Arrhythmias in Children, 1st Edition

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 pediatrician’s office
9-month-old with recurrent episodes of supraventricular tachycardia despite medical therapy

2. 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

3. Pre-teen/Teenager
13-year-old with syncope while standing in line for lunch
15-year-old with intentional ingestion of grandparent’s 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

4. 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 grandmother’s 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

Vincent C. Thomas, MD, MHA, Pediatric Cardiologist and ElectrophysiologistMedical Safety OfficerJohnson and Johnson, USA and Seshadri Balaji, MBBS, MRCP (UK), PhD, Professor, Department of Pediatrics, Division of Cardiology, USA