PHARMACOTHERAPY of cardiac arrhythmias in children

Arrhythmia in adolescents

Arrhythmia in adolescence is usually not associated with any pathology, but is a feature of the transition period.

In adolescent children, the most common conditions are:

• Respiratory arrhythmia is a typical teenage arrhythmia. When you inhale, the heart rate increases somewhat, and when you exhale it slows down. Such irregularity of heart rhythm indicates increased excitability of the autonomic nervous system and for a teenager this is the norm, while the appearance of respiratory arrhythmia in an adult is a symptom of the disease.
• Extrasystoles are sudden, extraordinary contractions of the heart. Usually they are not felt by a person, but are detected on an ECG. Extrasystoles in adults are a pathology, and in adolescence they can be a variant of the norm. Such cardiac arrhythmia in adolescents occurs due to increased growth of the heart.

Fii Sanatos

Posthypoxic complications of the cardiovascular system (CVS) in newborns range from 40 to 70% and represent an urgent problem in pediatric cardiology. In terms of frequency of occurrence, posthypoxic maladaptation states of the cardiovascular system are in second place after organic heart pathology in the neonatal period.

As a result of hypoxia in the fetus and newborn, the autonomic regulation of the heart and coronary circulation is disrupted, which can subsequently lead to the formation of persistent vegetative-visceral disorders, one of the manifestations of which is “posthypoxic syndrome of disadaptation of the cardiovascular system.”

What it is?

This is a functional disorder of the cardiovascular system in a newborn and young child, which is associated with chronic antenatal (unfavorable course of pregnancy: long-term gestosis, threat of miscarriage, anemia during pregnancy, exacerbation of chronic diseases) and intranatal hypoxia (weakness of labor, premature birth, labor stimulation, cesarean section, umbilical cord entanglement).

The clinical symptoms of this pathology are polymorphic, appear from the first days of life and are often disguised as other diseases. Therefore, the doctor has to carry out differential diagnosis with congenital heart defects, congenital carditis, and cardiomyopathies. Stay close to us on:

Symptoms

In approximately 40% of cases, rhythm disturbances in children are asymptomatic and are detected by chance (on an ECG), or during an objective examination during medical examination or after suffering viral or infectious diseases. Arrhythmias are manifested by palpitations, a feeling of interruptions in the work of the heart, and its freezing. In addition, the child may experience weakness, dizziness, fainting, shortness of breath, and periodically pale skin.

One of the common clinical variants of this syndrome in newborns is cardiac arrhythmia, most often in the form of supraventricular and ventricular extrasystole, rarely supraventricular paroxysmal tachycardia.

These changes can occur even in the prenatal period and the first hours after birth.

The severity of the condition is usually due to hypoxic-traumatic damage to the central nervous system in the form of hyperexcitability syndrome, hypertensive-hydrocephalic and convulsive syndromes, impaired innervation of the heart, the condition of the myocardium (heart muscle) and hormonal status.

Extrasystole is a heartbeat that is premature in relation to the main rhythm.

Depending on the location of the ectopic focus, atrial, atrioventricular and ventricular extrasystoles are distinguished.

The problem of extrasystole attracts the attention of cardiologists due to its high prevalence and the possibility of sudden death. Ventricular extrasystole is considered the most unfavorable prognostically.

Are extrasystoles dangerous? – Most arrhythmias in childhood are benign, reversible and do not pose a threat to the child’s life.

In newborns and young children, they can lead to the development of arrhythmogenic cardiomyopathy or heart failure, contributing to early disability and even death.

Ventricular extrasystole has an adverse effect on hemodynamics, causes a decrease in cardiac output and blood supply to the heart muscle, and as a result can lead to ventricular fibrillation and is associated with a risk of sudden death.

Diagnostics

1. Assessment of clinical, anamnestic and genealogical data.
2. ECG examination (it is necessary to record a long ECG tape, since often NDCs are of an unstable nature and they do not have time to appear on a short tape).
3. Daily ECG monitoring.
4. Holter monitoring (HM) is a long-term recording of an ECG (a day or more) on a special recorder, followed by decoding on a special analytical system.
   The method is available for any age, incl. and for newborn children. Today, the method is leading in the examination of children with disabilities. The uniqueness of the method is that ECG registration is carried out without restricting the patient’s free activity. The method has no contraindications.
5. Consultation with a neurologist with NSG (neurosonography) and EEG (electroencephalography) during sleep
6. Consultation with an endocrinologist with an ultrasound of the thyroid gland and determination of hormonal status.

Treatment

Treatment of heart rhythm disturbances, especially life-threatening ones, is carried out strictly individually depending on their origin, form, duration, impact on the child’s well-being and the state of his hemodynamics.

For all types of arrhythmias, cardiac and extracardiac causes should be treated simultaneously. Treatment should be comprehensive and include the prescription of neurometabolic, vascular drugs, cell membrane stabilizers and antioxidants.

The interaction of these types of therapy makes it possible to ensure long-term remission and complete clinical recovery.

There are situations when it is necessary to prescribe specialized antiarrhythmic therapy. Such changes include malignant arrhythmias and arrhythmogenic left ventricular dysfunction. Stay close to us on:

Course of the disease

Clinical observation should be regular. Its frequency is determined depending on the underlying disease (rheumatism, non-rheumatic carditis, congenital heart disease, etc.), the form of arrhythmia and the characteristics of its course. Dynamic ECG recording and 24-hour ECG monitoring are required to assess the effectiveness of therapy. Stay close to us on:

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Causes of arrhythmia in adolescents and children

In young children, the cause of arrhythmia may be perinatal pathology (disturbances during pregnancy and childbirth), which can lead to a disorder of the neurovegetative regulation of cardiac activity with a change in the relationship between the parasympathetic and sympathetic parts of the nervous system. As a result, electrical instability of the conduction system and heart muscle occurs.

Children's cardiac arrhythmia can be caused by many reasons, but they can be grouped into 3 groups:

1. Extracardiac (associated with other, non-cardiac diseases).

Cardiac arrhythmia in children often has extracardiac origin. In this case, an abnormal heart rhythm in a child may be the result of damage to the nervous system (trauma, infection

, tumors, malformations, etc.), leading to a disorder of the innervation of the heart and immaturity of the conduction system.

2. Cardiac (related to the pathology of the heart itself).

Cardiac causes are not the leading ones in children and adolescents, but when arrhythmia is detected they are excluded first. These could be heart defects, infectious diseases, heart tumors, hereditary syndromes, etc.

3. Mixed.

Classification

All arrhythmias are classified into 3 main groups:

• automatism disorders (sinusoidal arrhythmia, tachycardia, extrasystole, bradycardia, atrial fibrillation, ventricular flutter),
• conduction disorders (blockades),
• combined arrhythmias.

Extrasystoles occur in more than 20% of healthy children and are not dangerous to health, but some types of arrhythmias, especially paroxysmal tachycardia, heart block or atrial fibrillation can have serious consequences, including death.

Signs and symptoms of arrhythmia in children and adolescents

The main manifestations of arrhythmias in infancy:

• periodic blue or pale skin;
• dyspnea;
• periodic causeless restlessness of the baby;
• sluggish breast or bottle sucking, refusal to eat, little weight gain;
• frequent awakenings, poor sleep, cry

  at night.

In an older child, arrhythmia may manifest itself as follows:

• exercise intolerance;
• fainting;
• feeling of heart failure;
• increased fatigue.

Types of arrhythmia in children and adolescents

1. Arrhythmias due to impulse formation disorder:

• sinus bradycardia is a decrease in heart rate compared to normal age-related rates;
• sinus arrhythmia

  – may be associated with breathing (respiratory) or not;

• sinus tachycardia is an increase in heart rate that exceeds age norms;

• pacemaker migration – change in the source of impulse formation;
• extrasystole - premature contraction of the heart, can be supraventricular or ventricular;
• paroxysmal and non-paroxysmal (constant) tachycardia: supraventricular and ventricular;
• atrial flutter is a significantly accelerated, but correct, regular contraction of the atria with a frequency of 250–300 per minute;
• atrial fibrillation – atrial contraction 400–700 per minute;
• ventricular flutter - their contraction with a frequency of 250–300 per minute;
• ventricular fibrillation (fibrillation) – chaotic rhythm (frequency – up to 400 or more per minute).

2. Arrhythmias provoked by impaired impulse conduction:

• Atrioventricular (AV) blocks;
• Intraatrial blocks;
• Intraventricular blocks;
• Sinoatrial (SA) block;

3. Combined arrhythmias:

• Atrioventricular dissociation;
• Sick sinus syndrome;
• Ventricular preexcitation syndrome.

Diagnosis of heart rhythm disorders in children

Cardiac arrhythmia in a child and its nature will be determined using an ECG examination, which is carried out not only if cardiac pathology is suspected or if there are “heart” complaints, but also for other childhood diseases.

ECG can successfully detect pathological arrhythmias (complete AV block, atrial fibrillation

) or arrhythmias that are a variant of the norm for children (incomplete block of the right bundle branch - RBBB, sinus respiratory arrhythmia in children).

However, to make a correct diagnosis and find out the causes of arrhythmia, a comprehensive examination is necessary:

• Studying the child’s medical history, morbidity in the family;
• Electrocardiography;
• X-ray examination of the chest organs;
• Holter monitoring – long-term ECG recording;
• Stress tests (treadmill test);
• Drug electrocardiographic tests;
• Neurophysiological studies (EEG), rheoencephalography;
• Echocardiographic examination (ECHO-CG).

Symptoms and diagnosis

Carrying out an ECG does not cause any concern in children

Most often, arrhythmias in children are diagnosed using ECG. In some cases, 24-hour monitoring and transesophageal electrophysiological study are used.

Since arrhythmias often have an asymptomatic course, it is important to undergo regular preventive screenings with an ECG and consult a doctor as soon as possible at the slightest sign of the disease, especially if the child experiences fainting. Infants may experience the following manifestations of arrhythmia:

• dyspnea;
• pallor or bluishness of the skin;
• poor sleep, periodic episodes of causeless restlessness, crying;
• poor appetite, poor weight gain;
• lethargy.

An older child may experience symptoms almost similar to adults:

• feeling of discomfort, pain, shortness of breath after physical activity;
• fainting conditions;
• weakness, significant fatigue;
• palpitations, a feeling of interruptions in the functioning of the heart.

To assess the heart rate of a child, special age standards are used:

If your child’s heart rate does not fit into the given standards, then this only means the need for examination. At the same time, he can be absolutely healthy.

Treatment of heart rhythm disorders in children and adolescents

Treatment of arrhythmia in children is prescribed individually depending on its cause, duration, as well as the effect on the child’s well-being and the state of his hemodynamics.

Treatment of arrhythmia in adolescents and children is always complex and includes vascular, neurometabolic

drugs,
antioxidants
and cell membrane stabilizers.

In some situations, it is necessary to use specialized antiarrhythmic drugs ( amiodarone

, procainamide, verapamil, etc.). For example, with a malignant course of arrhythmia, arrhythmogenic dysfunction of the left ventricle.

Determination of indications for pharmacotherapy and selection of medications is carried out in a hospital setting by a cardiologist.

Sick children with persistent, life-threatening, prognostically unfavorable rhythm disorders are indicated for surgical treatment.

Arrhythmia in the fetus and newborn: causes, treatment, prognosis

One of the problems of the infant's cardiovascular system is a failure of the heart rhythm.
Arrhythmia in a newborn, just like in a fetus in the womb, develops under the influence of certain factors and can lead to very serious consequences.

What does a heart rhythm disorder look like in a newborn or baby in the womb, how is the pathology treated, and why is this condition dangerous for an infant? We will look into the material below.

What is fetal arrhythmia?

In general, arrhythmia refers to some disruption in the sequence of contractions of the heart muscle. It is worth noting here that the heart of a person (even a very tiny one) beats with a certain rhythm, which is inherent in nature for a healthy and strong body. If the sequence of heart contractions is disrupted, this is already a pathology.

Modern cardiologists can determine the heart rate of the fetus in the womb from the 19th week of its development. In this case, the heart rate is considered normal within the range of 120–160 beats/min. If the rate of contractions of the heart muscle is less than 100 beats/min, the pathology is called bradycardia. A heart rate above 160 is called tachycardia.

Bradycardia in the fetus is most pronounced between 6 and 7 a.m. or between 3 and 7 p.m. During these periods, the baby's activity is noticeably reduced. Tachycardia can best be detected in the fetus between 11 and 15 o'clock in the afternoon or between 19 o'clock in the evening and 1 o'clock at night.

Important:

in most cases, arrhythmia in the fetus during pregnancy is considered normal if the deviations in the frequency of contraction of the heart muscle are only short-term.
The pathology is persistent sinus tachycardia (more than 200 contractions per minute), the same bradycardia (less than 100 contractions per minute) or extrasystoles, which occur more than 1 time per 10 healthy and normal heart contractions.
Such palpitations require medication adjustment and medical supervision.

Why is arrhythmia diagnosed in the fetus and newborn?

The reasons why arrhythmia develops in utero or in a newborn may be different. In particular, in the fetus, disturbances in the contraction of the heart muscle occur for the following reasons:

1. Diabetes mellitus in a woman (type 1 insulin dependent).
2. Endocrine diseases of pregnant women.
3. Lesions of the nervous system in a pregnant woman.
4. Pathologies of fetal development due to hypoxia (anemia and anemia in the mother).
5. Frequent stress in a pregnant woman.
6. Smoking and drinking alcohol.
7. Failures in metabolic processes.
8. Unbalanced nutrition and lack of electrolytes in the body of the expectant mother (potassium, iodine, manganese, iron).



The causes of arrhythmia in newborns are the following pathologies and conditions:

• Congenital and acquired heart defects.
• Hemorrhage in the area of ​​the cardiac conduction tract.
• Immaturity of the heart muscle due to disturbances in its intrauterine development.
• Intoxication due to tonsillitis and other viral diseases.
• Early birth (prematurity).
• Pathological pregnancy.
• Emotional experiences and stress.
• Anemia.
• Problems with the thyroid gland (hypo- or hyperthyroidism).

Symptoms of arrhythmia

For an embryo in the womb and for a newborn baby with an abnormal heart rhythm, their own clinical picture is drawn. The main symptoms and signs in both cases are given below.

Signs of fetal arrhythmia during pregnancy

Here, the main symptoms of an abnormal heart rhythm are changes in the frequency of contractions of the heart muscle and low/high fetal mobility. The number of heartbeats can be heard both on an ultrasound and simply through the abdominal wall of a pregnant woman using a special stethoscope tube.

Signs of arrhythmia in a newborn baby up to one year old

Most often, an abnormal heart rhythm in babies under one year of age hardly manifests itself at all. Pathology is mainly detected by chance during a routine medical examination. If there is a serious deviation in the functioning of the baby’s heart, then the main signs of this condition are:

• paroxysmal shortness of breath and heavy breathing;
• pallor or cyanosis of the nasolabial triangle;
• restless behavior of the baby;
• small weight gain (deviations from the norm);
• visually noticeable pulsation of veins in the neck;
• restless sleep.

Important:

If one or more of the listed signs appear, you should immediately contact your pediatrician or immediately see a pediatric cardiologist. The sooner the pathology is detected, the greater the chances of a speedy recovery for the baby.

How is arrhythmia diagnosed in the fetus and newborn?

It is possible to diagnose abnormal heart rhythm in utero using two methods:

• Ultrasound in M-mode. In this case, the specialist monitors the movement of the walls of the ventricles and at the same time the movement of the leaflets of the atrioventricular valves. Here the doctor monitors the work of the aortic valve (closing/opening) and at the same time looks at how rhythmically the walls of the atria work. In addition, the doctor studies the speed of blood flow in the heart ventricles.

Arrhythmia in a newborn baby is diagnosed using the following methods:

1. ECG (Holter monitoring). In this case, the cardiogram device is worn throughout the day. The data obtained by conducting such a test allows us to track the direct connection between stressful conditions and disruptions in heart rate.
2. Ultrasound of the baby's heart (Dopplerography). Makes it possible to track the work of all parts of the heart, including valves, leaflets, atria and ventricles.

Treatment of arrhythmia

Treatment of arrhythmia in the fetus and newborn baby should only be carried out by a pediatric cardiologist. Self-medication is under no circumstances allowed, and even more so, pathology should not be left to chance.

Features of treatment of arrhythmia in the fetus

If a serious arrhythmia is diagnosed in the fetus, the expectant mother is prescribed a number of medications that stabilize the functioning of the baby’s heart. In most cases, medications are administered intravenously. In some cases, drugs are prescribed orally. In particular, the following medications are used:

• propranolol, magnesium and lidocaine;
• sotalol and amiodarone (for tachycardia above 200 beats per minute);
• dexamethasone (if fetal myocarditis is suspected).

Important:

treatment of the supraventricular form of arrhythmia in the fetus is successful in 90% of cases.

Features of treatment of arrhythmia in a child under one year old

For a newborn, treatment tactics for abnormal heart rhythm are selected strictly individually, depending on the cause of the pathology. In case of serious abnormalities in the heart, the baby should be constantly monitored by a cardiologist and pediatrician.

Surgery is a last resort and is prescribed only if there is a real threat to the baby’s life, or if the selected drug therapy does not produce the expected effect.

What complications can there be during the development of arrhythmia, after diagnosis and after recovery?

Most short-term arrhythmias in newborns or the fetus do not require correction. However, if the pathology manifests itself frequently and remains untreated, the baby may develop the following complications:

If the pathology was detected on time and the diagnosis was made accurately, in 85% of cases the prognosis for the baby is quite favorable.

Forecast for future health

In general, most types of existing arrhythmias require only constant monitoring of the state of the baby’s heart.

Such abnormalities are benign and generally have a favorable prognosis.

However, if the baby is diagnosed with atrial fibrillation, paroxysmal or transverse heart block, then the prognosis may be disappointing (in the absence of proper therapy).

Prevention of arrhythmia in the fetus (advice for expectant mothers)

In order not to put the health of the unborn baby at risk and to exclude possible heart problems, a pregnant woman needs to adhere to some rules of a healthy lifestyle. These are:

1. Frequent walks in the fresh air.
2. Timely treatment of any infectious and viral pathologies.
3. Undergoing a medical examination before a planned pregnancy.
4. A balanced diet with sufficient potassium in foods.
5. A calm lifestyle without stress and mental strain.
6. Rejection of bad habits.

Prevention of arrhythmia in a child up to one year old

To prevent a newborn child from suffering from arrhythmia for a long time, it is necessary to take the following preventive measures:

1. Neutralize all factors predisposing to arrhythmia.
2. Undergo preventive medical examinations in a timely manner.
3. Timely follow-up of a child with cardiac pathologies.
4. Provide the baby with oxygen baths of sufficient duration and adequate nutrition.

Every mother should understand that the baby’s health comes first. Therefore, you should take care of yourself before the planned pregnancy during the period of gestation. Only high-quality care for the functioning of a woman’s body gives a high chance of conceiving, bearing and giving birth to a baby with a healthy heart. 

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