Arrhythmia Identification: Stabilization and Treatment
Of the over 25 million yearly pediatric emergency room (ER) visits in the United States, primary cardiac-related issues in children <18 years of age are much less common than seen in adults who frequently present with acute coronary issues (Wier et al., Overview of children in the emergency department 2010. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, 2013). However, heart rate changes and arrhythmias occur not infrequently, and monitoring the rate and rhythm and obtaining an electrocardiogram (ECG) are often useful. Since children are seen in many ER settings from those in a dedicated children’s hospital to primarily adult-oriented hospitals, to urgent care facilities, and to rural areas where pediatric specialty services may not be readily available, interpretation of pediatric ECGs often becomes the responsibility of physicians who may have limited experience with the age-related variances of ECG patterns among children with and without congenital heart defects (CHD) (Lee et al., Korean Circ J 40: 36–41, 2010). In addition, with the increasing numbers of patients with repaired congenital heart defects surviving into adulthood who present to emergency rooms with various complaints, variations of their ECGs associated with their underlying anatomical/structural CHD may mimic ECG findings associated with ischemic coronary disease. In this regard, close examination of the full 15-lead ECG, rather than a single rhythm strip, is often required for proper interpretation. In addition the computer interpretation of ECGs may be erroneous with a reported error rate up to 75% which can result in unnecessary additional testing and costs, as well as patient distress and inappropriate referrals to cardiac specialists (Shah and Rubin, J Electrocardiol 40: 385–390, 2007; Guglin and Datwani, J Electrocardiol 40: 144–146, 2007).
The purpose of this chapter is to enable the reader to identify commonly seen normal and abnormal ECGs and the diverse rhythm disturbances seen in children and adults with various congenital heart defects. In addition, specific pathophysiologies of arrhythmias and appropriate therapies will be presented.
KeywordsECGs Electrocardiogram Arrhythmias Supraventricular tachycardia Ventricular tachycardia Heart block Electrolyte imbalance Drug effects Ischemia Pacemakers Wolff-Parkinson-White
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