Arrhythmia at children – various violations of warm activity which are shown in change of frequency, the sequence or a regularity of warm reductions. Displays of arrhythmia at children are, as a rule, not specific: weakness, short wind, pallor of skin, refusal of food, increased fatigue, faints. Diagnosis of arrhythmia at children includes registration of the ECG, carrying out daily monitoring of heart, ChPEKG, EhoKG, stress tests. In treatment of arrhythmia at children medicamentous and non-drug methods (RChA, a krioablyation, implantation of antiarrhytmic devices) are used.
Arrhythmia at children
Arrhythmia at children – the changes of a warm rhythm various by origin arising owing to malfunction of automatism, excitability and conductivity of heart. In pediatrics and children's cardiology the same numerous violations of a rhythm of heart, as occur at adults. Arrhythmias at children come to light in all age groups, however the periods of the greatest risk on development and display of arrhythmias are the period of a neonatality, 4-5 years, 7-8 years and 12-14 years. For this reason within medical examination of children of this age it is expedient to provide obligatory consultations of the children's cardiologist and ECG screening.
The statistical analysis of prevalence of arrhythmias at children is complicated because even episodes of violations of a rhythm of heart occur at healthy children: migration of the driver of a rhythm, bradycardia, tachycardia, premature ventricular contraction, WPW phenomenon, atrioventricular blockade of the I degree, etc. The causes of arrhythmias, their current, therapy and the forecast and at children have the features.
The arrhythmia reasons at children
All reasons leading to developing of arrhythmia at the child can be divided on kardialny (warm), ekstrakardialny (extra warm) and mixed.
First of all, it is necessary to carry to the kardialny reasons of development of arrhythmia in children congenital heart diseases (Ebstein's anomaly, defect of a mezhpredserdny partition, the open atrioventricular channel, Fallo's tetrad), heart operations concerning DMZhP, DMPP, etc., the acquired heart diseases. Defeat of the carrying-out ways of heart at children can develop owing to myocardites, a miokardiodistrofiya, a dilatatsionny and gipertrofichsesky cardiomyopathy, the postponed vaskulit and rheumatism. In some cases as the arrhythmia reason at children tumors of heart, a perikardita, the heart injuries which are followed by hemorrhage to the area of the carrying-out ways, intoxications act. Heavy infections can provoke arrhythmia at children: quinsy, diphtheria, pneumonia, bronchitis, the intestinal infections, sepsis which are followed by loss of liquid and leading to electrolytic violations. Mechanical influences when sounding cavities of heart and carrying out an angiography belong to the yatrogenny reasons of arrhythmia at children. At children the congenital violations of a rhythm caused by anomalies of development of the carrying-out system (WPW syndrome), an aritmogenny right ventricular cardiomyopathy, etc. are possible.
As Ekstrakardialny factors of arrhythmia at children the pathological course of pregnancy and childbirth, prematurity, the pre-natal hypotrophy of a fruit resulting in immaturity of the carrying-out system of heart and violation of its innervation can act. Among extra heart mechanisms of arrhythmia at children the large role is played by functional frustration of nervous system (an emotional overstrain, vegeto-vascular dystonia), endocrine violations (a hypothyroidism, a thyrotoxicosis), blood diseases (iron deficiency anemia), etc.
At children speak about the mixed arrhythmias in case the combination of organic diseases of heart and violations of neurohumoral regulation of its activity takes place.
Sinusovy arrhythmia at children can often have functional character, i.e. be natural reaction of an organism to hot weather, inadequate physical activity, strong emotions etc.
Classification of arrhythmia at children
The most widespread classification of arrhythmias at children is their division according to violation of functions of a myocardium (automatism, excitability, conductivity and their combinations). According to this principle, sinusovy bradycardia, sinusovy tachycardia, migration of the driver of a rhythm and the slow slipping-out rhythms belong to malfunction of automatism sinusovy arrhythmia at children.
The arrhythmias at children caused by violation of excitability of a myocardium include premature ventricular contraction, neparoksizmalny and paroksizmalny tachycardia, vibrating arrhythmia (blinking and trembling of auricles), blinking and trembling of ventricles.
Malfunction of conductivity are presented by sinoatrialny blockade, vnutripredserdny and intra ventricular blockade, atrioventricular blockade. At children carry WPW syndrome, a syndrome of the extended QT interval, a syndrome of weakness of sinusovy knot to the combined arrhythmias.
On the basis of the clinical importance of arrhythmia at children are subdivided into 2 groups. Clinically insignificant arrhythmias at children include unstable, symptomless, not influencing health of the child and the forecast of violation of a rhythm (single ekstrasistola, migration of the driver of a rhythm in the period of a dream, not shown clinically sinusovy bradycardia and tachycardia, etc.). The group of clinically significant arrhythmias at children is made by the permanent violations of a rhythm exerting impact on health of the child and the forecast (frequent ekstrasistola, paroksizmalny arrhythmias, SSSU, WPW syndrome, etc.).
Arrhythmia symptoms at children
About 40% of arrhythmias at children come to light incidentally, in the course of planned medical examination or during inspection of the child after the postponed disease. In other cases clinical displays of arrhythmia at children are not specific. At babies arrhythmia should be suspected at emergence of pristupoobrazny short wind, change of color of integuments (pallor or a tsianotichnost), uneasy behavior, refusal of food or sluggish sucking, a bad increase of the weight, a bad dream, a pulsation of vessels of a neck.
Arrhythmia at the child of advanced age can be followed by increased fatigue, bad shipping of physical activities, unpleasant feelings in heart (interruptions, dying down, a strong push), arterial hypotonia, dizzinesses and faints.
The lengthening of an interval of QT, ventricular takhiaritmiya which are followed by hypoxemic encephalopathy, myocardium ischemia, an acute heart failure belong to potentially dangerous arrhythmias at children interfaced to the increased risk of sudden death.
Diagnosis of arrhythmia at children
Objectively at arrhythmia at children delay or increase of a warm rhythm in comparison with age norm, unevenness of reductions of heart, deficiency of pulse come to light. At pulse assessment at children it is necessary to consider age norms: so, at newborn ChSS makes 140 . in min.; in 1 year - 120 . in min.; in 5 years – 100 . in min., in 10 years – 90 . in min.; at teenagers - 60-80 . in min.
Electrocardiographic inspection of children with arrhythmia includes registration of the ECG lying, standing also after insignificant physical activity. Such approach allows to reveal vegetozavisimy violations of a rhythm. Daily monitoring of the ECG does not limit free activity of the patient and today can be carried out to children of any age, including newborns. By means of holterovsky monitoring any forms of arrhythmia at children come to light. ChPEKG is used at inspection of children of advanced age.
Researches by means of load tests (a veloergometriya, the tredmil-test) are irreplaceable for identification of the hidden violations of a rhythm and conductivity, definition of tolerance to physical activity, forecasting of a course of arrhythmias at children. In children's cardiology pharmacological tests are applied to detection of arrhythmias (atropinic, potassium-obzidanovaya). For the purpose of detection of the organic reasons of arrhythmia at children EhoKG is carried out.
For determination of interrelation of arrhythmia at children with a condition of TsNS EEG, a rheoencephalography, a X-ray analysis of cervical department of a backbone, consultation of the children's neurologist is carried out.
Treatment of arrhythmia at children
Functional arrhythmias do not demand from children of treatment; in this case parents should pay attention to the organization of a day regimen of the child, good rest, moderate physical activity. In treatment of clinically significant arrhythmias at children conservative medicamentous and surgical approaches are used.
In all cases therapy has to begin with an exception of the factors causing arrhythmia in children: treatments of rheumatism, sanitation of the chronic centers of an infection (an adenotomiya, a tonzillektomiya, treatment of caries and so forth), cancellations of the medicines causing violations of a rhythm etc.
The conservative pharmacotherapy of arrhythmia at children includes three directions: normalization of electrolytic balance of a myocardium, application of antiarhythmic means, improvement of metabolism of a cardiac muscle. Medicines of potassium and magnesium belong to the means normalizing electrolytic balance. Antiarhythmic therapy is performed by procaineamide, propranolol, amiodarony, verapamil, etc. For the purpose of metabolic support a myocardium cocarboxylase, inosine, calcium are used.
At arrhythmias, resistant to medicamentous therapy, at children low-invasive surgical treatment is shown: radio-frequency ablyation or krioablyation of pathological aritmogenny zones, implantation of an electropacemaker or kardioverter-defibrillator.
The forecast and prevention of arrhythmia at children
The course of arrhythmia at children is defined by the reasons and a possibility of their elimination, and also extent of haemo dynamic frustration. At functional arrhythmias the forecast favorable. Vibrating arrhythmia increases risk of development of heart failure and tromboembolichesky complications. The greatest fears concerning risk of sudden death cause the arrhythmias at children developing against the background of organic damage of heart, AV-blockade of the III degree, the combined arrhythmias.
Prevention of arrhythmia at children provides elimination of the contributing factors, treatment of the main diseases, preventive inspection of cardiovascular system. Dispensary observation of children with arrhythmia is carried out by the pediatrician, the children's cardiologist, according to indications – the children's endocrinologist, the children's neurologist, the children's rheumatologist, etc.