Recognising supraventricular tachycardia in children: An arrhythmia not to miss
Friday, December 7, 2012
CaseA paramedic team was requested to attend a children's party when a previously healthy two-year-old boy had became acutely unwell. He was sweaty, clammy and his parents reported that his heart was racing when they cuddled him. The initial observations by the paramedic team revealed a heart rate well over 200 bpm, temperature of 37.7 ° C and blood glucose of 5.9 mmol/l. He was immediately transferred to the nearest emergency department. High flow oxygen was administered by face mask during the transfer. His parents were requested to accompany him during the transfer to keep the child comfortable and avoiding further distress.A heart rate of 230 bpm was recorded in the emergency department and a 12 lead ECG confirmed the diagnosis of SVT (Figure 1 shows an ECG with SVT). The ECG showed narrow complex tachycardia with no preceding P-waves. There were no other abnormalities detected. Continuous ECG monitoring was commenced and the paediatric team was urgently summoned. Vagal manoeuvres of applying ice-packs on his face were attempted but this failed to revert back the rhythm to normal sinus rhythm. An intravenous cannula was inserted and a dose of IV adenosine at 100 mcg/kg was given followed by a quick saline bolus. The boy responded well and the rhythm reverted back to normal.Figure 1.ECG showing SVT in a child(Garg and Paul, 2012)The boy was admitted to the paediatric ward for cardiac monitoring which remained normal and the boy well. He was discharged home with advice to return if he became unwell. He is also currently being followed by a paediatrician at the local hospital.
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