A seven-year-old boy presented with a sudden onset of chest pain or dyspnea while in consultation with Primary Care Pediatrics for 30 minutes before and while fever appeared.
He had not exercised before.
No personal history of heart disease or family history of heart disease or sudden death.
Upon arrival at the health center, the patient is conscious and oriented, without signs of respiratory distress.
Cardiac auscultation revealed rhythmic tone at 170-180 beats per minute (lpm), without murmurs.
Peripheral pulses are rhythmic and symmetrical.
Good capillary refill.
Arterial hypertension (TA) systolic: 90 mmHg, 31 percentile (P31), diastolic: 65 mmHg (P76).
An electrocardiogram (ECG) was performed.
Figure 2 shows the measurement of QRS width.
1.
Established electrodes for wide QRS tachycardia without hemodynamic repercussions, the pediatrician begins to infuse amiodarone (5 mg/kg, intravenously [IV]) and refers the patient to the hospital by medical examination
Upon arrival at the Pediatric Emergency Department, the patient was asymptomatic, except for the sensation of bleeding episodes.
The physical examination was as follows: weight 22.5 kg (P21), height 119.5 cm (P14), systolic BP 88 mmHg (P25) and diastolic 63 (P71).
Aware and oriented.
Good perfusion.
Cardiac arrest with tachycardia without murmurs.
Peripheral plaques were normal.
Normal rectum.
After the ECG analysis, it is considered the possibility of a supraventricular tachycardia (VT) with rhythm reversed, so it is decided to try to try to reverse vagal manoeuvres by successfully administering an IV supraventricular tachycardia, sinus tachycardia.
A baseline ECG showed no abnormalities.
Blood tests showed myocardial enzymes within normal limits.
1.
The patient was observed for 24 hours, without presenting new episodes, an echocardiogram was normal and was discharged with subsequent follow-up in cardiology consultations, with diagnosis of paroxysmal enteropathy with conduction.
