Category: Cardiology

Categories
Cardiology

Commotio Cordis

Commotio cordis is caused by the blunt impact of a hard object directly over the heart occurring during a specific window of ventricular repolarization leading to immediate collapse, ventricular fibrillation, and cardiac arrest. This episode focuses on risk factors and management of this rare but catastrophic injury.

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References

Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol. 2012 Apr;5(2):425-32. doi: 10.1161/CIRCEP.111.962712. PMID: 22511659.

Madias C, Maron BJ, Weinstock J, et al. Commotio cordis–sudden cardiac death with chest wall impact. J Cardiovasc Electrophysiol 2007; 18:115.

Maron BJ, Gohman TE, Kyle SB, et al. Clinical profile and spectrum of commotio cordis. JAMA 2002; 287:1142.

Maron BJ, Estes NA 3rd. Commotio cordis. N Engl J Med 2010; 362:917.

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Categories
Cardiology

Return to sports following COVID-19

Even though we won’t be “clearing” patients in the ED we still need to be familiar with return to sports recommendations for children and adolescents who have had COVID-19. Remember, these are just recommendations and are based off of practice patterns at many centers and on the AAP guideline. Consult with your local hospital and Cardiology groups for up to date information. The information in this episode is intended for any young person (21 and under) who tests positive for COVID-19 and wants to return to sports. It is structured based on the severity of initial presenting symptoms.

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References

COVID-19 Interim Guidance: Return to Sports. American Academy of Pediatrics. December 17, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Accessed 12/23/2020.

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Categories
Cardiology

SVT

Three of my favorite letters in the Pediatric Emergency Department are S, V and T. This episode of PEM Currents, the Pediatric Emergency Medicine Podcast focus on the diagnosis and management of paroxysmal supraventricular tachycardia in the ED. I discuss preparation, vagal maneuvers, cardioversion, disposition and more!

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References

Appelboam, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. The Lancet, 2015.

Friedman. Intraosseous adenosine for the termination of supraventricular tachycardia in an infant. Annals of EM, 1996

Garson et al. Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients. The Journal of Pediatrics, 1981.

Getschman SJ et al. Intraosseous adenosine. As effective as peripheral or central venous administration? Arch Pediatr Adolesc Med. 1994 Jun;148(6):616-9.

Goodman et al. Intraosseous infusion is unreliable for adenosine delivery in the treatment of supraventricular tachycardia. Peds Emerg Care, 2012.

Hayes, Tricks of the Trade: Combine Adenosine with the Flush. Academic Life in Emergency Medicine, 2012. Accessed June 3, 2019.

Müller et al. “Vagal maneuvers” and adenosine for termination of atrioventricular reentrant tachycardia. The American Journal of Cardiology, 1994.

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Categories
Cardiology Rheumatology

Kawasaki Disease

Kawasaki Disease, AKA Mucocutaneous Lymph Node Syndrome, is one of the most common vasculitides of childhood. The hallmark is fever ≥5 days plus 4/5 of the following; mucous membrane changes, conjunctivitis, polymorphous rash, extremity changes and lymph node enlargement. It can also lead to coronary artery aneurysms, which is why its so important to make an accurate diagnosis.

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References

Dominguez SR, Anderson MS, El-Adawy M, Glodé MP. Preventing coronary artery abnormalities: a need for earlier diagnosis and treatment of Kawasaki disease. Pediatr Infect Dis J. 2012 Dec;31(12):1217-20.

Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16(3):178.

McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.. Circulation. 2017;135(17):e927. Epub 2017 Mar 29.

Son MB, Gauvreau K, Ma L, Baker AL, Sundel RP, Fulton DR, Newburger JW. Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006. Pediatrics. 2009;124(1):1.

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