Arrhythmia in children
Arrhythmia can be defined as a rhythm disorder when the heart beats faster, slower or irregularly depending on the child's age, other than the normal rhythm. The fact that the heart is working at a different rate than its normal rate causes the heart to not be able to perform its function properly, and clinical findings such as chest pain, palpitations, dizziness, fainting and weakness may occur. While it can often occur without any structural defect in the heart, some rhythm problems may occur in some congenital heart diseases, the use of certain medications, thyroid gland disorders, some systemic diseases and after heart surgeries.
Palpitations in children
Heart rate in children varies according to age. There are lower and upper heart rate limits for each age. In the pediatric age group who may express palpitations, anamnesis, that is, the information given by the patient, is more valuable. Heart; It may beat rapidly when the child is excited, scared, panicked, crying, in a hospital environment, or it may beat rapidly in cases of anemia, iron deficiency and some hormonal disorders. So, not every heart palpitation means a rhythm disorder. However, in the childhood age group, the complaint of palpitations is a complaint that should be taken into consideration in terms of rhythm disorders.
Which complaints and clinical findings should arrhythmia be suspected in children and infants?
In older children, palpitations, rapid fatigue and weakness, Symptoms such as decreased effort capacity, need for deep breathing, chest pain, sweating, fainting, especially chest pain and fainting that occur with exertion, restlessness in babies and younger children, reluctance to suck, excessive crying, rapid and frequent breathing, cyanosis, rhythm rhythm. It may be a clue for disorders. If the palpitations are intermittent, that is, sometimes the heart rhythm is faster than normal and then returns to normal, it progresses in the form of attacks and the patient may not have any complaints between attacks. Families, especially mothers, often state that their child's heart beats fast and that they cannot count its speed by placing their ear on their child's chest or placing their hand on their heart. The most common rapid rhythm disorders usually begin suddenly and end suddenly. Sieve between attacks Trocardiograms (ECGs) are usually completely normal. Every child with fainting, fainting or dizziness should be evaluated once by a pediatric cardiologist. Rhythm disorders can sometimes be confused with epileptic seizures. For this reason, every patient complaining of seizures should definitely consult a pediatric cardiologist after being evaluated by a pediatric neurologist. Sometimes, without any complaints, rhythm disturbance can be detected only in the ECG taken routinely before screening or applying for sports. Unfortunately, the first sign of serious rhythm disturbances is sudden death.
What is Rhythm Holter or Holter ECG?
The heart rhythm recorder is a recorder of heart rhythm, which usually has 5 electrodes attached to the chest wall and the cables attached to them. These are devices weighing 70-120 grams, in which rhythm recordings are taken and recorded from three channels with one device. The Holter device takes its name from the American biophysicist Dr. Norman Jefferis Holter (1914-1983). Depending on the patient, the devices can record from a minimum of 24 hours to a maximum of 7 days. The presence of the device has no side effects or harm to the patient. Hunger does not require a special condition like satiety. The patient can go to school and continue all daily activities. Only bathing or showering should not be taken. Care should be taken to ensure that the cables do not come out when sleeping at night. It is recommended not to use a mobile phone. As long as the device is attached and recording, if there is any complaint (such as chest pain, palpitations, dizziness, fainting, fainting, shortness of breath), the symptom button should be pressed and the current recording should be taken, and the physician should be warned when the device is delivered. After the recording period is completed, the device automatically ends the recording and the electrodes are removed by the ECG nurse and the smart disk (SD card) is loaded into the computer and the entire recording is analyzed, the reporting process is completed by creating the necessary outputs and the analyzes are explained to the family in detail by the pediatric cardiologist.
When should Holter ECG/Rhythm Holter be performed in children?
Holter ECG should be performed especially in the patient group complaining of intermittent palpitations, dizziness, fainting and chest pain. Rhythm Holter recording shows the type, duration, frequency and severity of palpitations, heart or Depending on the situation, important information is obtained about the slow shot, pause, duration, type of blocks or irregular shots. The examination is more valuable, especially if the complaints do not always occur every day. Normal findings can often be detected even during a pediatric cardiologist's examination. After evaluating the patient, the physician makes a rhythm Holter decision based on the complaints and current findings.
Is Holter ECG alone sufficient for rhythm disturbances?
The ECG taken when the patient has complaints and detecting an arrhythmia is the most valuable finding. This is not always possible. There may be more than one and different rhythm disorders in the same patient. Holter ECG is very valuable when longer-term rhythm recording is needed. In some special clinical cases, instant event recorder can be used, and in more serious cases accompanied by fainting, devices called ILR (implantable loop recorder) can be used, which are the size of a flash memory and are placed under the skin in the chest muscle area. Nowadays, rhythm disorders can be detected with some applications downloaded to smartphones and some devices attached to the back of the phone. Stress ECG can also provide valuable information in some clinical situations.
Are rhythm disorders in children permanent?
Although rhythm disorders in children and infants may be temporary, unfortunately, many of them are permanent. Rhythm disorders accompanied by palpitations are usually due to congenital abnormal electrical conduction disorders. Depending on the patient's age at the time of diagnosis, the type and duration of the arrhythmia, the patient may be treated with medication or a procedure called ablation may be performed by pediatric electrophysiology specialists. Rhythm disorders, especially those that begin in the womb in the last weeks of pregnancy or occur in the first year after birth, can improve with time and age. The medications used do not treat the arrhythmia permanently, they only suppress the disorder, and each has different side effects.
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