Arrhythmias in childhood

Arrhythmias in childhood. Palpitations, dizziness, syncope, chest pain, loss of consciousness, etc., are some of the symptoms of arrhythmias, although in some cases they may go unnoticed.

Summary

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  • 1 Arrhythmia
  • 2 Causes of Arrhythmias in childhood
  • 3 Classifications of arrhythmias
    • 1 By its origin
    • 2 By your heart rate
    • 3 For its mode of presentation
  • 4 Symptoms
  • 5 Diagnosis
  • 6 Forecast
  • 7 Treatment
    • 1 bradyarrhythmias
    • 2 Tachyarrhythmias
  • 8 Source

Arrhythmia

An arrhythmia is an alteration of the heart rhythm. But to better understand what an arrhythmia is, we must first know how and why the heart beats .

The heartbeat occurs as a result of electrical impulses that cause the atria and ventricles to contract properly, synchronously, and rhythmically. The heart rate normally ranges from 60 to 100 beats per minute (bpm), and responds to the following sequence: The heart’s electrical impulse begins at the sinus node, located in the right atrium. From there it passes through the atria to the atrio-ventricular node , located at the junction of the atria with the ventricles and reaches the ventricles through the bundle of His.

Finally, this stimulus is conducted through the ventricles through the Purjinke system. We are now ready to drill down into more details about arrhythmias.

Causes of arrhythmias in childhood

The arrhythmias heart appear one of three reasons:

  • The electrical impulse is not properly generated.
  • The electrical impulse originates from the wrong place.
  • The paths for electrical conduction are altered.

Arrhythmia classifications

By its origin

  • Supraventricular: they are located above the bundle of His, that is, in the atria or in the atrio-ventricular node
  • Ventricular: originate in the ventricles

By your heart rate

  • Rapids or tachycardias: frequency greater than 100 bpm
  • Slow or bradycardia: frequency below 60 bpm

Due to its presentation

  • Chronicles: permanent
  • Paroxysmal: they appear on specific occasions

Symptoms

The arrhythmias can cause symptoms such as palpitations, dizziness, syncope, chest pain or unconsciousness, but may also go unnoticed and casually detected when diagnostic tests are performed.

Diagnosis

To make the diagnosis it is necessary to demonstrate that there is an alteration in the cardiac electrical activity. The reference diagnostic test is the electrocardiogram, but it has the disadvantage that it only records cardiac electrical activity at the time it is being performed and therefore only shows us if there are arrhythmias at that time.

Occasionally, other tests may be used, such as the Holter, which records cardiac electrical activity over a longer period of time (one or more days), or more rarely implantable Holters, which are placed under the skin through a simple surgical procedure. They can be worn for years and are reserved for patients with suspected serious arrhythmias that could not be detected by other methods.

When a physical effort related arrhythmia is suspected, a stress test may be performed. Finally, the cardiac conduction system can be studied in depth and try to reproduce the arrhythmias by means of the so-called electrophysiological study, which is carried out by inserting cables inside the heart, generally from the veins of the legs (femoral vein) that allow the activity to be recorded. cardiac electrical and stimulate the heart to reproduce arrhythmias.

It is also often important to find out if there is any structural alteration of the heart associated with the arrhythmia, for which an echocardiography can be performed .

Forecast

The prognosis depends on the type of arrhythmia and the patient’s baseline state. In general, bradyarrhythmias have a good prognosis after being treated, and among tachyarrhythmias , supraventricular ones have a more favorable prognosis than ventricular ones.

Treatment

It depends on the type of arrhythmia , its cause and the characteristics of the patient:

Bradyarrhythmias

Once possible non-cardiac causes have been resolved, sometimes they may require the placement of a [pacemaker], which is a device that is implanted under the [skin] and that has cables that go to the heart . that record its electrical activity and stimulate it when necessary.

Tachyarrhythmias

It is also very important to treat the factors that predispose or aggravate them ( cardiac ischemia , inadequate blood oxygenation, heart failure ). Once these situations are resolved, the management of tachyarrhythmias is generally carried out by means of drugs (which can be used to control the arrhythmia by reducing the heart rate, to make it disappear and to prevent new episodes).

Sometimes it may be necessary to perform an electrical cardioversion (after sleeping the patient, an electric shock is administered using paddles placed on the chest) to eliminate the arrhythmia . An electrophysiological study can be carried out, as previously mentioned, which, in addition to diagnosing the arrhythmias, allows treating some of them by means of an ablation, which consists of applying electric currents that produce small burns, canceling out the areas responsible for the arrhythmias.

Finally, in those patients at risk for life-threatening arrhythmias , a defibrillator may be implanted, which is similar to a [pacemaker] but with the ability to deliver electrical shocks from within the heart that can cut life-threatening arrhythmias.

 

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