Causes, symptoms, diagnosis and treatment of tachycardia in children

Causes of tachycardia in children

Do not forget that normal heart rate (HR) in a child is significantly higher than that for an adult. This is due to a more active metabolism, leading to increased oxygen consumption by the cells of the growing organism. Heart rate rates for children of different ages are shown in the table below:

The causes of tachycardia in children can be both physiological and pathological; associated with heart disease or resulting from other ailments.

With a healthy cardiovascular system, an increase in heart rate can be triggered by the following factors:

• hyperthermia with ARVI or other infectious diseases;
• high ambient temperature;
• increased physical activity;
• emotional overexcitation;
• diseases of the thyroid gland;
• vegetative-vascular dystonia;
• being overweight;
• pheochromocytoma;
• dehydration;
• anemia.

As for heart diseases, most often tachycardia in children is observed with congenital heart defects, myocarditis, and some types of conduction disorders. Depending on the age of the child, certain reasons come out on top.

In babies

Babies in the first months of life most often undergo tachycardia attacks under the influence of the following factors:

• external mechanical influences, such as examinations or swaddling;
• cardiovascular insufficiency;
• congenital malformations;
• perinatal encephalopathy;
• respiratory failure;
• acute asphyxia;
• hypoglycemia;
• anemia.

Naturally, the baby is not immune from the development of infectious diseases and, first of all, colds.

Schoolchildren

The reasons why tachycardia can develop in a child who starts attending school is different from those of an infant. By this time, congenital developmental anomalies have partially lost their positions, since they have been healed, stabilized, or have already led to a more sad result, but continue to remain in the first places. The frequency of acute asphyxia is also markedly reduced. The main reasons for the rapid heart rate in schoolchildren are:

• vegetative disorders due to increased stress, both psychological and physical;
• dysfunction of the thyroid gland;
• hyperthermia of various origins;
• organic pathologies of the heart;
• excessive physical activity;
• electrolyte dysfunction;
• neoplasms.

The task of parents of schoolchildren who want to reduce the likelihood of tachycardia in their children is to normalize the regimen, minimize the physical and psychological stress on the child, undergo regular medical examinations and fight infectious pathologies that can cause inflammation of the heart membranes.

All carious teeth need to be cured, and if a child has a sore throat or discomfort in the heart against a background of fever, then no exam or new topic should be a reason to postpone a visit to the doctor.

In adolescents

The adolescent period is characterized by a significant increase in the development of risks for the cardiovascular system. At this time, there is an increased growth of the body, and puberty with a characteristic surge of emotions, and the first experiments with the use of psychoactive substances.

Let's figure out what causes a rapid heartbeat in a teenager.

Their list is as follows:

• chronic infections (caries, frequent tonsillitis), provoking inflammation of the heart tissue;
• imbalance in the rate of growth between the heart (lagging behind) and the rest of the body (leading);
• general hobby for tonic low-alcohol drinks;
• "Small heart" against the background of an underdeveloped musculoskeletal system;
• vegetative-vascular manifestations;
• electrolyte imbalance;
• tumors.

From this list, parents, even without going to doctors, can cope with a good third of the reasons.

Young men and women should be educated about the negative effects of drinks containing caffeine and other stimulants. If he or she really wants alcohol in front of a disco, it is better to drink wine or vodka than Red Bull or Jaguar.

What tachycardias are most common in children?

In a child, a rapid heartbeat is divided into two main types:

• sinus;
• paroxysmal.

The first type is found most often and, as a rule, against the background of a healthy heart.

Paroxysmal tachycardia is a whole group of diseases characterized by:

• sudden onset;
• high level of heart rate;
• spontaneous restoration of a normal heart rhythm;
• maintaining the normal sequence of cardiac complexes on the ECG;
• short duration of an attack - from a few seconds to several days.

The frequency of occurrence in the child population: 1 in 25,000 people, which is an average of 15% of all arrhythmias. Paroxysmal tachycardia is subdivided into the following forms:

• atrial;
• ventricular;
• atrioventricular.

Pathology develops as a consequence of such factors:

• congenital or childbirth pathology of the central nervous system;
• unfavorable family and social situation;
• congenital malformations of the child's heart;
• heart surgery;
• some infectious pathologies;
• installation of a catheter in the heart cavity;
• trauma to the heart (closed);
• angiocardiography.

The next attack can be provoked by:

• mental strain;
• physical overload;
• hyperthermia;
• stress.

A child with paroxysmal tachycardia makes the following complaints:

• palpitations starting with a "push" behind the breastbone;
• pain in the region of the heart and "in the stomach";
• feeling of lack of air;
• dizziness;
• headache;
• insomnia;
• weakness;
• nausea;
• fear.

As for the changes on the ECG, they differ depending on the form of the disease and are indicated in the table below:

This condition can be life-threatening for a child and requires urgent treatment.

Sinus tachyarrhythmia in a child

This type occurs due to the enhancement of the functioning of the sinus node. This condition can be triggered by a number of irritants:

• stress;
• dehydration;
• shock conditions;
• physical activity;
• an increase in the concentration of calcium ions in the blood;
• the use of large doses of stimulating substances (tea, coffee);
• taking medications (caffeine, antidepressants, antiallergic drugs, theophylline and some others).

The main external hallmarks of sinus tachyarrhythmia are:

• short duration;
• lack of significant discomfort;
• normalization of heart rate after canceling the influence of the irritating factor.

Tachycardia, which persists for a long time, can develop under the influence of various pathological conditions associated with both heart problems and diseases of other organs - anemia, respiratory failure, etc. In this case, an increase in heart rate is accompanied by certain complaints of moderate intensity: palpitations, sensation lack of air.

Sinus tachyarrhythmia is a condition characterized by a heart rate that exceeds the child's age norm. It is based on the acceleration of the production of electrical impulses by the pacemaker of the first order - the sinus node. In the absence of other symptoms, in addition to an increase in heart rate, sinus tachycardia is considered a normal variant.

With a significant acceleration of the heart, the child has the following symptoms:

• fatigue and weakness, inappropriate to physical activity;
• emotional excitement;
• discoloration of the skin;
• dizziness;
• palpitations;
• capriciousness;
• fussiness and so on.

Sinus tachycardia in most cases goes away spontaneously immediately after the effect of the provoking factor stops.

The following techniques are used to make a diagnosis of sinus tachycardia:

• collection of anamnesis;
• physical examination;
• ECG types (conventional, stress test, high resolution, Holter monitoring);
• electrophysiological research.

Differential diagnosis with other rhythm disturbances is of great importance. Sinus tachycardia of all arrhythmias has the most favorable prognosis.

How to proceed

When a child develops any type of arrhythmia, parents must first call the ambulance team. And only after the call or in parallel with it, start providing first aid:

• unbutton tight clothes on the chest and neck of the child;
• provide fresh air access to the room;
• put a wet napkin on the patient's forehead.

It would be nice to try so-called vagal tests:

• turn the baby upside down for half a minute, an older child can be helped to stand at the same time in his arms;
• ask him to strain the abdominal press, strain, while holding his breath, press the child on the epigastrium (these actions are also performed for 30 - 40 seconds);
• press the root of the tongue and induce vomiting;
• immerse the child's face in a bath of cold water (procedure duration from 10 to 30 seconds).

It is clear that these actions can be performed only with a child over 7-10 years old, to whom the meaning of the manipulations can be explained.

I would not recommend carrying out another test, in which it is required to massage the carotid sinus, without special preparation, since there it is necessary to press the carotid artery.

These tests can be beneficial for half an hour after the onset of the tachycardia attack.

When to see a doctor and how often to get checked

A doctor should be consulted immediately after parents notice any of the above symptoms of any tachyarrhythmia. And it would be better to hedge and bother the pediatrician with physiological tachycardia, which developed in response to stress or physical overload, than to miss the first "bells" indicating the onset of a serious illness.

All babies are covered by regular medical examinations from the moment of birth, so the identification of arrhythmias should not be difficult. However, unfortunately, it is not always possible to detect symptoms and prescribe treatment for tachycardia in children in a timely manner.

There are several reasons for this:

• formal attitude of pediatricians to mass examinations of children;
• inattention of parents to complaints of children;
• children's fear of doctors, due to which they do not inform their parents and doctors about their problems.

The solution is simple: attention to your own child and regular ECG diagnostics, especially during seizures.

A lot depends on parents in the matter of early diagnosis. After all, doctors, unfortunately, are not psychics and do not feel at a distance when a baby develops the first attack of tachyarrhythmia in his life, but dad and mom are quite capable of noticing this and contacting a doctor in time.

An electrocardiogram is the most indicative method for detecting arrhythmias. The difference between sinus and paroxysmal tachyarrhythmias is indicated in the pictures below:

When is treatment required?

Only a doctor should decide whether treatment is necessary in each specific case and what it will consist of! Self-medication for tachyarrhythmias can end very sadly. Appointments are made by a pediatric cardiologist or, in non-critical cases, by a pediatrician after consultation with a cardiologist. Treatment is carried out in accordance with approved protocols and can be either therapeutic or surgical.

Rhythm disorders of a functional nature do not need treatment; it is enough to organize the child the correct mode of work, study, rest.

An integrated approach should be applied to clinically significant arrhythmias. Therapy should begin with the removal of all chronic infectious foci, treatment of diagnosed rheumatism.

In the conservative treatment of childhood tachyarrhythmias, there are three main areas:

• bringing to normal levels of electrolyte balance in the heart muscle (preparations of magnesium and potassium ions);
• taking antiarrhythmic drugs (Verapamil, Propranolol, Amiodarone, etc.);
• improvement of metabolism in the myocardium (Riboxin, Cocarboxylase).

If rhythm disturbances are resistant to the action of drugs, then it is the turn of minimally invasive surgical interventions:

• radiofrequency or cryoablation of arrhythmogenic foci;
• implantation of a cardioverter defibrillator or pacemaker.

In the vast majority of cases, arrhythmias that developed in childhood, subject to timely access to a doctor, are completely cured or stabilized.

Should parents worry

Regardless of whether the child has complaints, parents should be attentive to the state of his health. Indeed, in the life of a growing organism there are 4 periods of the risk of arrhythmias, through which everyone passes:

• newborn;
• from four to five years old;
• from seven to eight;
• from twelve to thirteen years old.

Children of these age groups must undergo compulsory electrocardiographic examination. If the child presents even one cardiogenic complaint, then doctors should prescribe additional types of ECG, various tests and examinations.

If problems are identified, then it is necessary, without delay, to deal with the treatment of the child. Most arrhythmias have a favorable prognosis. Clear recommendations on treatment tactics have been developed; in severe cases, surgical interventions are performed. Arrhythmia is not a sentence, you need to fight it and you can defeat it by returning the child to a full life.