Paroxysmal supraventricular tachycardia in children

Abstract

Introduction: Cardiac rhythm disturbances in children are rare and do not have to be associated with structural damage to the heart muscle. The most common are paroxysmal atrial tachycardia with an incidence of 1:500. These tachyarrhythmias in children are characterised by the number of strokes ranging 160-360. Aim: The aim of this paper is to present the quality of life in children with paroxysmal supraventricular tachycardia (PSVT), and the role of Emergency Department (ED) in the treatment of attacks of tachycardia. Case report: A girl aging 7 was taken by her mother to the Emergency Department of Health Care Centre (HCC) Becej on 1st November 2008 at 17:09 for palpitations. The attack occurred in the child for the first time, in an effort, half hour earlier. Clinical examinations revealed that the patient was hypotensive (TA 85/50 mmHg), tachycardia (300 beats/min) with oxygen saturation in the peripheral blood of 100%. On electrocardiogram (ECG) recorded the reading in sinus rhythm 300/min in frequency, levogram, the displacement of the ST segment in all leads of 3-5 mm. Accompanied by a nurse, the patient was transported and diagnosed with Tachycardia Parohysmalis (I 47.) without any pre-hospital therapy applied. She was hospitalized for ten days at the Cardiology Department of the Institute for Health Care of Children and Youth, Novi Sad (Novi Sad IZZZDiO). She was discharged with the diagnosis of Tachycardia Paroxysmalis Supraventrikularis (I 47.1) and Propranolol therapy was recommended. In spite of the treatment, attacks of PSVT were still being recorded in the patient. The therapy was replaced by the cardiologist. The applied therapy included Presolol, then Amiodarone, and then combinations Amiodarone and Presolol and since Avgusta 2011 she started using Propafen tablets. Until 10th February 2013 the patient had 27 attacks of tachycardia in total. The patient was treated at the Children's Medical Centre Becej for five times, four times the ED HCC were invited to take her from the CMC and for 18 times she was brought directly to the ED. In most cases, when the patient was cared for at ED HCC, PSVT was converted to sinus rhythm by Presolol or a combination of Presolol and Amiodaron. In two cases PSVT was converted by Valsalva maneuver. In two thirds of the visits, the patient was sent back home after the therapy and converting PSVT to a sinus rhythm. Nine times she was sent to IZZZDiO in Novi Sad, where he was hospitalized. Conclusion: If the PSVT attacks in children older than one, with a severe clinical course and frequent, continual medical therapy is applied. The highest efficiency is demonstrated by Amiodarone preventing the attacks in even 85% cases. However, in our patient the attacks continued despite of continuous drug therapy. They are frequent, with severe clinical course, limiting the child's daily activities. ED HCC physicians manage to convert most of the attacks to the sinus rhythm, so she does not have to be sent each time to a tertiary health institution and hospitalised.