Pediatric emergency medicine trisk 1526 1526
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Children with fever and sinus tachycardia typically have a self-limited febrile
illness. If the tachycardia is to be attributed to the presence of fever, then it would
be prudent to at the least reassess the heart rate after defervescence. If the
tachycardia persists then one must consider other etiologies such as sepsis,
dehydration, or cardiac pathology. Fever is also present in patients with cardiac
pathologies such as myocarditis, pericarditis/pericardial effusion, Kawasaki
syndrome, and acute rheumatic fever. Myocarditis describes inflammation of the
muscle wall of the heart. Clinical features of this disease are fever, tachycardia
out of proportion to the activity or degree of fever, pallor, cyanosis, respiratory
distress secondary to pulmonary edema, muffled heart sounds with gallop, and
hepatomegaly caused by passive congestion of the liver (see Chapter 86 Cardiac
Emergencies ). A child with tachycardia and clinical findings suggestive of
myocarditis requires emergent supportive care (see Chapter 7 A General
Approach to the Ill or Injured Child ), infectious disease/cardiology consultations,
echocardiography, and admission to a unit capable of intensive monitoring and
rapid treatment of cardiac arrhythmias and hemodynamic instability.
