HIV In Children
 
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ARRHYTHMIAS
Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

ARRYTHMIAS WITH NORMAL HEART RATE

They are seen in the following conditions:

  • Arrythmias with narrow QRS

    • Wandering atrial pacemaker.

    • Aberrant atrial pacemaker.

    • Accelerated junctional rhythm.

  • Arrythmias with wide QRS

    • Accelerated ventricular rhythm.

    • Sinus with aberrancy.

    • Accelerated junctional rhythm with aberrancy.

SINUS ARRHYTHMIA

Definition: Irregular rhythm originating in the sinus node.
(P-P interval varies > 0.08 sec)

BRADYCARDIA

It is calculated from the lowest heart rate for 6 sec in normal individuals. It is defined as less than
68 BPM in Infants
42 BPM in Child
26 BPM in Adolescent.

Causes of bradycardia :

  • Sinus bradycardia

  • Atrial escape

  • Junctional escape

  • Ventricular escape

  • Asystole

Causes of Bradycardia with narrow QRS :

  • Sinus arrhythmia or bradycardia

  • Wandering atrial pacemaker (Atrial escape)

  • Junctional escape(40 - 60 BPM)

Causes of Bradycardia with wide QRS :

  • Ventricular Escape (30 - 40 BPM)

  • Escape above bifurcation of His with aberrancy

TACHYCARDIA

Definition: Three successive beats fatter than normal for age.

Types :

  • Sinus tachycardia

  • Atrial tachycardia

  • Junctional tachycardia

  • Ventricular tachycardia

Tachycardia with Narrow QRS :

  • SVT

  • Flutter

  • Atrial Fibrillation

  • Junctional tachycardia

Tachycardia with wide QRS :

Mechanism of formation of tachycardia :

  • Disorders of impulse formation

    • Abnormal automaticity

    • Triggered dysrhythmia.

  • Disorders of impulse propagation

    • Reentry

    • Reflection

  • Abnormal Automaticity

  • Reentry

Anatomical Malformations causing reentry :

  • Bypass tracts

  • Dual AV Nodal Pathways

  • Damaged tissue

  • Anatomical obstruction

  • Anisotropy

Mechanism for reentry: Figure 2




 
 
 
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