Pediatric emergency medicine trisk 1720 1720

In patients with ACHD the risk of sudden death increases with increasing age,
complexity of the repair, and with poor ventricular function. Lesions carrying the
highest risk include TOF, aortic stenosis, transposition of the great arteries,
coarctation of the aorta, AVSD, pulmonary stenosis, and single ventricle
anomalies that undergo the Fontan procedure. Repaired VSD and PDA ligation
are low risk procedures with respect to SCD.

ARRHYTHMIC EMERGENCIES
Goal of Treatment
The primary goal of treatment in a cardiac arrhythmic emergency is rapid
recognition and correction of unstable arrhythmias while simultaneously
documenting the rhythm on EKG. A secondary goal is to identify patients with
subtle signs of aborted SCD.
CLINICAL PEARLS AND PITFALLS
Any incessant tachycardia can cause CHF and diminished LV function.
In dilated cardiomyopathy (DCM), it may be difficult to discern which
came first: tachycardia or DCM.
Arrhythmias are not well tolerated in the setting of structural heart
disease, especially single ventricle or in those who have undergone
palliative repairs.
Arrhythmias are not well tolerated in patients with poor LV function.
Adenosine may be diagnostic as well as therapeutic.
Never give adenosine in a wide complex irregular rhythm.
In heart transplant patients, use adenosine with extreme caution at
one-third to half the normal recommended dosage. Be prepared to
pace in the event of asystole.
Ventricular tachycardia (VT) may look narrow in infants.
Long QT syndrome (LQTS) presents more frequently with sudden
death as the first symptom in pediatrics than in adults.