7. Rhythm recognition

Question 1

Give examples of acquired cardiac disease

Answer 1

cardiomyopathy
myocarditis
pericarditis

Question 2

What is the average heart rate up to 3 months of age

Answer 2

140bpm

Question 3

What is the average heart rate up to 2 years

Answer 3

130bpm

Question 4

What is the average heart rate up to 10 years

Answer 4

80 bpm

Question 5

What is the average heart rate over 10 years

Answer 5

75 bpm

Question 6

What does the PR interval represent

Answer 6

Time taken for electrical impulse to travel from SA node, through atria, through the SA node, down the purkinje fibres and to the ventricles

Should be 3-5 small squares

Question 7

What does P wave represent

Answer 7

atrial depolarisation

Question 8

What does QRS complex represent

Answer 8

Ventricular depolarisation
Should be <3 small squares

Question 9

What 4 factors must be considered to manage a cardiac arrhythmia?

Answer 9

1. Presence / absence of circulation (a pulse)
2. Clinical status (haemodynamically stable or unstable)
3. Heart rate (brady or tachy)
4. Width of QRS (narrow or broad)

Question 10

What heart rate defines bradycardia in an infant (<1 year)

Answer 10

HR <80

Question 11

What heart rate defines bradycardia in a child (>1 year)

Answer 11

HR <60

Question 12

What is the commonest cardiorespiratory arrest arrhythmia in paediatrics?

Answer 12

asystole

Question 13

What heart rate defines tachycardia in an infant (<1 year)

Answer 13

> 180bpm

Question 14

What heart rate defines tachycardia in a child (>1 year)

Answer 14

> 160bpm

Question 15

What are the commonest causes of bradycardia in children and infants

Answer 15

Hypoxia
Vagal stimulation

Question 16

What are the 3 common tachycardia rhythms in children?

Answer 16

Sinus tachycardia
The two tachyARRHYTHMIAS:
- SVT
- VT

Question 17

List causes of sinus tachy

Answer 17

Fever
Pain
Airway obstruction
Hypovolaemia
Anaphylaxis
Drugs
Seizures

Question 18

What are the two tachycardias with narrow QRS complexes?

Answer 18

ST
SVT

Question 19

How can you differentiate SVT from sinus tachy

Answer 19

Generally faster heart rates >220 infant / >180 child
abrupt onset
no preceding Hx
P waves absent

Question 20

What is the most common primary cardiac arrhythmia in children?

Answer 20

SVT

Question 21

To try and treat SVT in children, how are vagal manouevres performed?

Answer 21

soak a flannel in ice cold water and place briefly over the face
valsalva manouevre by blowing through an occluded drinking straw in co-operative children