tailieunhanh - A Lange Medical Book Pediatrics on call - part 2

Hoàn thành khối tim. Nguyên nhân phổ biến nhất của nhịp tim chậm đáng kể ở trẻ sơ sinh và trẻ em chủ yếu tim. Có thể không có triệu chứng hoặc gây sốc và suy tim sung huyết (CHF). Thông thường không đáp ứng với các biện pháp bình thường resuscitative như thông gió, oxy hóa, điều trị nhiễm toan | 11. BRADYCARDIA 53 C. Intracranial Hypertension 1. Bradycardia is part of Cushing triad along with hypertension and irregular respirations. 2. Head injury CNS space-occupying lesion tumor abscess epidural subdural or intracranial hemorrhage hydrocephalus malfunctioning ventricular shunt meningitis cerebrovascular event or diabetic ketoacidosis. D. Hypothyroidism. E. Hypothermia. F. Primary Heart Conditions 1. Complete heart block. The most common cause of significant primarily cardiac bradycardia in infants and children. May be asymptomatic or cause shock and congestive heart failure CHF . Usually does not respond to normal resuscitative measures such as ventilation oxygenation treatment of acidosis and catecholamine support. a. Congenital i. Idiopathic. ii. Associated with congenital heart defects such as corrected transposition of the great arteries or left atrial isomerism and polysplenia syndromes heterotaxy . iii. Associated with collagen disease in mother. b. Acquired nonsurgical heart block i. Idiopathic. ii. Associated with congenital heart defects. iii. Infectious diseases myocarditis viral or Lyme or endocarditis. iv. Connective tissue diseases lupus rheumatic fever. v. Kawasaki disease. vi. Muscle disease. vii. Cardiac tumor. viii. Cardiac sclerosis. c. Postsurgical. Incidence 1 because of improved operative technique. i. Transient. Resolves within 8 days. ii. Permanent. Usually develops immediately after surgery but may occur many years later. 2. Sick sinus syndrome. Depressed sinus node function. a. Presentation. Sinus bradycardia or slow junctional rhythm alternating with episodes of tachycardia. May present with syncope. b. Causes. Surgery to correct atrial septal defect Mustard procedure for d-transposition of the great vessels Fontan repair for single ventricle complexes viral myocarditis idiopathic. G. Toxins. Common drugs and toxins that can cause bradycardia include 54 I ON CALL PROBLEMS 1. Antidysrhythmics. 2. a-Adrenergic agonists. 3. .