Paroxysmal Atrioventricular Nodal Tachycardia in a New-Born Infant
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Cited by 15 publications
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The occurrence of paroxysmal tachycardia in children is rare, as Taran and Jennings 1 found from a recent survey of the literature. The treatment for this disorder was frequently uncertain until Starr 2 worked out a technic which, by the use of acetylbetamethylcholine chloride (mecholyl), was effective in terminating 90 per cent of acute paroxysms in adults. The case described below is of interest because the victim was a child and the attacks were frequently repeated and because mecholyl, when used in adequate dosage, was invariably effective. REPORT OF A CASEA Jewish girl of 6 years came to the Babies Hospital on March 8, 1936, because of an excessively rapid heart action. During her life she had eight similar attacks, lasting from two to fourteen days each. The first of these occurred when she was 9 months old. At the time of its inception she had been riding in a closed automobile, and it was thought that the fumes were responsible for her symptoms. Vomiting ushered in the attack and continued intermittently for the next twelve hours. Later, the mother noted violent pulsation of the anterior wall of the chest, and a physician who was summoned stated that the heart rate was 220 per minute. Vomiting ceased after twelve hours, but the infant remained weak until the heart rate abruptly returned to normal three days later, after which she gained rapidly in strength and appetite.The second attack occurred during the course of an infection of the upper ' respiratory tract with associated cervical adenitis when the girl was 2y2 years old. This attack lasted for two days and was not accompanied by any symptoms other than the tachycardia. At 3y2 years, the child had a similar episode during a cold with cervical adenitis. On this occasion the paroxysm persisted for two weeks and made her weak. After her fourth birthday party, she had a bout that lasted two days. At Ay2 years, a similar episode followed excitement, and again at 5 years the same train of events took place. At 554 years another attack of two days' duration occurred, apparently without inciting cause. The child's most severe seizure occurred in January 1936, about two months before she came to the Babies Hospital. There was no apparent cause. On the third day of tachycardia, the girl lost consciousness and was taken to a hospital in From the Department of Diseases of Children of the College of Physicians and Surgeons, Columbia University, and the Babies Hospital.
The occurrence of paroxysmal tachycardia in children is rare, as Taran and Jennings 1 found from a recent survey of the literature. The treatment for this disorder was frequently uncertain until Starr 2 worked out a technic which, by the use of acetylbetamethylcholine chloride (mecholyl), was effective in terminating 90 per cent of acute paroxysms in adults. The case described below is of interest because the victim was a child and the attacks were frequently repeated and because mecholyl, when used in adequate dosage, was invariably effective. REPORT OF A CASEA Jewish girl of 6 years came to the Babies Hospital on March 8, 1936, because of an excessively rapid heart action. During her life she had eight similar attacks, lasting from two to fourteen days each. The first of these occurred when she was 9 months old. At the time of its inception she had been riding in a closed automobile, and it was thought that the fumes were responsible for her symptoms. Vomiting ushered in the attack and continued intermittently for the next twelve hours. Later, the mother noted violent pulsation of the anterior wall of the chest, and a physician who was summoned stated that the heart rate was 220 per minute. Vomiting ceased after twelve hours, but the infant remained weak until the heart rate abruptly returned to normal three days later, after which she gained rapidly in strength and appetite.The second attack occurred during the course of an infection of the upper ' respiratory tract with associated cervical adenitis when the girl was 2y2 years old. This attack lasted for two days and was not accompanied by any symptoms other than the tachycardia. At 3y2 years, the child had a similar episode during a cold with cervical adenitis. On this occasion the paroxysm persisted for two weeks and made her weak. After her fourth birthday party, she had a bout that lasted two days. At Ay2 years, a similar episode followed excitement, and again at 5 years the same train of events took place. At 554 years another attack of two days' duration occurred, apparently without inciting cause. The child's most severe seizure occurred in January 1936, about two months before she came to the Babies Hospital. There was no apparent cause. On the third day of tachycardia, the girl lost consciousness and was taken to a hospital in From the Department of Diseases of Children of the College of Physicians and Surgeons, Columbia University, and the Babies Hospital.
Two cases of paroxysmal tachycardia demonstrated certain unusual features which appeared to warrant their being reported: Case 1.\p=m-\History.\p=m-\J.E., a girl aged 13, was admitted to the Hospital for Sick Children Aug. 25, 1938. She was the third child in a family of 6. The rest were in good health except for one who had mild kidney trouble and one who occasionally had bronchitis. The patient had usually been in good health. She had measles at the age of 4 years. At 7 she began to have tachycardia at intervals, the attacks lasting from a few minutes to four days. They were usually characterized by the sudden onset of a choking feeling which lasted a few minutes and was followed by a sense of weakness. At such times her heart rate was reported to be close to 200 beats per minute. Often her pulse was difficult to count because of the extremely fast rate. The onset of attacks was occasionally, but not usually, preceded by some excitement. One attack was initiated by her falling down stairs. Three came on while she was eating meals. One occurred during physical activity. None appeared to be initiated by infections. The intervals between paroxysms varied from a few days to several months. After each attack she felt weak and exhausted for two or three days, and often she had a mild headache.There was no history of rheumatic fever or of chorea or of symptoms suggestive of these. Infections of the upper part of the respiratory tract were rare. Her appetite was excellent, and bowel movements were regular. Her menses began when she was 12 years old and had been regular since then, with a normal flow. She was menstruating at the time of admission to the hospital and said that she was more liable to attacks during menstrual periods. The present attack began while she was eating supper. She had a sudden choking sensation and then felt as if her heart had stopped beating. She had been well during the day and had had no premonition of the attack.Physical Examination.--On admission to the Hospital for Sick Children, the child's temperature was 99 F., her pulse rate 200 and her respiratory rate 22. She was well developed, somewhat obese, very apprehensive and almost afraid to move. The pupils reacted to light, and slight strabismus was present. The ears were normal. The teeth were in excellent condition. The tonsils were not enlarged but were cryptic. The breasts were of the enlarged adolescent type. The lungs were resonant throughout, and no adventitious sounds were heard. Breathing was shallow. The heart beats were regular, with a rate of 200 to 210. The heart From the
It has been suggested that paroxysmal tachycardia in children is more frequent than a search of the literature would indicate. Many adults with this cardiac arrhythmia have stated that the condition dated from childhood.1 Cases in children have probably been overlooked because of the mildness of symptoms. Taran and Jennings2 in a review of the literature from 1892 to 1935 found only 52 cases occurring between the ages of 9 days and 15 years. A few of their observations are cited here.
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