Il bambino con il batticuore in Pronto Soccorso: dalla teoria alla pratica andata e ritorno

Palpitations are a common cause of complaint in the paediatric population and can be a reason of serious concern for children, adolescents and parents. Despite this, palpitations are known to have a benign prognosis, but still are cause of referral to the Emergency Unit (EU). The aim of the present retrospective study was to make a review of prevalence and long-term prognosis of emergency accesses for palpitations between 2009-2015. The study was conducted in the EU of the Paediatric Hospital \u201cBurlo Garofolo\u201d, Trieste, Italy. Despite a low prevalence of access to the EU, namely 0.1%, 96 patients in a time span of 7 years, 16.7% of patients (n = 16) had an underlying arrhythmic cause for the symptom. The presence of a heart rate above 150 beats per minute was highly suggestive of cardiac arrhythmia, more often of paroxysmal supraventricular tachycardia. As far as the long-term follow-up is concerned, 10.4% of patients (n = 10) received medical therapy and 6.2% (n = 6) underwent transcatheter ablation for supraventricular arrhythmia. In conclusion, palpitations turned out to be an infrequent cause of access to the EU. Nonetheless, 1 out of 6 patients requires long term medical therapy or percutaneous intervention

Isolation of the left innominate artery: A question of connection

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An Unusual Cardiomyopathy after Physical Stress in a Child

Takotsubo cardiomyopathy, or broken heart syndrome, is characterized by transient left ventricular dysfunction associated to chest pain, elevation of cardiac enzymes, and electrocardiographic changes, mimicking an acute coronary syndrome, especially in older women after a physical or emotional stress. It is extremely infrequent in children as well as after infective stress. We described a celiac 4-year-old girl, following a gluten-free diet, who developed features of cardiac failure few days after episodes of acute diarrhea with fever. The patient was treated with oral anticongestive therapy and intravenous immunoglobulins, and she had a dramatic and rapid improvement; echocardiographic features normalized in 48hours. © 2012 Wiley Periodicals, Inc

Follow-up study of patients admitted to the pediatric emergency department for chest pain

Chest pain is a relatively common cause of admission to the Emergency Department, being related in most of the cases to benign conditions with only a minority of the cases affected by heart disease. Limited data are available about the follow up of these patients in terms of risk of recurrence of symptoms, Emergency Department re-admissions, level of impairment, and school absenteeism. We identified 761 children who visited our ED with the chief complaint of chest pain, equal to 0.68% of all admissions. Twenty-four patients were excluded for a previous history of cardiac disease. Eight (1%) patients were determined to have chest pain of cardiac origin. Ninety-seven percent of patients were successfully contacted by telephone: 69% agreed to answer the questionnaire. Of these, 33% experienced recurrent chest pain, up to 41% was forced to be absent from school, about 20% was limited in its daily activities, and about 20% repeated a cardiologic evaluation. Conclusion: Chest pain is mainly due to benign causes and is a recurrent symptom in a high percentage of patients, associated with re-admission and school absenteeism.What is Known:\u2022 Chest pain is a relatively common cause of admission to the Emergency Department.\u2022 It is mainly due to benign causes and is among the most common reasons for referral to the pediatric cardiologist.What is New:\u2022 Chest pain is a recurrent symptom associated with re-admission and school absenteeism.\u2022 As a family history of cardiac disease or exertional symptoms are a well-known red flag for chest pain of cardiac origin, school absenteeism should be considered a red flag for symptoms related to psychological distress in patients with non-cardiac chest pain

A strident girl

A 12-year-old girl was referred with a 7-month history of episodes of dyspnoea, stridor and a sense of chest constriction during physical exercise. These were self-limiting and never occurred at night. Physical examination was normal. An initial diagnosis of vocal cord dysfunction was made. Spirometry showed a plateau of forced expiratory flow, with a truncated aspect of the expiratory phase (figure 1). Six weeks later she described occasional dysphagia with solid foods. The barium swallow, performed only in anteroposterior projection, did not show oesophageal dilation. A bronchoscopy showed extrinsic compression of the middle lower third of the trachea and the right main bronchus. A chest CT scan was performed (figures 2 and 3). Figure 1 The spirometry showed a truncated expiratory phase with a substantially decreased PEF, compared with FEV1: indicating central intrathoracic airway obstruction. FEF, forced expiratory flow; FEV1, forced expiratory volume in 1 s; FIF, forced inspiratory flow; FIV1, forced inspiratory volume in 1 s; FIVC, forced inspiratory vital capacity; FVC, forced vital capacity; PEF, peak expiratory flow; PIF, peak inspiratory flow. Figure 2 Contrast enhanced CT axial section image showing right aortic arch (white arrow on the left) with aberrant subclavian artery (red arrow on the right) encircling the trachea and the oesophagus. Figure 3 CT three-dimensional reconstruction arteriography posterior view showing right aortic arch (white arrow), diverticulum of Kommerell (white star) from which the left subclavian artery (red arrow) arose. D Ao, descending aorta. Questions: What is your diagnosis? Persistent vocal cord dysfunction Achalasia Vascular ring Asthma What is the gold standard for diagnosis of VR? ECG Chest radiograph CT and/or MRI Bronchoscopy How should this patient be treated? Surgical correction Video-assisted thoracoscopy Decompression of the oesophagus with a nasogastric tube Inspiratory muscle training and ipratropium bromide inhaler What signs in the history pointed away from vocal cord dysfunction? Dysphagia with solid food was present. The episodes of dyspnoea and stridor never occurred at night. The episodes arose mainly on exertion. The episodes of dyspnoea and stridor were self-limiting. Answers can be found on page 2

Is antiarrhythmic therapy safe in twin pregnancies?

AIM: The optimal treatment for foetal supraventricular tachycardia (SVT) in twin pregnancies is unclear because of the possible impact on the second twin. This review compared a foetus we treated with antiarrhythmic drugs with the previous case studies. METHODS: Our case was a dichorionic diamniotic twin pregnancy, where one twin developed foetal hydrops secondary to SVT at 22 weeks of gestation. We searched PubMed to look for previous cases of SVT in twin pregnancies. RESULTS: Treatment with transplacental antiarrhythmic therapy from 22 to 36 weeks of gestation successfully resolved the SVT in our affected twin without any impact on the healthy twin or mother. We only found seven similar cases of SVT in twin pregnancies from 1999 to 2017. Although there was no consensus on the treatment that should be provided, none of the studies reported side effects in the twins or the mothers. CONCLUSION: Despite a lack of data on SVT in twin pregnancies, our case, and the previous cases we identified, allowed us to conclude that transplacental antiarrhythmic treatment can successfully achieve cardioversion in the affected twin. It can do this without side effects for the healthy foetus or the mother, even if the treatment lasts for a long period of time

Early prenatal diagnosis of right ventricular myocardial sinusoidal-coronary artery connections in pulmonary atresia with intact septum

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Surgical approach to a rare case of Beckwith Wiedemann syndrome with left thigh hyperplasia

Thigh lift surgery is generally performed in patients with severe weight loss outcomes, particularly those undergoing bariatric surgery. However, there are other congenital malformation conditions that may require the same treatment, such as Beckwith Wideman syndrome