot of the usual referral problems encountered by pediatric cardiologists. In our practice, the most common overall reason for referral in all ages was âheart murmurâ, constituting 26% of total referrals. Second were rhythm and rhythm related problems (inclusive of palpitations, abnormal ECG and diagnosed premature beats) constituted 19% of the total. In the age group of interest for this book of 11-18 years, the most common presenting issues were rhythm related (23%) and chest pain (23%), followed by syncope or dizziness (19%) and heart murmur (12%). Congenital heart disease diagnoses encountered in the 11 to 18 year age group comprised only 6.5% of referrals within that age group. It is likely that many of these were not new diagnoses (with a few exceptions), but rather represented transfers to our practice. Our own outpatient clinical experience reveals that the majority of outpatients referred by pediatricians for pediatric cardiology evaluation are between the ages of 11 and 18. The majority of these new referrals are not for congenital heart disease. Our intent for this edition of Pediatric Clinics of North America is to describe the types of problems which seem to be of concern to the pediatric community within this age group and to describe strategies for evaluation.