Pediatric emergency medicine trisk 1524 1524
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The most common form of SVT involves an accessory atrioventricular (AV)
pathway. Additional etiologies include drug exposure, congenital heart disease,
and Wolff–Parkinson–White syndrome. Sympathomimetics in cough and cold
preparations are the most common drugs to incite SVT in children. Unregulated
dietary supplements such as ephedra (and its congeners, often advertised as
“ephedra-free” products) and high-caffeine energy drinks also have the potential
to precipitate SVT. Cardiac lesions associated with SVT include Ebstein anomaly,
repaired dextrotransposition of the great arteries, and single-ventricle lesions
status post-Fontan operation.
Ventricular tachycardia (monomorphic or polymorphic/torsades de pointes) and
atrial flutter rarely occur in children (see Chapter 86 Cardiac Emergencies ).
Congenital heart disease, electrolyte disturbance (e.g., hyperkalemia,
hypocalcemia, hypomagnesemia), genetic predisposition (e.g., long QT
syndromes), or poisoning accounts for most cases of ventricular tachycardia in
children. Atrial flutter usually arises from an intra-atrial reentry circuit. Most
children with atrial flutter have congenital heart disease. Although rare, atrial
flutter carries a significant risk of sudden death if not controlled by medications
or surgical intervention.
TABLE 77.2
COMMON CAUSES OF TACHYCARDIA
Fever
Pain
Crying
Anxiety
Anemia
Drug induced (e.g., caffeine, herbal medications, dietary supplements, illicit
drugs)
Hypovolemic shock
