1. Arrhythmia in babies and children

2. Bradycardia in infancy
Mostly related to complete 3rd degree heart block
Mum may have history of Lupus
Anti-La or anti-Ro antibodies
Incidence: 1:
Picked up in antenatal (hydrops) or postnatal period (CCF or well with low heart rate)
Heart rate: <70 Regular or Irregular
Temporary Pacemaker: HR <45, Pauses: >3 sec
Almost always need permanent pacemaker in the long run

3. Electrical Heart Diseases Tachyarrhythmia
0-5 years
Serious
Non- Specific Symptoms
Maternal History
5- 10 years
Significant
Specific Symptoms
Maternal and Patient History
10-16 years
Significant and Interesting
Specific Symptoms
Patient History
History is the Key

4. Supraventricular tachycardia
SVT
Infants and Toddlers
Unaware
Funny Turn
Pallor, Poor feeding
Signs of CCF
Older children
Aware
Palpitation
Dizziness

5. Case of J H 5 ½ year old boy Increased appetite  Obesity
Temperamental, Arguments
Lack of concentration, Hyperactivity
Snoring, Nightmares
Dietary history confirmed food intake
Past history unremarkable
No F/H obesity

6. Case of J H Wt: 34.9 kg Ht: 121cm BMI - 24 BP: 107/70 mg of Hg
Almond shaped eyes
Flat nasal bridge
Hyper-mobile joints
Apprehensive & Anxious

7. Hyperphagia, Obesity, ?Genetic obesity
Investigations for Obesity
Dietary referral
Sleep pulse oximetry
Review 3 months

8. Was he a bit tachycardic?
Something bothered me
Was he a bit tachycardic?

9. Case of J H Pulse: 100/min BP: 107/70 mm of Hg O2 saturation: 99%
Rest of the examination normal
No signs of cardiac failure

10. ECG

11. ECHO

12. Royal Brompton Hospital Paediatric Cardiology
Supraventricular Tachycardia
 
Cardiomyopathy

13. Is something worrying you! Act on it

14. WPW Syndrome 1930: Wolf,Parkinson,White
Characteristic ECG: Short PR interval
Delta wave: Slow upstroke QRS
1944: Accessory pathway
Common Pathway: Bundle of Kent
Incidence: 0.15 to 0.35%
First Degree relatives affected: 0.55%

15. WPW Syndrome

16. Arrhythmias

17. Supraventricular tachycardia
Commonest tachyarrhythmia in childhood
Majority has a structurally normal heart
Short lived SVTs are not life threatening
Baseline ECG: May reveal predisposing features
24 hour ECG
Event recorder

18. SVT in children Common Arrhythmia in children Can be asymptomatic
Adenosine mainstay for acute attacks
Chronic SVTs can lead to poor LV function

19. SVT Diagnosis&Treatment My experience
SHO: 2 cases newborn from postnatal ward Asymptomatic Ice packs on the face, Digoxin
SHO: 8 week old baby: Pale, poor feeding Dipping the face in ice water Baptism treatment for SVT

20. SVT Diagnosis & Treatment My experience
Registrar: Adenosine Drug shock!
Cardiology registrar: AdenosineDigoxin Flecanide
Post Cardiac Op: DC Conversion
No experience with AF

21. SVT Long term treatment
No treatment
Vagal manoeuvres
Drugs
Beta Blockade: Propranolol, Atenolol
Flecanide, Amiodarone
Radiofrequency Catheter Ablation