Arrhythmias in Children

• 1. Newborn/Infant

• Newborn nursery infant that has bradycardia

What am I thinking about?

History and Physical

Differential Diagnosis

Fetus with premature beats

Newborn with complete heart block

Hypothyroidism

Medication-induced

Apnea

Tests to Order

Practical Plan of Action

NICU infant noted to have extrasystoles on cardiac monitor

Full-term infant noted to have persistent tachycardia

2-month-old presenting to the ER with tachycardia, fussy, unable to eat

4-month-old with extrasystoles on auscultation at pediatricians office

9-month-old with recurrent episodes of supraventricular tachycardia despite medical therapy

Child

2-year-old presents to ER with an episode of passing out and turning blue

3-year-old is noted by pediatrician to have a low resting heart rate

4-year-old presents to ER with supraventricular tachycardia

7-year-old presents to ER with recurrent SVT

8-year-old presents with ADHD presents to cardiology office with ECG in hand for cardiac clearance to start stimulants

10-year-old presents to ER with dizziness and bradycardia with a pacemaker that does not appear to be functioning

11-year-old whose father recently died at the age of 45

5-year-old, asymptomatic, with ECG obtained for physical demonstrating WPW

Pre-teen/Teenager

13-year-old with syncope while standing in line for lunch

15-year-old with intentional ingestion of grandparents calcium channel blockers

16-year-old with premature ventricular contractions noted during athletic participation physical.

14-year-old cross country runner presents with syncope during a race

15-year-old with syncope while playing soccer

17-year-old with palpitations and dizziness while playing football

14-year-old who had to be pulled from the pool during a swim meet

Special Circumstances

Maternal fetal evaluation reveals fetus with tachycardia

Maternal fetal evaluation reveals fetus with premature beats

A newborn infant with complete heart block noted immediately after birth

A 3-month old child with complete heart block after surgery for AV canal defect

A 4-month old post-operative ventricular septal defect with junctional ectopic tachycardia

A 2-year old child who took an overdose of grandmothers digoxin pills

A 10-year old child with a pacemaker who is dizzy and had a syncope episode

An 11-year old child resuscitated from sudden collapse, found to have a long QT on ECG

A 12-year old with hypertrophic cardiomyopathy presents to the emergency room with syncope

A 13-year old with repaired tetralogy of Fallot with frequent PVCs

A 15-year old presents to ER after successful resuscitation with an AED for documented ventricular fibrillation

A 16-year old teen with a defibrillator who received a shock