eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Williams Syndrome: Treatment & Medication

Author: Lennox H Huang, MD, Associate Clinical Chair, Assistant Professor, Department of Pediatrics, McMaster University; Deputy Chief of Pediatrics, McMaster Children's Hospital
Coauthor(s): Aneal Khan, MD, MSc, FRCP(C), FAAP, FCCMG, Assistant Professor of Medical Genetics and Pediatrics, University of Calgary; Consulting Staff, Departments of Pediatrics and Medical Genetics, Alberta Children's Hospital, Canada; Nathaniel H Robin, MD, Professor, Departments of Genetics and Pediatrics, University of Alabama at Birmingham; Consulting Staff, University of Alabama at Birmingham University Hospital and Children's Hospital of Alabama
Contributor Information and Disclosures

Updated: Jul 16, 2008

Treatment

Medical Care

Williams syndrome is a complex multisystem medical condition that requires the attention of multiple health care professionals. A few large tertiary care centers have Williams syndrome clinics, which help organize and coordinate the care of patients with Williams syndrome. Williams Syndrome Associations are available in the United States and Canada and are a valuable resource for both parents and health care professionals.

Tailor specific management of Williams syndrome to the presenting clinical spectrum. Initial care often centers on failure to thrive, hypercalcemia, or repair of the cardiac lesion. School performance, physical therapy, hyperactivity, and the child's eventual role in society are long-term issues that need to be addressed on an ongoing basis. Anticipatory guidance is essential to help parents prepare for future needs of children with Williams syndrome. Anticipatory care guidelines and growth curves for children with Williams syndrome are available through the American Academy of Pediatrics.

  • Hypercalcemia is frequently asymptomatic and resolves in the first few years of life but can be lifelong.
    • Signs and symptoms of hypercalcemia, in addition to blood calcium levels, should be periodically monitored throughout life and prior to the administration of any anesthetic or sedative agent and prior to any invasive procedure. Symptomatic hypercalcemia can present with decreased feeding, irritability, and severe colic in infants and may require multidisciplinary management through restriction of calcium, vitamin D intakes (including vitamin formulations), specialized formulas and some patients may require bisphosphonates to control elevated calcium levels.52,53 For more information, see Hypercalcemia.
    • The goal of managing calcium and vitamin D levels is to monitor and achieve levels in the normal range for age at intakes adequate for bone growth. The need for dietary manipulation and medication to control hypercalcemia should be frequently monitored because long-term unrestricted use of a low calcium, low vitamin D formula has been reported to lead to rickets in a patient with Williams syndrome.54
    • Nephrocalcinosis and sclerosis of the long bones are occasionally observed.
  • Systemic hypertension should be treated when identified. For more information see the eMedicine topic in pediatrics for Hypertension or Neonatal Hypertension.
  • Periodically assess visual problems and hearing loss. Middle ear infusions should be periodically performed. Acoustic-visual-behavioral training has been reported to improve symptoms of hyperacusis in an adult.55
  • Patients with short stature should have a bone age assessment and be referred to an endocrinologist for assessment and management of growth hormone deficiency.
  • Monitor for signs of precocious puberty and arrange referrals with an endocrinologist as necessary.56
  • Feeding difficulties in children are common, and referral to a gastroenterologist should be considered.
  • Early involvement of dentist is suggested.

Surgical Care

For cardiac findings in children with Williams syndrome, early involvement with a pediatric cardiologist and cardiothoracic surgeon is essential.

  • SVAS is the most frequently observed operable cardiac lesion in Williams syndrome. SVAS may be progressive in some individuals, and life-long cardiac follow-up is recommended.57
  • Timing of the operative repair depends on the presence of cardiac symptoms, the gradient across the supraaortic obstruction, and whether ischemic changes are noted on a stress test. Peripheral branch pulmonary stenosis usually spontaneously resolves and generally should not be treated with catheter or surgical intervention.
  • In general, the degree of supraaortic obstruction in Williams syndrome patients tends to progress over time, whereas peripheral branch pulmonary stenosis improves over time.

Consultations

Williams syndrome requires the attention of multiple health care professionals, depending on the specific phenotypic manifestations. Many large tertiary care centers have Williams syndrome clinics that help organize and coordinate the care of patients with Williams syndrome.

  • For cardiac findings in children with Williams syndrome, early involvement of a pediatric cardiologist and cardiothoracic surgeon is essential.
  • An anesthesiologist should be consulted prior to administration of anesthetics. Sedation should be administered only by physicians experienced in pediatric procedural sedation.
  • Geneticists, dentists, ophthalmologists, orthopedists, physical and occupational therapists, and psychologists all contribute to the care of the patient with Williams syndrome.
  • Parents of children with Williams syndrome should be offered genetic counseling to review their recurrence risks and options for prenatal diagnosis. If neither parent is affected with Williams syndrome, the risk of having another affected child with Williams syndrome is usually less than 1%. However, recurrences of Williams syndrome have been reported, even with unaffected parents, because of apparent germline mosaicism.58 If one parent is affected with Williams syndrome, the risk for having an affected child is typically 50% because the deletion behaves in an autosomal dominant manner. When of appropriate age, affected children should receive genetic counseling prior to considering having children of their own.
  • Women with Williams syndrome who are considering pregnancy or who are pregnant should be referred to a maternal-fetal medicine specialist for close monitoring. In particular, a pregnant woman with Williams syndrome should be monitored for hypertension, hypercalcemia, and cardiovascular and other complications.59

Medication

See Treatment.

More on Williams Syndrome

Overview: Williams Syndrome
Differential Diagnoses & Workup: Williams Syndrome
Treatment & Medication: Williams Syndrome
Follow-up: Williams Syndrome
References
[ CLOSE WINDOW ]

References

  1. Ewart AK, Morris CA, Atkinson D, et al. Hemizygosity at the elastin locus in a developmental disorder, Williams syndrome. Nat Genet. Sep 1993;5(1):11-6. [Medline].

  2. Lowery MC, Morris CA, Ewart A, et al. Strong correlation of elastin deletions, detected by FISH, with Williams syndrome: evaluation of 235 patients. Am J Hum Genet. Jul 1995;57(1):49-53. [Medline].

  3. Nickerson E, Greenberg F, Keating MT, et al. Deletions of the elastin gene at 7q11.23 occur in approximately 90% of patients with Williams syndrome. Am J Hum Genet. May 1995;56(5):1156-61. [Medline].

  4. Urbán Z, Helms C, Fekete G, et al. 7q11.23 deletions in Williams syndrome arise as a consequence of unequal meiotic crossover. Am J Hum Genet. Oct 1996;59(4):958-62. [Medline].

  5. Hockenhull EL, Carette MJ, Metcalfe K, et al. A complete physical contig and partial transcript map of the Williams syndrome critical region. Genomics. Jun 1 1999;58(2):138-45. [Medline].

  6. Heller R, Rauch A, Luttgen S, et al. Partial deletion of the critical 1.5 Mb interval in Williams-Beuren syndrome. J Med Genet. Aug 2003;40(8):e99. [Medline].

  7. Merla G, Ucla C, Guipponi M, Reymond A. Identification of additional transcripts in the Williams-Beuren syndrome critical region. Hum Genet. May 2002;110(5):429-38. [Medline].

  8. Mari A, Amati F, Mingarelli R, et al. Analysis of the elastin gene in 60 patients with clinical diagnosis of Williams syndrome. Hum Genet. Oct 1995;96(4):444-8. [Medline].

  9. Dridi SM, Ghomrasseni S, Bonnet D, et al. Skin elastic fibers in Williams syndrome. Am J Med Genet. Nov 19 1999;87(2):134-8. [Medline].

  10. Frangiskakis JM, Ewart AK, Morris CA, et al. LIM-kinase1 hemizygosity implicated in impaired visuospatial constructive cognition. Cell. Jul 12 1996;86(1):59-69. [Medline].

  11. Tassabehji M, Metcalfe K, Fergusson WD, et al. LIM-kinase deleted in Williams syndrome. Nat Genet. Jul 1996;13(3):272-3. [Medline].

  12. Hirota H, Matsuoka R, Chen XN, et al. Williams syndrome deficits in visual spatial processing linked to GTF2IRD1 and GTF2I on chromosome 7q11.23. Genet Med. Jul-Aug 2003;5(4):311-21. [Medline].

  13. Osborne LR. Williams-Beuren syndrome: unraveling the mysteries of a microdeletion disorder. Mol Genet Metab. May 1999;67(1):1-10. [Medline].

  14. Wessel A, Gravenhorst V, Buchhorn R. Risk of sudden death in the Williams-Beuren syndrome. Am J Med Genet A. Jun 15 2004;127(3):234-7. [Medline].

  15. Bird LM, Billman GF, Lacro RV, et al. Sudden death in Williams syndrome: report of ten cases. J Pediatr. Dec 1996;129(6):926-31. [Medline].

  16. Bragg K, Fedel GM, DiProsperis A. Cardiac arrest under anesthesia in a pediatric patient with Williams syndrome: a case report. AANA J. Aug 2005;73(4):287-93. [Medline].

  17. Horowitz PE, Akhtar S, Wulff JA, et al. Coronary artery disease and anesthesia-related death in children with Williams syndrome. J Cardiothorac Vasc Anesth. Dec 2002;16(6):739-41. [Medline].

  18. Yetkin U, Bal F, Bayata S, Gurbuz A. Severely calcified valvular aortic stenosis firstly diagnosed in monozygotic male twins with suspected Williams-Beuren syndrome. Jpn Heart J. Sep 2004;45(5):877-83. [Medline].

  19. Partsch CJ, Siebert R, Caliebe A, et al. Sigmoid diverticulitis in patients with Williams-Beuren syndrome: relatively high prevalence and high complication rate in young adults with the syndrome. Am J Med Genet A. Aug 15 2005;137(1):52-4. [Medline].

  20. Yau EK, Lo IF, Lam ST. Williams-Beuren syndrome in the Hong Kong Chinese population: retrospective study. Hong Kong Med J. Feb 2004;10(1):22-7. [Medline].

  21. Amenta S, Sofocleous C, Kolialexi A, et al. Clinical manifestations and molecular investigation of 50 patients with Williams syndrome in the Greek population. Pediatr Res. Jun 2005;57(6):789-95. [Medline].

  22. Sadler LS, Pober BR, Grandinetti A, et al. Differences by sex in cardiovascular disease in Williams syndrome. J Pediatr. Dec 2001;139(6):849-53. [Medline].

  23. Bruno E, Rossi N, Thuer O, et al. Cardiovascular findings, and clinical course, in patients with Williams syndrome. Cardiol Young. Dec 2003;13(6):532-6. [Medline].

  24. Zaghloul N, Hutcheon RG, Tepperberg JH. Visual diagnosis: monozygotic twins who have congenital heart disease and distinctive facial features. Pediatr Rev. Oct 2002;23(10):365-7. [Medline].

  25. Mervis CB, Robinson BF, Bertrand J, et al. The Williams syndrome cognitive profile. Brain Cogn. Dec 2000;44(3):604-28. [Medline].

  26. Blomberg S, Rosander M, Andersson G. Fears, hyperacusis and musicality in Williams syndrome. Res Dev Disabil. Oct 31 2005;[Medline].

  27. Gallo FJ, Klein-Tasman BP, Gaffrey MS, Curran P. Expecting the worst: Observations of reactivity to sound in young children with Williams syndrome. Res Dev Disabil. Nov 16 2007;[Medline].

  28. Porter MA, Coltheart M. Cognitive heterogeneity in Williams syndrome. Dev Neuropsychol. 2005;27(2):275-306. [Medline].

  29. Tsai SW, Wu SK, Liou YM, Shu SG. Early development in Williams syndrome. Pediatr Int. Apr 2008;50(2):221-4. [Medline].

  30. Klein-Tasman BP, Mervis CB, Lord C, Phillips KD. Socio-communicative deficits in young children with Williams syndrome: performance on the Autism Diagnostic Observation Schedule. Child Neuropsychol. Sep 2007;13(5):444-67. [Medline].

  31. Withers S. A new clinical sign in Williams syndrome. Arch Dis Child. Jul 1996;75(1):89. [Medline].

  32. Einfeld SL, Tonge BJ, Rees VW. Longitudinal course of behavioral and emotional problems in Williams syndrome. Am J Ment Retard. Jan 2001;106(1):73-81. [Medline].

  33. Davies M, Udwin O, Howlin P. Adults with Williams syndrome. Preliminary study of social, emotional and behavioural difficulties. Br J Psychiatry. Mar 1998;172:273-6. [Medline].

  34. Davies M, Howlin P, Udwin O. Independence and adaptive behavior in adults with Williams syndrome. Am J Med Genet. May 16 1997;70(2):188-95. [Medline].

  35. Schulman SL, Zderic S, Kaplan P. Increased prevalence of urinary symptoms and voiding dysfunction in Williams syndrome. J Pediatr. Sep 1996;129(3):466-9. [Medline].

  36. Partsch CJ, Dreyer G, Gosch A, et al. Longitudinal evaluation of growth, puberty, and bone maturation in children with Williams syndrome. J Pediatr. Jan 1999;134(1):82-9. [Medline].

  37. Spadoni GL, Colloridi V, Finocchi G, et al. Williams syndrome and growth hormone deficiency. J Pediatr. Apr 1983;102(4):640. [Medline].

  38. Kuijpers GM, De Vroede M, Knol HE, Jansen M. Growth hormone treatment in a child with Williams-Beuren syndrome: a case report. Eur J Pediatr. Jun 1999;158(6):451-4. [Medline].

  39. Xekouki P, Fryssira H, Maniati-Christidi M, et al. Growth hormone deficiency in a child with Williams-Beuren syndrome. The response to growth hormone therapy. J Pediatr Endocrinol Metab. Feb 2005;18(2):205-7. [Medline].

  40. Pankau R, Partsch CJ, Neblung A, et al. Head circumference of children with Williams-Beuren syndrome. Am J Med Genet. Sep 1 1994;52(3):285-90. [Medline].

  41. Greenberg F, Lewis RA. The Williams syndrome. Spectrum and significance of ocular features. Ophthalmology. Dec 1988;95(12):1608-12. [Medline].

  42. Kapp ME, von Noorden GK, Jenkins R. Strabismus in Williams syndrome. Am J Ophthalmol. Mar 1995;119(3):355-60. [Medline].

  43. Marler JA, Elfenbein JL, Ryals BM, et al. Sensorineural hearing loss in children and adults with Williams syndrome. Am J Med Genet A. Nov 1 2005;138(4):318-27. [Medline].

  44. Dutly F, Schinzel A. Unequal interchromosomal rearrangements may result in elastin gene deletions causing the Williams-Beuren syndrome. Hum Mol Genet. Dec 1996;5(12):1893-8. [Medline].

  45. Baumer A, Dutly F, Balmer D, et al. High level of unequal meiotic crossovers at the origin of the 22q11. 2 and 7q11.23 deletions. Hum Mol Genet. May 1998;7(5):887-94. [Medline].

  46. Robinson WP, Waslynka J, Bernasconi F, et al. Delineation of 7q11.2 deletions associated with Williams-Beuren syndrome and mapping of a repetitive sequence to within and to either side of the common deletion. Genomics. May 15 1996;34(1):17-23. [Medline].

  47. Osborne LR, Li M, Pober B, et al. A 1.5 million-base pair inversion polymorphism in families with Williams-Beuren syndrome. Nat Genet. Nov 2001;29(3):321-5. [Medline].

  48. von Dadelszen P, Chitayat D, Winsor EJ. De novo 46,XX,t(6;7)(q27;q11;23) associated with severe cardiovascular manifestations characteristic of supravalvular aortic stenosis and Williams syndrome. Am J Med Genet. Feb 14 2000;90(4):270-5. [Medline].

  49. van Hagen JM, Eussen HJ, van Schooten R, van Der Geest JN, Lagers-van Haselen GC, Wouters CH, et al. Comparing two diagnostic laboratory tests for Williams syndrome: fluorescent in situ hybridization versus multiplex ligation-dependent probe amplification. Genet Test. Fall 2007;11(3):321-7. [Medline].

  50. Voit T, Kramer H, Thomas C. Myopathy in Williams-Beuren syndrome. Eur J Pediatr. May 1991;150(7):521-6. [Medline].

  51. Sforzini C, Milani D, Fossali E, et al. Renal tract ultrasonography and calcium homeostasis in Williams-Beuren syndrome. Pediatr Nephrol. Nov 2002;17(11):899-902. [Medline].

  52. Cagle AP, Waguespack SG, Buckingham BA, et al. Severe infantile hypercalcemia associated with Williams syndrome successfully treated with intravenously administered pamidronate. Pediatrics. Oct 2004;114(4):1091-5. [Medline].

  53. Oliveri B, Mastaglia SR, Mautalen C, et al. Long-term control of hypercalcaemia in an infant with williams-Beuren syndrome after a single infusion of biphosphonate (Pamidronate). Acta Paediatr. Jul 2004;93(7):1002-3. [Medline].

  54. Mathias RS. Rickets in an infant with Williams syndrome. Pediatr Nephrol. Jun 2000;14(6):489-92. [Medline].

  55. Miani C, Passon P, Bracale AM, et al. Treatment of hyperacusis in Williams syndrome with bilateral conductive hearing loss. Eur Arch Otorhinolaryngol. Sep 2001;258(7):341-4. [Medline].

  56. Partsch CJ, Japing I, Siebert R, et al. Central precocious puberty in girls with Williams syndrome. J Pediatr. Sep 2002;141(3):441-4. [Medline].

  57. Wessel A, Pankau R, Kececioglu D, et al. Three decades of follow-up of aortic and pulmonary vascular lesions in the Williams-Beuren syndrome. Am J Med Genet. Sep 1 1994;52(3):297-301. [Medline].

  58. Kara-Mostefa A, Raoul O, Lyonnet S, et al. Recurrent Williams-Beuren syndrome in a sibship suggestive of maternal germ-line mosaicism. Am J Hum Genet. May 1999;64(5):1475-8. [Medline].

  59. Mulik VV, Temple KI, Howe DT. Two pregnancies in a woman with Williams syndrome. BJOG. May 2004;111(5):511-2. [Medline].

  60. Chodirker BN, Greenberg CR, Giddins NG, et al. Low MSAFP levels and Williams syndrome. Am J Med Genet. Nov 12 1997;72(4):448-50. [Medline].

  61. Committee on Genetics. American Academy of Pediatrics: Health care supervision for children with Williams syndrome. Pediatrics. May 2001;107(5):1192-204. [Medline].

  62. Eronen M, Peippo M, Hiippala A, et al. Cardiovascular manifestations in 75 patients with Williams syndrome. J Med Genet. Aug 2002;39(8):554-8. [Medline].

  63. Greer MK, Brown FR 3rd, Pai GS, et al. Cognitive, adaptive, and behavioral characteristics of Williams syndrome. Am J Med Genet. Sep 19 1997;74(5):521-5. [Medline].

  64. Huang L, Sadler L, O'Riordan MA, Robin NH. Delay in diagnosis of Williams syndrome. Clin Pediatr (Phila). May 2002;41(4):257-61. [Medline].

  65. Lopez-Rangel E, Maurice M, McGillivray B, Friedman JM. Williams syndrome in adults. Am J Med Genet. Dec 1 1992;44(6):720-9. [Medline].

  66. Mack G, Silberbach M. Aortic andpulmonary stenosis. Pediatr Rev. Mar 2000;21(3):79-85. [Medline].

  67. Morris CA, Mervis CB, Hobart HH, et al. GTF2I hemizygosity implicated in mental retardation in Williams syndrome:Genotype-phenotype analysis of five families with deletions in theWilliams syndrome region. Am J Med Genet. Nov 15 2003;123A(1):45-59. [Medline].

  68. Perez Jurado LA, Peoples R, Kaplan P, et al. Molecular definition of the chromosome 7 deletion in Williams syndrome and parent-of-origin effects on growth. Am J Hum Genet. Oct 1996;59(4):781-92. [Medline].

  69. Rae C, Karmiloff-Smith A, Lee MA, et al. Brain biochemistry in Williams syndrome: evidence for a role of the cerebellum in cognition?. Neurology. Jul 1998;51(1):33-40. [Medline].

  70. Sadler LS, Olitsky SE, Reynolds JD. Reduced stereoacuity in Williams syndrome. Am J Med Genet. Dec 18 1996;66(3):287-8. [Medline].

  71. Stagi S, Bindi G, Neri AS, et al. Thyroid function and morphology in patients affected by Williams syndrome. Clin Endocrinol (Oxf). Oct 2005;63(4):456-60. [Medline].

  72. Toomey KE. Medical genetics for the practitioner. Pediatr Rev. May 1996;17(5):163-74. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Williams syndrome, WS, Williams' syndrome, Williams-Beuren syndrome, elfin facies syndrome, hypercalcemia, mental retardation, microcephaly, failure to thrive, pulmonary stenosis, mitral valve regurgitation, supravalvar aortic stenosis, SVAS, short upturned nose, flat nasal bridge, long philtrum, flat malar area, wide mouth, full lips, dental malocclusion, widely spaced teeth, micrognathia, stellate irides, periorbital fullness, attention deficit hyperactivity disorder, ADHD, sigmoid diverticulitis, multicystic dysplastic kidney, hypertension, short stature, growth hormone deficiency, abnormal joint mobility, hernias, diverticula, precocious puberty

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Lennox H Huang, MD, Associate Clinical Chair, Assistant Professor, Department of Pediatrics, McMaster University; Deputy Chief of Pediatrics, McMaster Children's Hospital
Lennox H Huang, MD is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, Ontario Medical Association, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Aneal Khan, MD, MSc, FRCP(C), FAAP, FCCMG, Assistant Professor of Medical Genetics and Pediatrics, University of Calgary; Consulting Staff, Departments of Pediatrics and Medical Genetics, Alberta Children's Hospital, Canada
Aneal Khan, MD, MSc, FRCP(C), FAAP, FCCMG is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics, Canadian Medical Association, Canadian Paediatric Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Nathaniel H Robin, MD, Professor, Departments of Genetics and Pediatrics, University of Alabama at Birmingham; Consulting Staff, University of Alabama at Birmingham University Hospital and Children's Hospital of Alabama
Nathaniel H Robin, MD is a member of the following medical societies: American Cleft Palate/Craniofacial Association, American College of Medical Genetics, American Society of Human Genetics, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA, Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital
Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, Heart Rhythm Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Ameeta Martin, MD, Clinical Associate Professor, Department of Pediatric Cardiology, University of Nebraska College of Medicine
Ameeta Martin, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.