Grand Rounds

Tachyarrhythmia in a congenital heart disease

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India.

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}.

Why did this child present with tacharrhythmia as presentation of PDA_?

Discussion :
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

Correct Answers :  yes 33%
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0