4th Pediatric Infectious Diseases Conference
 
 
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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
Arrhythmias
ARRHYTHMIAS
Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

ARRHYTHMIA WITH NORMAL HEART RATE

They are seen in the following conditions:

  • Arrhythmia with narrow QRS

    • Wandering atrial pacemaker

    • Aberrant atrial pacemaker

    • Accelerated junctional rhythm

  • Arrhythmia 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 faster than normal for age.

Types:

  • Sinus tachycardia

  • Atrial tachycardia

  • Junctional tachycardia

  • Ventricular tachycardia

Tachycardia with Narrow QRS:

Tachycardia with wide QRS :

Mechanism of formation of tachycardia:

  • Disorders of impulse formation

    • Abnormal automaticity

    • Triggered dysrhythmia

  • Disorders of impulse propagation

    • Re-entry

    • Reflection

  • Abnormal Automaticity

  • Re-entry

Anatomical Malformations causing reentry :

  • Bypass tracts

  • Dual AV Nodal Pathways

  • Damaged tissue

  • Anatomical obstruction

  • Anisotropy

Mechanism for re-entry: Figure 2


Mechanism for Reentry

 
 
 
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