Dr. Venkat Kumar Raju,Dr. Mahesh, DrPraveena Bhaskaran ,Dr. Jayakumar
Departments of pediatrics and pediatric cardiology
Amrita Institute of Medical Sciences, Kochi
Kerala ,India
A 3-year-old female from Maldives presented with fever for 2 days, and palpitations since evening. Child was brought to ER during 11pm,
In Initial Assessment, Airway is patent, Tachypneic with HR 240/min
Child was Restless
Vitals- HR-240/min, BP- 100/60mmhg, Spo2- 98% on room air, CRT<2sec RR-35/min Temp- 101F
Urgent ECG was done
ECG- Abnormal P waves, QRS narrow
Narrow Complex tachycardia
Immediately after seeing the ECG, an Ice pack was kept on the face suspecting Supraventriculat tachy arrhythmia , for 20 seconds, and IV line was secured. The Child was stable, but the rhythm did not convert
Inj Adenosine at 0.1mg/kg was given as rapid IV bolus through 3 way Stopcock flush technique
Immediately within a second, ECG reverted to normal,
HR was 130/min
The child was shifted to the ICU for observation
Background history- No h/o heart diseases and Sudden deaths in the family
The child was stable throughout the admission
ECHO done was normal.
She was discharged on an Oral Beta Blocker for prophylaxis
Pediatric Tachycardia with Pulse
Diagnostic Evaluation of SVT
1). Abrupt onset tachycardia
2). HR > 220/min in infants, >180/min in Children
3). P waves absent or abnormal
4). Heart rate does not vary with activity
Management-
Mild/No symptoms- Vagal Maneuvers (Ice water on face/Valsalva method)
(Carotid and orbital massage should not be performed in children
If SVT refractory to vagal maneuvers
Adenosine (0.1mg/kg IV) (It acts interacting with A1 receptors on the surface of cardiac cells, slowing sinus rate and increase in AV nodal conduction delay
SVT refractory to adenosine, Amiodarone (5mg/kg over 30-60min) or Verapamil (15mg/kg over 30-60min) is used
• If Ineffective, synchronized cardioversion is tried
• Radiofrequency catheter ablation or surgical interruption of accessory pathways should be considered If medical management fails, or frequent recurrences occur.
Take Home Message – It is important to identify and treat tachyarrhythmias immediately to prevent complications like heart failure, or even sudden death. Early detection and intervention are crucial for improving patient outcomes