Cardiac dysrhythmia or arrhythmias are caused by abnormalities in the electrical activity of the heart and can be classified as bradyarrhythmias, tachyarrhythmias or pulseless arrest.
Bradyarrhythmias are the most common arrhythmias in children and usually presents with hypoxemia, hypotension and acidosis. Bradycardia is a heart rate which is slower than the normal for the age of the child; usually less than 60 bpm is indicative of bradycardia and immediate CPR should be initiated.
|Signs of Bradycardia|
|Symptoms of Bradycardia|
There are 5 examples of bradyarrthmias that are seen in children:
Sinus Node Arrest/Sick Sinus Syndrome
Sinus node arrest/sick sinus syndrome is associated with abnormal heart rhythms due to malfunction of the sinus node. These may include atrial, junctional and idioventricular escape rhythms.
|Signs of Tachycardia|
|Symptoms of Tachycardia|
The following are examples of tachycardia:
Atrial flutter is abnormal heart rhythm causing fast irregular heartbeat. Usually occurs in the atria of the heart and is uncommon in children. Some causes of atrial flutter include: hypertension, ischemia, cardiomyopathy, and abnormal heart valve.
Torsades de Pointes/Polymorphic VT
Polymorphic VT or Torsades de Pointes is when different areas in the ventricles fire fast, uncoordinated impulses. Ventricular rates range from 150-250 bpm and QRS complex vary in apprearance. Some causes of polymorphic VT or Torsades de pointes include: diarrhea, hypomagnesaemia, and hypokalemia.
Management of Tachyarrhytmias
Upon recognizing the child with tachycardia immediately activating the EMS and conducting the ABCs
The following algorithms show management of tachycardia with a pulse and adequate perfusion and one with poor perfusion for children.
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