A ten-year-old boy presented to his health center with a six-hour history of diffuse abdominal pain with no other associated symptoms.
The patient has no personal or family history of interest, does not receive any pharmacological treatment, has good general condition and a blushing abdomen, without signs of peritoneal irritation or other warning signs.
However, your pediatrician draws attention to cardiac auscultation, as it does not seem to have an electrocardiogram (ECG) and decides to refer the child for evaluation in the pediatric cardiology consultation.
1.
What is the interpretation of the ECG? (review the ECG before reading again): the ECG shows sinus rhythm at 65 beats per minute (lpm), with no abnormalities in the P-wave repolarization (ST segment).
The QRS complex presents an incomplete right bundle branch block morphology (RSR' pattern in V1, with normal duration) and a normal axis (in the lower left quadrant, i.e., between 0 and + 90o).
Premature beats with wide QRS complex and polarized T wave with bigeminism and trigeminism are observed.
This last finding (ventricular extrasystoles) motivated the referral of the child.
In the pediatric cardiology consultation, a new ECG was performed, with findings similar to those described by the physician, aiming at a single ventricular extrasystole at rhythm.
An echocardiography (normal) was performed and a 24-hour Holter ECG was requested, which showed frequent ventricular extrasystole, so the study was completed by complete blood count, blood biochemistry and cardiac extraparesis profile (e.g. normal).
All the electrode tracings of the patient were reviewed (the ECG of the pediatrician and that of the consultation, Holter and ergometry) and if the extrasystoles always had the same morphology.
The child follows periodic check-ups in the clinic, with no indication of any type of restriction regarding physical exercise, and remains completely asymptomatic.
