What is Arrhythmia in Children?
Arrhythmia in children is a disease that is characterized by cardiac rhythm disorders and is recorded in children and adolescents of all ages, but mainly in older children.
The form of arrhythmia can be congenital or acquired. Also, this disease is divided into organic and functional. Rhythm disorders occur when any major function of the heart muscle is disturbed – arousal, automatism, myocardial contractility or conduction. Because of the automatism disorder, bradycardia or sinus tachycardia occurs, as well as the migration of a source of rhythm and sinus arrhythmia, etc.
Sinus tachycardia and bradycardia are diseases that are characterized by an increase or decrease in the normal heart rhythm by 20-30 beats per minute (the norms are specified based on the child’s age).
Sinus arrhythmia is a disease that can have several options. The most frequent is respiratory arrhythmia, which can affect children of any age. In infants, this disease is rare, a little more often – in preschool children. An even greater number of diseases among schoolchildren. During exercise, respiratory arrhythmia is reduced. On the ECG, a significant variability in the duration of the cardiac complexes is recorded.
The migration of the source of the rhythm is a disease that can be diagnosed only when conducting an ECG on a different shape of the P wave in separate leads. If the source of the rhythm goes beyond the sinus node, which affects the direction of the P wave, this indicates heart disease in most cases. There is no special treatment for migrating the source of rhythm in children.
Disorders of arousal of the heart can cause beats, paroxysmal tachycardia.
Extrasystole is an extraordinary contraction of the heart. The extrasystoles are divided into supraventricular and ventricular at the place of occurrence of the excitation pulse. If the alternation of extrasystoles with a normal rhythm is correct, it is called alorhythmia. More frequent cases of erratic contraction with a normal rhythm. Extrasystole in children can be at any age. Complaints from the baby does not occur. But there may still be complaints of discomfort in the heart area. To make a diagnosis, an ECG is performed.
Functional extrasystoles in most cases are characteristic of the prepubertal and pubertal periods. They change when you change the position of the body, during exercise. Also, with functional extrasystoles in children, there may be foci of chronic infection, signs of vascular dystonia, endocrine disorders, and so on.
Organic extrasystoles are more permanent. A sick child has a violation of the general condition, there are signs of functional heart failure. This type of extrasystoles is found in congenital heart defects, myocarditis, and may also be rare in children with rheumatism.
Paroxysmal tachycardia – attacks of a sharp increase in heart rate, when the heart beats 160-180 beats per minute and more often. There are two types of this disease: supraventricular and ventricular.
Violations of the function of the blockade, which basically do not lead to arrhythmias and can only be detected by ECG. Symptoms can reveal only complete atrioventricular blockade with Morgagni-Edems-Stokes attacks. The basis of this syndrome is acute brain ischemia due to a sudden decrease in cardiac output. In such cases, attention is drawn to the sharp bradycardia.
Impaired function may be a functional impairment or observed as in the pathology of the heart. It is necessary to treat the underlying disease that caused the disturbances. With a complete atrioventricular block, surgical methods of treatment are applied, with electrostimulators.
Atrial fibrillation is a complex rhythm disorder associated with a change in the proper atrial activity. In children, such a disorder is rare, mainly if there are severe lesions of the myocardium: idiopathic myocarditis, congenital heart defects, rheumatism. Atrial fibrillation forms: bradyarrhythmic, tachyrhythmic.
Sick sinus syndrome – tachy bradycardia syndrome is a complex arrhythmia. Sometimes it occurs in the absence of congenital heart defects, but more often with their presence or after heart surgery.
Causes of Arrhythmia in Children
Sinus tachycardia and bradycardia
The frequency of contractions of the heart may vary due to various diseases, organic lesions of the cardiovascular system of the child. In children, functional disorders are often the cause. Sinus bradycardia most often speaks of pathology. It is necessary to treat the main disease, there are no special measures.
By genesis, paroxysmal tachycardias are associated, as a rule, with the phenomena of repeated “recurrent arousal” as a result of the existence of additional pathways. If the disease is functional in nature, the attacks are short, there are no signs of impaired blood circulation, there is a connection with emotional aspects.
Symptoms of Arrhythmia in Children
The attack begins, as a rule, suddenly. The child has chest tightness, discomfort in the heart, pain in the epigastric region. Often there are also fainting, dizziness, vomiting. On examination, doctors detect shortness of breath, pallor, signs of impaired blood circulation, pulsation of the jugular veins. More often borders of heart are normal, note purity of tones. Against the background of severe tachycardia, the pendulum-like heart rhythm can be considered characteristic – the intervals between the tones become equal. The pulse is filled with little blood pressure in a child below normal. The attack can last 3-4 seconds at least a few months maximum.
Pallor appears, which can then be replaced by cyanosis, convulsions, loss of consciousness. There may be involuntary discharge of feces and urine. For some time, the pulse is not detectable. The duration of the attack from 3-4 seconds to 2 minutes. If the attack lasts longer, a fatal outcome is likely.
They note a sharp deterioration of the condition, there may be a feeling of fear and anxiety. The doctor listens to different sounds of tones, randomly alternating short and long pauses. Typical for atrial fibrillation in children is the presence of a “deficit” pulse, when the number of heartbeats exceeds the number of pulse beats. Usually there are signs of impaired blood circulation of various degrees.
Sick sinus syndrome
Symptoms of this disease may not manifest. In severe bradycardia, there may be fainting or dizziness.
Diagnosis of Arrhythmia in Children
In order to diagnose arrhythmia in children, the examination by a pediatrician or cardiologist is obligatory. The doctor conducts an external examination, measures pressure, probes the pulse if necessary, listens to the heart. Next, the child may be assigned special research methods, for example, ECG.
Special research methods do not allow to detect violations of myocardial contractility. Clinooorostatic test, samples with metered exercise, pharmacological tests with ECG recording in rare cases provide an opportunity to clarify the basic mechanism of the origin of functional extrasystoles.
An accurate diagnosis can only be made with an ECG. In frequent cases, the Wolff — Parkinson-White syndrome is also found in a child with this diagnosis.
Arrhythmia Treatment in Children
Extrasystoles organic genesis in children
In most cases, these are functional lesions, so special therapy is not needed. Therapy of the main disease that caused rhythm disturbances is necessary. To remove an extrasystole, doctors use first with potassium preparations: potassium orotat, asparkam, panangin in a dosage according to the patient’s age.
If the therapy did not produce the expected results, apply β-adrenergic blockers. Anaprilin is effective (it is also obzidan, it is also inderal), cordaron. The dose for 24 hours is calculated according to the formula: from 1 to 2 mg per 1 kg of body weight of the child. When circulatory failure, these drugs are prohibited to use! Doctors may prescribe procainamide or isonikamide as treatment.
To relieve a paroxysmal tachycardia attack, initially mechanical techniques are used to excite the vagus nerve: pressure on the carotid sinus (preferably to the right) or on the eyeballs. In some cases, there is the effect of the Valsalva maneuver: the child is straining at the height of a deep breath with the voice gap closed and the nose clamped.
With regard to drug therapy for paroxysmal tachycardia in children, apply r-adrenergic blockers, for example, obzidan. The doctor may prescribe isoptin, which blocks the entry of calcium into myocardial cells. Newborn isoptin is administered intravenously at a dose of 0.3-0.4 ml. For children up to 12 months, the dose is 0.4-0.8 ml, from 1 to 5 years old – 0.8-1.2 ml, from 5 to 10 years old – 1.2-1.6 ml and from 10 to 18 years – 1.6-2.0 ml. The attack can be removed using procainamide or isonikamida. As an emergency treatment, you can apply a single intravenous drip of 1% ATP solution (up to 2 ml) in a solution of 10% glucose with parallel use of sedatives (seduxen).
If a child has signs of circulatory failure, the above described treatment is carried out along with taking cardiac glycosides. For recurrent forms of paroxysmal tachycardia, sedative therapy, obsidan, isoptin and other drugs can be used orally in individual dosage for a long time as prophylaxis.
Atrial fibrillation in children
It is necessary to treat the underlying disease. With the tachyarrhythmic form, doctors prescribe cardiac glycosides to the child. In cases of the bradyarrhythmic form, glycosides can be used with great care. In some cases, the child is prescribed quinidine, novokinamid, aymaline. If there is no effect from the medication, electrical defibrillation is prescribed. The prognosis for this disease in a child is serious, the most unfavorable for tachyarrhythmic form.
Sick sinus syndrome
The treatment is carried out with the same preparations as with tachyarrhythmias: quinidine, anaprilin. Digitalis preparations are prohibited! In severe cases, implantation of an artificial pacemaker, operating on the principle of feedback, is performed.
Prevention of Arrhythmia in Children
Treatment of diseases leading to arrhythmia
Preventive measures against arrhythmias are associated with the treatment of those diseases that cause cardiac arrhythmias. It is necessary to treat such diseases as quickly as possible:
- atherosclerotic cardiosclerosis
- mitral stenosis
- heart defects
- hypertonic disease
- coronary heart disease
For teens you need to stop smoking, drinking alcohol. Children and adolescents should be as nervous as possible, temper physical exertion.
Traditional methods of preventing arrhythmia in children
Maintain a healthy lifestyle
With a tendency to arrhythmia in the child in the diet should prevail plant food and low-fat products. Food is taken in small portions, do not eat at night. Include in the child’s diet foods that contain magnesium and potassium: dried apricots, honey, zucchini, pumpkin, walnuts, zucchini.
- physical exercise
Physical activity of the child should be moderate. You need to walk with the child in the fresh air, do exercises in the morning, swim. The doctor may recommend jogging and skiing.
- reduction of emotional stress
The child must be in a calm emotional state. The child is involved in auto-training. You can prescribe a patient to take sedatives: valerian infusions, motherwort, etc.
- rest in the daytime, sleep at least 8 hours a day
Maintaining body weight and cholesterol and glucose values in normal. Parents should monitor these factors, periodically conduct appropriate tests for the child. Protect your child from obesity. If there is such a problem, the child is put on a low-calorie diet.
Prevention of arrhythmia in children with unconventional drugs
- a collection of mint leaves, calendula flowers, hawthorn, chicory and rue herbs is poured with boiling water and heated for half a minute. The infusion obtained in this way must be filtered and given to the child for ½ cup 3 times a day.
- 5 grams of hawthorn flowers are poured with boiling water and heated for 15 minutes in a water bath. The tincture is cooled, filtered, diluted with water to a volume of 200 ml. Give a child ½ cup 30 minutes before a meal
- yarrow juice is given to a child by diluting 20-30 drops in half a glass of water at room temperature.
- loving grass, chicory, calendula, hawthorn in a ratio of 4: 1: 1: 2 pour boiling water on the fire for half a minute. Give the child 2 tbsp. spoons 7 times a day
- collection of valerian, St. John’s wort, rosemary, mint, hops, taken in equal proportions, mixed. 2 tablespoons of the mixture poured boiling water (0.5 l) and insist for 8 hours. Collection give the child for 2 months 3 times a day
Herbal medicine can not be an independent preventive or therapeutic measure. Reception of those medicines which the doctor will register to the child is obligatory. For the prevention can be used several drugs. When the doctor prescribes them, be sure to clarify the purpose and features of the reception. Observe the dosage and frequency of administration, which the doctor advises, since many drugs for treating and preventing arrhythmias in children are potent, can have side effects.