eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Tachycardia: Differential Diagnoses & Workup

Author: Mirna M Farah, MD, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
Coauthor(s): Christine S Cho, MD, MPH,, Attending Physician, Division of Emergency Medicine, Children's Hospital and Research Center of Oakland; HS Assistant Clinical Professor, Department of Pediatrics, University of California, San Francisco School of Medicine
Contributor Information and Disclosures

Updated: Sep 23, 2009

Differential Diagnoses

Anemia, Chronic
Toxicity, Cocaine
Atrial Fibrillation
Toxicity, Cyclic Antidepressants
Atrial Flutter
Toxicity, Digitalis
Hyperthyroidism, Thyroid Storm, and Graves Disease
Toxicity, Hallucinogen
Hypoglycemia
Toxicity, Organophosphate and Carbamate
Pediatrics, Bacteremia and Sepsis
Toxicity, Sympathomimetic
Pediatrics, Dehydration
Toxicity, Theophylline
Pediatrics, Diabetic Ketoacidosis
Toxicity, Thyroid Hormone
Torsade de Pointes
Ventricular Tachycardia
Toxicity, Amphetamine
Wolff-Parkinson-White Syndrome
Toxicity, Anticholinergic
Toxicity, Antidepressant
Toxicity, Antihistamine

Workup

Laboratory Studies

Laboratory studies for tachycardia may include the following:

  • Electrolyte levels - Particularly potassium, bicarbonate, calcium, and magnesium
  • Blood glucose level
  • Complete blood count
  • Toxicology screen
  • Arterial blood gas measurement
  • Thyroid function tests
  • Urine catecholamine metabolites (homovanillic and vanillylmandelic acid)

Imaging Studies

Imaging studies for tachycardia may include the following:

  • Chest radiography (posteroanterior and lateral)
  • Echocardiogram
This ECG belongs to an asymptomatic 17-year-old m...

This ECG belongs to an asymptomatic 17-year-old male who was incidentally discovered to have Wolff-Parkinson-White (WPW) pattern. It shows sinus rhythm with evident preexcitation. To locate the accessory pathway (AP), the initial 40 milliseconds of the QRS (delta wave) are evaluated. Note that the delta wave is positive in lead I and aVL, negative in III and aVF, isoelectric in V1, and positive in the rest of the precordial leads. Therefore, this is likely a posteroseptal AP.

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This ECG belongs to an asymptomatic 17-year-old m...

This ECG belongs to an asymptomatic 17-year-old male who was incidentally discovered to have Wolff-Parkinson-White (WPW) pattern. It shows sinus rhythm with evident preexcitation. To locate the accessory pathway (AP), the initial 40 milliseconds of the QRS (delta wave) are evaluated. Note that the delta wave is positive in lead I and aVL, negative in III and aVF, isoelectric in V1, and positive in the rest of the precordial leads. Therefore, this is likely a posteroseptal AP.


Other Tests

Other tests may include the following:

  • 12-lead electrocardiogram
This is a 12-lead ECG from an asymptomatic 7-year...

This is a 12-lead ECG from an asymptomatic 7-year-old boy with Wolff-Parkinson-White (WPW) pattern. Delta waves are positive in leads I and aVL; negative in II, III, and aVF; isoelectric in V1; and positive in the rest of the precordial leads. This again predicts a posteroseptal location for the accessory pathway (AP).

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This is a 12-lead ECG from an asymptomatic 7-year...

This is a 12-lead ECG from an asymptomatic 7-year-old boy with Wolff-Parkinson-White (WPW) pattern. Delta waves are positive in leads I and aVL; negative in II, III, and aVF; isoelectric in V1; and positive in the rest of the precordial leads. This again predicts a posteroseptal location for the accessory pathway (AP).

  • Cardiac rhythm strip
  • Holter monitoring
  • Event recorder
  • Electrophysiology testing

More on Pediatrics, Tachycardia

Overview: Pediatrics, Tachycardia
Differential Diagnoses & Workup: Pediatrics, Tachycardia
Treatment & Medication: Pediatrics, Tachycardia
Follow-up: Pediatrics, Tachycardia
Multimedia: Pediatrics, Tachycardia
References
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References

  1. Custer JW, Rau RE, eds. Johns Hopkins: The Harriet Lane Handbook. 18th ed. Philadelphia, PA: Mosby Elsevier Inc; 2008.

  2. Wiley JF. Tachycardia/palpitations. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 5th ed. 2006:657-668.

  3. Kaltman J, Shah M. Evaluation of the child with an arrhythmia. Pediatr Clin North Am. Dec 2004;51(6):1537-51, viii. [Medline].

  4. [Guideline] 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 12: Pediatric Advanced Life Support. Circulation. 2005;112(24 Suppl):IV167-87. [Full Text].

  5. Gewitz MH, Woolf PK. Cardiac emergencies. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 5th ed. 2006:717-758.

  6. Samson RA, Atkins DL. Tachyarrhythmias and defibrillation. Pediatr Clin North Am. Aug 2008;55(4):887-907, x. [Medline].

  7. Perondi MB, Reis AG, Paiva EF, et al. A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest. N Engl J Med. Apr 22 2004;350(17):1722-30. [Medline].

  8. Physicians' Desk Reference. 63rd ed. Thomson Healthcare; 2009.

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Further Reading

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Keywords

tachycardia in children, supraventricular tachycardia, SVT, atrial fibrillation, AF, atrial flutter, junctional ectopic tachycardia, JET, ventricular tachycardia, VT, torsade de pointes, ventricular fibrillation, VF, dysrhythmia

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Contributor Information and Disclosures

Author

Mirna M Farah, MD, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
Mirna M Farah, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Christine S Cho, MD, MPH,, Attending Physician, Division of Emergency Medicine, Children's Hospital and Research Center of Oakland; HS Assistant Clinical Professor, Department of Pediatrics, University of California, San Francisco School of Medicine
Christine S Cho, MD, MPH, is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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