Pediatric cardiac arrhythmias resulting in hemodynamic compromise

Arrhythmias and Cardiac Bedside Monitoring in the Neonatal Intensive Care Unit

Cardiac physiology is unique in neonates and infants; there are several physiologic changes that occur in the first weeks of life. Important changes can be captured on the bedside monitor and provide vital data in a noninvasive way to providers. The importance of diligent observation cannot be overstated. Bedside monitoring has improved in the last decade, which has enhanced the ability to detect changes in heart rates and rhythms. The purpose here is to review cardiac physiology, describe those arrhythmias able to be observed on bedside monitors, and highlight heart rate changes that can be early signs of sepsis.

Emergency diagnosis and management of pediatric arrhythmias

True emergencies due to unstable arrhythmias in children are rare, as most rhythm disturbances in this age group are well-tolerated. However, presentation to an emergency department with symptoms of palpitations, fatigue and/or syncope is much more common. Sinus tachycardia is by far the most commonly reported arrhythmia, followed by supraventricular tachycardia. Emergency physicians should be prepared for diagnosis and to acutely manage various types of arrhythmias seen in children, to assess the need for further diagnostic testing, and to determine whether cardiology evaluation and follow-up are needed. This article is intended to provide diagnostic and management guidelines of the most common types of arrhythmias seen in children with structurally normal hearts as well as those associated with congenital heart disease and cardiomyopathies.