Heart rhythm disorders in children

Heart rhythm disorders in children


Post-hypoxic complications from the cardiovascular system (CVS) in newborn children range from 40 to 70% and represent an urgent problem of pediatric cardiology. In terms of the frequency of occurrence of the state of post-hypoxic maladjustment of the cardiovascular system, they are in second place after the organic pathology of the heart in the neonatal period.

As a result of hypoxia in the fetus and newborn, the autonomic regulation of the heart and coronary circulation is disturbed, which in the future can lead to the formation of persistent vegetative-visceral disorders, one of the manifestations of which is “post-hypoxic syndrome of maladjustment of the cardiovascular system.”

What it is? This is a functional disorder of the cardiovascular system in a newborn and a young child, which is associated with a past chronic antenatal (unfavorable course of pregnancy: long-term gestosis, threatened abortion, anemia during pregnancy, exacerbation of chronic diseases) and intrapartum hypoxia (weakness of labor, premature birth, rhodostimulation, cesarean section, cord entanglement).
The clinical symptomatology of this pathology is polymorphic, manifests itself from the first days of life and is often disguised as other diseases. Therefore, the doctor has to carry out differential diagnostics with congenital heart defects, congenital carditis, cardiomyopathies.

One of the frequent clinical variants of this syndrome in newborns is heart rhythm disturbance, more often in the form of supraventricular and ventricular extrasystoles, 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 a syndrome of hyperexcitability, hypertensive-hydrocephalic and convulsive syndromes, impaired innervation of the heart, the state of the myocardium (heart muscle) and hormonal status.

Extrasystole is a heartbeat premature in relation to the main rhythm. Depending on the location of the ectopic focus, atrial, atrioventricular and ventricle are distinguished. 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 premature beats are considered to be the most unfavorable prognostically.

Are extrasystoles dangerous?


Most arrhythmias in childhood are benign, reversible, and not life threatening. 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 adversely affects hemodynamics, causes a decrease in cardiac output and blood supply to the heart muscle, as a result, it can lead to ventricular fibrillation and is associated with the risk of sudden death.

How are cardiac arrhythmias manifested?


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 a medical examination or after a viral or infectious disease. Arrhythmias are manifested by palpitations, a feeling of interruptions in the work of the heart, its sinking. In addition, the child may have weakness, dizziness, fainting, shortness of breath, pallor of the skin periodically occurs.

Plan of examination of children with cardiac arrhythmias:

  1. Evaluation of clinical, anamnestic and genealogical data.
  2. ECG examination (it is necessary to record a long ECG tape, as often LDCs have a fickle character and they do not have time to appear on a short tape).
  3. Daily ECG monitoring.
  4. Holter monitoring (HM) – long-term ECG registration (days or more) on a special recorder with subsequent decoding on a special analytical system. The method is available for any age, incl. and for newborn babies. Today the method is the leading one in the examination of children with LDCs. The uniqueness of the method is that ECG registration is carried out without restricting the patient’s free activity. The method has no contraindications. 3. Holter monitoring (HM) – long-term ECG registration (days or more) on a special recorder with subsequent decoding on a special analytical system. The method is available for any age, incl. and for newborns. Today the method is the leading one in the examination of children with LDCs. The uniqueness of the method is that ECG registration is carried out without restricting the patient’s free activity. The method has no contraindications. 3. Holter monitoring (HM) – long-term ECG registration (days or more) on a special recorder with subsequent decoding on a special analytical system. The method is available for any age, incl. and for newborns. Today the method is the leading one in the examination of children with LDCs. The uniqueness of the method is that ECG registration is carried out without restricting the patient’s free activity. The method has no contraindications. Ultrasound examination of the heart, or ECHO-cardiography (Echo-KG)
  5. Consultation of a neurologist with the conduct of NSG (neurosonography) and EEG (electroencephalography) sleep
  6. Consultation of an endocrinologist with an ultrasound of the thyroid gland and determination of hormonal status.

Principles of drug therapy for cardiac arrhythmias in children.


Treatment of cardiac arrhythmias, especially life-threatening ones, is carried out strictly individually, depending on their origin, shape, duration, influence on the well-being of the child and the state of his hemodynamics. With all types of arrhythmias, treatment of cardiac and extracardiac causes should be carried out at the same time. Treatment should be comprehensive and include the appointment 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. These changes include malignant arrhythmias and arrhythmogenic left ventricular dysfunction.

Dispensary 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. Be sure to dynamically take an ECG and prescribe daily ECG monitoring to assess the effectiveness of therapy.

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