Bradycardia
Bradycardia is a slow pulse (<90 in infants and <60 in children and adolescents). Causes range from the benign (athletic heart) to the life threatening (sepsis, severe heart block). Assessing the child's ABCs is the first priority.
Differential Diagnosis
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Vasovagal response
–Defecation, yawning, rectal stimulation, placement of nasogastric tube, sight of blood, etc.
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Drug reaction
–β-blockers, calcium channel blockers (diltiazem, verapamil), carbamates, clonidine, digoxin, opiates, organophosphates, gamma-hydroxybutyrate (“date rape” drug), and plants (lily of the valley, foxglove, oleander)
-
Healthy athlete
–Sinus bradycardia
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Hypothermia
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GER (in infants, especially premature)
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Low birth weight infants: Sinus bradycardia (great variations in sinus rate, can have junctional escape beats)
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Congenital complete heart block: Associated with maternal SLE
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Congenital heart disease
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Sepsis
- Obstructive sleep apnea
–Seen in children with obesity, tonsillar or adenoid hypertrophy, craniofacial anomalies, neuromuscular diseases
–Hypoxia and hypercapnia lead to pulmonary hypertension and arrhythmia
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Electrolyte abnormalities can lead to dysrhythmias
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Anorexia nervosa
–Prolonged QT syndrome and junctional arrhythmia
–Associated hypokalemia may also cause ECG changes and life-threatening dysrhythmias
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AV node blocks (second- and third-degree)
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Idioventricular rhythm
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Hypothyroidism (myxedema)
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Allergic reaction/anaphylaxis
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Increased intracranial pressure (IVH, extradural hemorrhage, trauma, etc.)
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Sick sinus syndrome (tachy-brady syndrome)
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Psittacosis, typhoid fever, Lassa fever
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Myocardial infarction
Workup and Diagnosis
- History
–For acute patients, history of present illness, associated
symptoms
–Birth history, PMH, and review of systems
–Medications, medications around the house, alternative
medicines/herbs
- Physical exam
–Vital signs, growth parameters, nutritional status,
physical fitness
–Craniofacial and ENT exam
–Complete cardiac exam: Evaluate cardiovascular
stability, BP, pulse, perfusion, mental status, tachypnea, as well as heart sounds, murmurs, distal pulses
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Labs
–ECG: Look for block, prolonged QTc, abnormal P
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wave, or QRS complex
–Electrolytes (include potassium, calcium, magnesium)
–CBC: Look for infection
–Consider drug screen: Look for toxic ingestion
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Studies
–Consider upper GI series, pH probe, or pneumogram (if suspect apnea as well) to look for GER
–Consider 24-hour Holter monitor if episodic bradycardia
–Consider echocardiogram to rule out congenital heart disease
Treatment
Stabilize the patient with attention to ABCs
- If bradycardia is symptomatic or life threatening, consider using:
–Epinephrine: 0.01 mg/kg (maximum: 10 mL/dose) every 3–5 minutes IV, IO; or 0.1 mg/kg (0.1 mL; 1:1,000)/kg/dose ET
–Atropine 0.01–0.03 mg/kg/dose every 5 minutes prn via IV, endotracheal, or interosseous
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Keep the patient in a monitored setting when appropriate (heart monitor to follow the bradycardia)
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Treat the underlying cause when possible: Stop causative medications; treat sepsis, hypothermia, increased intracranial pressure, and electrolyte abnormalities emergently; intensive therapy for eating disorders; synthroid for hypothyroidism
-
Cardiac surgery for CHD may not resolve arrhythmias
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Cardiac pacing (transcutaneous or implanted may be needed)
'>>
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Arrhythmias
Read excerpts from these other book chapters related to Arrhythmias:
Medical Books Excerpts
- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Murmurs
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Bradycardia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Murmurs
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Palpitations
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Tachycardia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Bradycardia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Palpitations
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Tachycardia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Bradycardia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Murmurs
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Palpitations
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Tachycardia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Bradycardia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Murmurs
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Tachycardia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Murmurs
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Arrhythmias
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: Tachycardia/Palpitations (In A Page: Pediatric Signs and Symptoms)
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