Circadian blood pressure rhythm in normotensive offspring of hypertensive parents

Background: The aim of this study was to explore the circadian blood pressure (BP) rhythm using ambulatory BP monitoring (ABPM) in normotensive children with a family history of essential hypertension. Methods: Group 1 consisted of children with hypertensive mothers and/or fathers (n = 20), Group 2 consisted of children with hypertensive grandparents (n = 20), and Group 3 consisted of children with normotensive parents (n = 20). All participating children underwent a 24-h ABPM and echocardiography. Results: Significantly higher systolic burden was found in children with hypertensive parents (p < 0.05) and grandparents (p < 0.05) compared to controls. Ambulatory BP measurements had a higher daytime systolic BP in Group 1 compared to controls (p < 0.05). While left ven­tricular (LV) posterior wall thickness was similar in Group 1 and Group 2, it was significantly higher in both of these groups compared to the controls. The LV mass index (LVMI) was signifi­cantly higher in Group 1 than in controls (p < 0.05). However, diastolic BP was significantly higher in dippers compared to non-dippers (p < 0.05). LV posterior wall thickness, interven­tricular septum thickness and LVMI were significantly higher among non-dippers compared to dippers (p < 0.05). In children with a family history of hypertension, a positive correlation between nocturnal systolic BP and LVMI was found, and increasing nocturnal BP values were associated with increasing LVMI (p < 0.01). Conclusions: In children with a family history of hypertension, target-organ damage may precede the clinical detection of hypertension, and in those with a nocturnal non-dipper status, a more marked effect on LVMI may occur

Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN (P<0.001), SDNNi (P<0.05), RMSDD (P<0.01), and pNN50 (P<0.01) were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF (P<0.05) and the LF/HF ratio (P=0.001) were significantly higher in the TCA intoxication group, while the nHF (P=0.001) values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF (P=0.001) in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher (P<0.05) in the intoxication group. The LF/HF ratio was higher in the seven children with seizures (P<0.001). These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients

Fetal and postnatal diagnosis and management of cardiac rhabdomyomas and association with tuberous sclerosis complex

Aim: Cardiac rhabdomyomas are the most frequently seen pediatric cardiac tumors and are predominantly associated with tuberous sclerosis complex. These tumors often shrink and disappear spontaneously. This study evaluated the clinical and echocardiographic data of patients followed up in our Pediatric Cardiology Clinic for cardiac rhabdomyoma. Methods: This study included patients with cardiac rhabdomyoma detected by echocardiography between 2008 and 2021. Data regarding the patients’ age at diagnosis, symptoms, physical examination findings, electrocardiography, 24-h Holter recordings, echocardiography, and follow-up data were obtained from the hospital records. Results: The age of the patients at the time of diagnosis ranged from 21-weeks gestational age to postnatal 10-months. A total of 49 tumors were detected in 10 patients. In all but 2 patients, the tumor was asymptomatic and the hemodynamic changes were not significant. One patient required surgery due to significant left ventricular outflow tract obstruction. Everolimus treatment was administered to 1 patient with right ventricular outflow tract obstruction. Five of the patients were diagnosed with tuberous sclerosis complex during the follow-ups. Except 1 patient who died post-surgery, the others demonstrated substantial regression of the tumors during the ongoing follow-ups. Conclusion: Although it is a rare tumor, cardiac rhabdomyoma may lead to life-threatening symptoms. They are typically asymptomatic and usually resolve spontaneously. Novel medical treatments, such as everolimus, are promising as an alternative to surgery in patients with hemodynamic deterioration. Resumen: Objetivo: Los rabdomiomas cardiacos son los tumores cardiacos pediátricos más frecuentes y se asocian predominantemente con el complejo de esclerosis tuberosa. Estos tumores a menudo se encogen y desaparecen espontáneamente. Este estudio evaluó los datos clínicos y ecocardiográficos de pacientes seguidos en nuestra Clínica de Cardiología Pediátrica por rabdomioma cardiaco. Métodos: El presente estudio incluyó pacientes con rabdomioma cardiaco detectado por ecocardiografía entre 2008 y 2021. Los datos sobre la edad de los pacientes al diagnóstico, síntomas, hallazgos del examen físico, electrocardiografía, registros Holter de 24 horas, ecocardiografía y datos de seguimiento se obtuvieron de los registros hospitalarios. Resultados: La edad de los pacientes al momento del diagnóstico osciló entre 21 semanas de edad gestacional y 10 meses posnatales. Se detectaron un total de 49 tumores en 10 pacientes. En todos menos en dos pacientes el tumor fue asintomático y los cambios hemodinámicos no fueron significativos. Un paciente requirió cirugía por obstrucción importante del tracto de salida del ventrículo izquierdo. Se administró tratamiento con everolimus a un paciente con obstrucción del tracto de salida del ventrículo derecho. Cinco de los pacientes fueron diagnosticados con complejo de esclerosis tuberosa durante los seguimientos. Excepto un paciente que murió después de la cirugía, los demás demostraron una regresión sustancial de los tumores durante los seguimientos en curso. Conclusión: Aunque es un tumor raro, el rabdomioma cardiaco puede causar síntomas potencialmente mortales. Por lo general, son asintomáticos y generalmente se resuelven espontáneamente. Nuevos tratamientos médicos como el everolimus, son prometedores como alternativa a la cirugía en pacientes con deterioro hemodinámico

Uric Acid Levels in Normotensive Children of Hypertensive Parents

This study evaluated uric acid concentrations in normotensive children of parents with hypertension. Eighty normotensive children from families with and without a history of essential hypertension were included. Concentrations of lipid parameters and uric acid were compared. Demographic and anthropometric characteristics were similar in the groups. Systolic and diastolic blood pressure were higher in the normotensive children of parents with hypertension without statistically significant difference (P>0.05). Uric acid concentrations were higher in the normotensive children of parents with hypertension (4.61 versus 3.57 mg/dL, P<0.01). Total cholesterol and triglyceride concentrations were similar in the two groups. Systolic and diastolic blood pressure were significantly higher in control children aged >10 years (P<0.01). Uric acid levels were significantly higher in all children with more pronounced difference after age 10 of years (P<0.001). Positive correlations were found between the level of serum uric acid and age, body weight, body mass index, and systolic and diastolic blood pressure in the normotensive children of parents. The higher uric acid levels in the normotensive children of hypertensive parents suggest that uric acid may be a predeterminant of hypertension. Monitoring of uric acid levels in these children may allow for prevention or earlier treatment of future hypertension

Clinical Study Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN ( &lt; 0.001), SDNNi ( &lt; 0.05), RMSDD ( &lt; 0.01), and pNN50 ( &lt; 0.01) were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF ( &lt; 0.05) and the LF/HF ratio ( = 0.001) were significantly higher in the TCA intoxication group, while the nHF ( = 0.001) values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF ( = 0.001) in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher ( &lt; 0.05) in the intoxication group. The LF/HF ratio was higher in the seven children with seizures ( &lt; 0.001). These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients