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Pediatrics, Tachycardia

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

Introduction

Background

Tachycardia is an abnormal rapidity of heart action that usually is defined as a heart rate more than 100 beats per minute (bpm) in adults. In children, the normal heart rate is age dependent, and the definition of tachycardia varies, as shown below.1

  • Age 1-2 days - 123-159 bpm
  • Age 3-6 days - 129-166 bpm
  • Age 1-3 weeks - 107-182 bpm
  • Age 1-2 months - 121-179 bpm
  • Age 3-5 months - 106-186 bpm
  • Age 6-11 months - 109-169 bpm
  • Age 1-2 years - 89-151 bpm
  • Age 3-4 years - 73-137 bpm
  • Age 5-7 years - 65-133 bpm
  • Age 8-11 years - 62-130 bpm
  • Age 12-15 years - 60-119 bpm

Pathophysiology

The heart is innervated primarily by the vagus nerve and the sympathetic ganglion. Pain sensation travels through afferent fibers associated with the sympathetic ganglia. In most patients, the sensation of a normal heartbeat is not felt. Some children may complain of palpitations or rushing or pounding in the ears.

Clinical

History

  • Chest pain
  • Palpitations
  • Syncope
  • Dizziness
  • Shortness of breath
  • Diaphoresis (for infants—while feeding)
  • Color changes
  • Neurologic changes (mental status, motor/sensory deficits)
  • Decrease in intake and output
  • Trauma
  • Pain
  • Fever
  • Onset/duration of illness
  • Relationship to exercise, meals, and stress
  • Medical history, especially history of tachycardia or other cardiac problems
  • Medications - Amphetamines, cocaine, caffeine, ephedrine, antihistamines, phenothiazines, antidepressants, theophylline, appetite suppressants, albuterol
  • Allergies
  • Family history of sudden death, deafness (Jervell-Lange Nielsen syndrome) or cardiac disease

Physical

  • General appearance
  • Temperature
  • Heart rate
  • Respiratory rate
  • Blood pressure
  • Oxygen saturation
  • Assessment of pain
  • Decreased level of consciousness, decreased level of activity
  • Jugular venous distention
  • Neck mass
  • Dyspnea, increased work of breathing, retractions
  • Crackles, wheezing
  • Cardiac gallop
  • Cardiac murmur
  • Increased liver size
  • Abdominal mass
  • Decreased urine output
  • Poor peripheral perfusion (delayed capillary refill >2 sec, cool extremities, pallor)
  • Cyanosis
  • Edema

Causes

Tachycardia can be due to a physiologic response of the heart to noncardiac stimuli or to a true dysrhythmia.2,3

  • Hyperdynamic cardiac activity
    • Increased heart rate and contractility are physiologic responses to catecholamine release.
    • Catecholamine release may occur with stress or anxiety, exercise, fever or infection, pain, anemia, seizure, hypovolemia, hypoxia, drugs or medications/stimulants (eg, amphetamines, cocaine, caffeine, ephedrine, antihistamines, phenothiazines, antidepressants, tobacco, theophylline, general anesthesia), vasodilation (eg, anaphylaxis), oncologic mass (pheochromocytoma, neuroblastoma), hypoglycemia, hyperthyroidism, or acidosis.
  • True dysrhythmias
    • Supraventricular tachycardia (SVT)
    • Atrial fibrillation or atrial flutter
      • Drug induced
      • Wolff-Parkinson-White syndrome (WPW)
      • Postoperative cardiac repair
      • Congenital or rheumatic mitral disease
      • Hyperthyroidism
    • Junctional ectopic tachycardia (JET) - Postoperative cardiac repair
    • Ventricular tachycardia (VT)
      • Drug induced (eg, tricyclics, phenothiazines, antiarrhythmics, chloral hydrate, organophosphates, hydrocarbons, digoxin, amphetamines, cocaine, arsenic)
      • Prolonged Q-T syndrome/torsades de pointes
      • Myocarditis
      • Rheumatic fever
      • Mitral valve prolapse
      • Cardiomyopathy
      • Myocardial ischemia
      • Postoperative cardiac repair
      • Hyperkalemia (peaked T waves, prolonged QRS and QT intervals)
      • Hypocalcemia (increased QT intervals secondary to ST-segment prolongation)
      • Hypokalemia (especially in association with digoxin use due to its synergistic effects on automaticity and conduction)
      • Hypomagnesemia (associated with hypocalcemia and hypokalemia)
      • Cardiac tumors
      • Arrhythmogenic right ventricular dysplasia

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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