ARRHYTHMIAS. Normal heart rate. O - 2 years years years
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1 ARRHYTHMIAS Incidence in childhood small, but a serious complication in children with congenital heart disease The most common arrhythmia in childhood supraventricular tachycardia 1 : 25 OOO Normal heart rate sleeping child wakefulness O - 2 years years years
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3 1.Origin of excitation 2. Heart rate 3. QRS axis orientation 4. Intervals 5. Morfology of Pwave 6. Morfology of QRS 7. Morfology ST segm. T event. U wave
4 PHYSIOLOGICAL ARRHYTMIAS Respiratory arrhytmia very often in children During inspiration acceleration of heart rate, during exspiration retardation of heart rate After load / running / respiratory arrythmia disappears during acceleration of heart rate Supraventricular extrasystoles - about 12/h in 14% children during 24 hours follow up Ventricular extrasystoles common, occuring in 1-2% of normal infant and up to 50% of healthy teenagers and adults,during exercise testing disappear Atrioventricular disturbances of conduction - in 11 % of children during sleep
5 1. Congenital arrhytmias a/ prenatal impairment of conducting system by inflammation b/ systemic lupus erythematosus in mother c/ impairment of conducting system in the heart with congenital heart disease 2. Others obtained : a/ postoperative b/ boreliosa, viral diseases of myocardium c/ disorders in Na,K, Ca levels in plasma d/ influence of hormones c/ drug intoxication d/ hypoxia e/ tumors 3. Idiopathic
6 Diagnostic tools History Physical examination ECG in rest and during exercise testing Holter ECG during 24 hours Electrofysiological studies Echocardiography Therapy drugs kardiostimulation Cathetrization and surgical ablation
7 Incidence : newborns, teenagers, sportsmen, in hypothyreosis, after intracranial injure with increase of intracranial pressure, therapy with Digoxin, beta blockers, hyperkalemia, cardiac surgery for congenital heart disease Cause: dysfunction of sinoatrial node BRADYCARDIA atrioventricular disturbances of conduction I.-III. / danger = sudden loss of consciousness due to cardiac arrest or ventricular fibrillation, sudden death/ ECG diagnosis The atria and ventricules beat independently in complete AV block, incomplete AV block is characterized by interruption of conduction at intervals
8 Drug therapy : heart rate below 4O/min Atropin O,1mg/5kg i.v. Isoprenaline - from 0,05 ug/kg/min to až do O,5ug/kg/min When cardiostimulation?? a/ ventrical rate in newborn and infant below 55/min / in CHD below 65/min/ b/ ventrical rate below 45/min in children c/ syncope, heart failure, fatigue during exercise
9 SUPRAVENTRICULAR TACHYCARDIA Is defined as a very rapid heart rate up 200/min with narrow QRS complexes 1 : 25 OOO a/ reentry phenomenon b/ arrhythmogenic focus outside the sinus node Epidemiology : CHD, result of cardiac surgery due to CHD, stress, WPW sy, kardiomyopathy, myokarditis Physical examination: Heart rate - 2OO-3OO/min infants- change of behavior, problems with feeding, sweating, cyanosis, heart failure symptoms children - palpitation, nausea
10 ECG Narrow QRS complexes, wave P is in wavet, RP shorter than PR,heart rate up 200/min
11 Digoxin TERAPHY of supraventricular tachycardia: Vagal stimulation / the face in cold water, emetic reflex../ adenosine - ADENOCOR /Sanofi-Winthrop/- 0,1-0,3 mg/kg i.v. /quick bolus/ propafenon - RYTMONORM / Knoll/ - 1 mg/kg i.v. during 5min verapamil - ISOPTIN /Knoll/ - 0,1 mg/kg i.v. during 30s Kardioversion 0,25 - O,5 J/kg
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