arrythmia_in_babies_and_children.neonate.ppt

Arrhythmia
Arrhythmia
Other names: Cardiac arrhythmia, cardiac dysrhythmia, irregular heartbeat, heart arrhythmia

Ventricular fibrillation (VF) showing disorganized electrical activity producing a spiked tracing on an electrocardiogram (ECG)

Specialty Cardiology
Symptoms Palpitations, lightheadedness, passing out, shortness of breath, chest pain
Complications Stroke, heart failure
Usual onset Older age
Types Extra beats, supraventricular tachycardias, ventricular arrhythmias, bradyarrhythmias
Causes Problems with the electrical conduction system of the heart
Diagnostic method Electrocardiogram, Holter monitor
Treatment Medications, medical procedures (pacemaker), surgery
Frequency Millions
Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a heart rate that is too slow – below 60 beats per minute – is called bradycardia. Some types of arrhythmias have no symptoms. Symptoms when present may include palpitations or feeling a pause between heartbeats. In more serious cases, there may be lightheadedness, passing out, shortness of breath or chest pain. While most types of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in sudden death.

There are four main groups of arrhythmia: extra beats, supraventricular tachycardias, ventricular arrhythmias and bradyarrhythmias. Extra beats include premature atrial contractions, premature ventricular contractions and premature junctional contractions. Supraventricular tachycardias include atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia. Ventricular arrhythmias include ventricular fibrillation and ventricular tachycardia. Arrhythmias are due to problems with the electrical conduction system of the heart. Arrhythmias may also occur in children, however, the normal range for the heart rate is different and depends on age. A number of tests can help with diagnosis including an electrocardiogram (ECG) and Holter monitor.

Most arrhythmias can be effectively treated. Treatments may include medications, medical procedures such as inserting a pacemaker and surgery. Medications for a fast heart rate may include beta blockers or agents that attempt to restore a normal heart rhythm such as procainamide. This latter group may have more significant side effects, especially if taken for a long period of time. Pacemakers are often used for slow heart rates. Those with an irregular heartbeat are often treated with blood thinners to reduce the risk of complications. Those who have severe symptoms from an arrhythmia may receive urgent treatment with a controlled electric shock in the form of cardioversion or defibrillation.

Arrhythmia affects millions of people. In Europe and North America, as of 2014, atrial fibrillation affects

1. Arrhythmia in babies and children

2. Bradycardia in infancy
•Mostly related to complete 3
rd
degree heart block
•Mum may have history of Lupus
•Anti-La or anti-Ro antibodies
•Incidence: 1:15000-20000
•Picked up in antenatal (hydrops) or postnatal period
(CCF or well with low heart rate)
•Heart rate: <70 Regular or Irregular
•Temporary Pacemaker: HR <45, Pauses: >3 sec
•Almost always need permanent pacemaker in the
long run

3. Electrical Heart Diseases
Tachyarrhythmia
0-5 years
Serious
Non- Specific Symptoms
Maternal History
5- 10 years
Significant
Specific Symptoms
Maternal and Patient History
10-16 years
Significant and Interesting
Specific Symptoms
Patient History
History is the
Key

4. Supraventricular tachycardia

5. Case of J H
•5 ½ year old boy
•Increased appetite  Obesity
•Temperamental, Arguments
•Lack of concentration, Hyperactivity
•Snoring, Nightmares
•Dietary history confirmed food intake
•Past history unremarkable
•No F/H obesity

6. Case of J H
•Wt: 34.9 kg
•Ht: 121cm
•BMI - 24
•BP: 107/70 mg of Hg
•Almond shaped eyes
•Flat nasal bridge
•Hyper-mobile joints
•Apprehensive &
Anxious

7. Hyperphagia, Obesity,
?Genetic obesity
Investigations for Obesity
Dietary referral
Sleep pulse oximetry
Review 3 months

8. Something bothered
me
Was he a bit tachycardic?

9. Case of J H
•Pulse: 100/min
•BP: 107/70 mm of Hg
•O2 saturation: 99%
•Rest of the examination normal
•No signs of cardiac failure

10. ECG

11. ECHO

12. Royal Brompton Hospital
Paediatric Cardiology
Supraventricular Tachycardia
 
Cardiomyopathy

13. Is something worrying you!
Act on it

14. WPW Syndrome
•1930: Wolf,Parkinson,White
•Characteristic ECG: Short PR interval
•Delta wave: Slow upstroke QRS
•1944: Accessory pathway
•Common Pathway: Bundle of Kent
•Incidence: 0.15 to 0.35%
•First Degree relatives affected: 0.55%

15. WPW Syndrome

16. Arrhythmias
WPW Syndrome




AVRT AF
Children Adults
Less Mortality Lethal AF VF
More common Incidence: 11-38%
Regular Irregular
Narrow/Wide Bizzare wide complex

17. Supraventricular tachycardia
•Commonest tachyarrhythmia in childhood
•Majority has a structurally normal heart
•Short lived SVTs are not life threatening
•Baseline ECG: May reveal predisposing
features
•24 hour ECG
•Event recorder

18. SVT in children
•Common Arrhythmia in children
•
•Can be asymptomatic
•Adenosine mainstay for acute attacks
•
•Chronic SVTs can lead to poor LV function

19. SVT Diagnosis&Treatment
My experience
•SHO: 2 cases newborn from postnatal ward
Asymptomatic
Ice packs on the face, Digoxin
•SHO: 8 week old baby: Pale, poor feeding
Dipping the face in ice water
Baptism treatment for SVT

20. SVT Diagnosis & Treatment
My experience
•Registrar: Adenosine Drug shock!
•Cardiology registrar: AdenosineDigoxin
Flecanide
•Post Cardiac Op: DC Conversion
•No experience with AF

21. SVT
Long term treatment
•No treatment
•Vagal manoeuvres
•Drugs
•Beta Blockade: Propranolol, Atenolol
•Flecanide, Amiodarone
•Radiofrequency Catheter Ablation