Title : Tachyarrhythmia in a congenital heart disease
 
Clinical Problem : A 6 months old boy presented in the emergency with excessive crying. He had cough, cold for 2 days and received some medications for the same. There was no fever. On examination, he had a heart rate of 190, min. There was no cardiomegaly, basal crepts or hepatomegaly. Blood pressure was on the higher range of normal for his age. An ECG showed sinus tachycardia. The tachycardia disappeared in next 12 hours without intervention following which excessive crying disappeared. Subsequently a train in tunnel murmur was heard over the precordium. An echocardiography was done that showed patent ductus arteriosus {PDA}.
 
Question : Why did this child present with tacharrhythmia as presentation of PDA_?
 
Expert Opinion : On enquiry, the mother got the medicine that the child was getting for cough and cold. The child had received an oral syrup containing phenylephrine hydrochloride 5mg and chlorpheniramine maleate. Phenylephrine is a selective a1-adrenergic receptor agonist used primarily as a decongestant. The primary side effect of phenylephrine is hypertension. Because this medication is a sympathomimetic amine, it can also increase contractility force and increase output to the cardiac muscle. In other words, phenylephrine mimics norepinephrine binding to a-adrenoreceptors and can cause increased heart rate.
Ideally, no cough syrups are recommended in children less than 2 years of age due to their side effects.

E-published: January - March 2014 Vol 11 Issue 1 Art No. 4
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2014.4
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