Miten tulkitsen lapsen EKG:n?

EKG on perustutkimus sydänsairautta ja rytmihäiriöitä epäiltäessä. Iän mukana muuttuvien viitearvojen ymmärtäminen ja järjestelmällinen analyysi helpottavat tulkintaa. Lapsen EKG:ssa oikeavoittoisuus ja oikean kammion hypertrofia tulevat helpommin esille kuin vasemman kammion kuormitusmuutokset. Vähäinen vasemman kammion volttikriteerien ylittyminen on yleensä ­merkityksetön ilman muita vasemman kammion hypertrofiaan liittyviä muutoksia. Superiorinen akseli, osittainen oikea haarakatkos ja positiivinen T-aalto kytkennässä V1 ennen murrosikää ovat aiheita sydäntutkimuksiin. Lapsen rytmi- ja johtumishäiriöitä tulkitaan samoin periaattein kuin aikuisten.Peer reviewe

Lapsen tajunnanmenetys - milloin tulee epäillä sydänperäistä syytä?

VertaisarvioituLapsen tai nuoren äkillinen tajunnanmenetys on pelottavuudestaan huolimatta useimmiten hyvänlaatuinen. Fyysisen tai henkisen rasituksen aikana ilmetessään se on aihe lisätutkimuksille. Sydänperäinen tajunnanmenetys on yhteydessä lisääntyneeseen äkkikuoleman vaaraan ja tulee siksi tunnistaa. Tavallisimpia sydänperäisen tajunnanmenetyksen syitä lapsuudessa ovat perinnölliset rytmihäiriösairaudet, kardiomyopatiat ja sepelvaltimoiden rakennepoikkeavuudet.Peer reviewe

Tarvitaanko urheilevien lasten ja nuorten sydänterveystarkastuksia Suomessa?

VertaisarvioituSydänperäiset äkkikuolemat ovat lapsilla harvinaisia. Jos lapsi liikkuu liikuntasuosituksen mukaan, liikunnan määrä voi olla yhtä suuri kuin kilpaurheiluvalmennuksessa. Esitiedot ja tutkimuslöydökset riittävät sydänsairauden seulomiseksi. EKG:tä ei suositella seulontaluonteiseen käyttöön. Suomessa on kouluterveydenhuollossa kattava terveystarkastusjärjestelmä, jossa sydänterveystarkastus voidaan toteuttaa kaikille lapsille.Peer reviewe

Lapselle tai nuorelle psyykenlääkitys - milloin tutkitaan EKG?

Vertaisarvioitu. English summary.• EKG:n tutkiminen ei ole tarpeen aloitettaessa psyykenlääkitystä lapselle tai nuorelle, jos sairaushistoria, statuslöydökset ja sukuanamneesi ovat normaalit. • Tarpeettomista EKG-tutkimuksista voi aiheutua potilaille ja perheille turhaa huolta, ja tarpeellisen hoidon aloitus saattaa viivästyä. • Jos käytetään samanaikaisesti useita psyykenlääkkeitä tai muita QT-aikaa pidentäviä lääkkeitä, EKG on hyvä tarkistaa. • Leikattu sydänvika tai perinnöllinen sydänlihas- tai rytmihäiriösairaus ei välttämättä ole esteenä ¬lääkityksille, mutta hoitavan kardiologin konsultaatio on aiheellinen

Elektrofysiologian uutuudet nopeiden rytmihäiriöiden diagnosoinnissa ja hoidossa

Vertaisarvioitu. Teema : lastenkardiologia. English summaryPeer reviewe

Multicenter cohort study on duration of antiarrhythmic medication for supraventricular tachycardia in infants

Antiarrhythmic medication (AM) is commonly used to prevent supraventricular tachycardia (SVT) recurrence in infants. Our aim was to determine whether a shorter duration of AM is sufficient to prevent atrioventricular reentrant tachycardia (AVRT) recurrence and evaluate risk factors for recurrence of SVT after discontinued AM.This multicenter cohort study included all infants diagnosed with SVT in the five university hospitals in Finland between 2005 and 2017. Those diagnosed between 2005 and 2012 received AM for 12 months (group 1), and those diagnosed between 2013 and 2017 received AM for 6 months (group 2). A total of 278 infants presented with AVRT (group 1, n = 181; group 2, n = 97), and the median AM duration was 12.0 months (interquartile range [IQR] 11.4-13.4) and 7.0 months (IQR 6.0-10.2), respectively. Propranolol was the most frequently used first-line AM (92% and 95%). Recurrence-free survival rates were over 88% until 12 months after AM prophylaxis in both groups, without any statistically significant difference between them. Independent risk factors for recurrence of SVT after discontinuation of AM were need of combination AM (HR 2.2, 95% CI 1.14-4.20), Wolff-Parkinson White (WPW) syndrome (HR 2.4, 95% CI 1.25-4.59), and age over 1 month at admission (HR 2.2, 95% CI 1.12-4.48). Conclusion: Shortening AM duration in infants from 12 to 6 months does not seem to lead to more frequent SVT recurrence. The risk factors for recurrence of SVT were WPW syndrome, need of combination AM, and age over 1 month.Peer reviewe

Automatic Atrial Threshold Measurement and Adjustment in Pediatric Patients

Background: Automatic threshold measurement and output adjustment are used as default settings in modern pacemakers. The purpose of the study was to assess Atrial Capture Management (ACM) of Medtronic pacemakers in pediatric patients. Methods: Forty children were enrolled in two centers. Median age was 9.8 years (range 0.8–17.5 years). Half had undergone surgery for congenital heart defects; 45% of patients had an epicardial atrial lead. The pacing indication was atrioventricular block in 82% of patients and sinus node disease in 18%. Manually determined atrial thresholds and ACM measurements were compared. Results: ACM measurements were within the expected variation in 37/40 (93%) of the patients. In one patient the threshold was 0.625-V lower manually than with ACM. One patient had too high an intrinsic atrial rate for ACM to be able to measure threshold. The mean threshold at 0.4 ms was 0.69 ± 0.32 V manually and 0.68 ± 0.35 V with ACM (two-tailed paired t- test, P = 0.52) in all patients. The mean difference was 0.012 V (95% confidence interval: −0.027, 0.053). The mean endocardial threshold was 0.70 ± 0.36 V manually and 0.69 ± 0.38 V with ACM; epicardial threshold was 0.67 ± 0.27 V manually and 0.68 ± 0.32 V with ACM. The difference between the measurements was 0.012 V for endocardial and 0.014 V for epicardial leads. No atrial arrhythmias due to ACM measurements were observed. Conclusions: ACM measures atrial thresholds reliably in pediatric patients with both endocardial and epicardial leads, allowing its use in both. Constant high intrinsic atrial rate may prevent automatic threshold measurement in young children. (PACE 2010; 33:309–313)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79326/1/j.1540-8159.2009.02619.x.pd

MYH7 Genotype–Phenotype Correlation in a Cohort of Finnish Patients

Cardiomyopathies (CMPs) are a heterogeneous group of diseases, frequently genetic, affecting the heart muscle. The symptoms range from asymptomatic to dyspnea, arrhythmias, syncope, and sudden cardiac death. This study is focused on MYH7 (beta-myosin heavy chain), as this gene is commonly mutated in cardiomyopathy patients. Due to the high combined prevalence of MYH7 variants and severe health outcomes, it is one of the most frequently tested genes in clinical settings. We analyzed the clinical presentation and natural history of 48 patients with MYH7-related cardiomyopathy belonging to a cohort from a tertiary center at Helsinki University Hospital, Finland. We made special reference to three age subgroups (0–1, 1–12, and >12 years). Our results characterize a clinically significant MYH7 cohort, emphasizing the high variability of the CMP phenotype depending on age. We observed a subgroup of infants (0–1 years) with MYH7 associated severe DCM phenotype. We further demonstrate that patients under the age of 12 years have a similar symptom burden compared to older patients

MYH7 Genotype–Phenotype Correlation in a Cohort of Finnish Patients

Cardiomyopathies (CMPs) are a heterogeneous group of diseases, frequently genetic, affecting the heart muscle. The symptoms range from asymptomatic to dyspnea, arrhythmias, syncope, and sudden cardiac death. This study is focused on MYH7 (beta-myosin heavy chain), as this gene is commonly mutated in cardiomyopathy patients. Due to the high combined prevalence of MYH7 variants and severe health outcomes, it is one of the most frequently tested genes in clinical settings. We analyzed the clinical presentation and natural history of 48 patients with MYH7-related cardiomyopathy belonging to a cohort from a tertiary center at Helsinki University Hospital, Finland. We made special reference to three age subgroups (0–1, 1–12, and >12 years). Our results characterize a clinically significant MYH7 cohort, emphasizing the high variability of the CMP phenotype depending on age. We observed a subgroup of infants (0–1 years) with MYH7 associated severe DCM phenotype. We further demonstrate that patients under the age of 12 years have a similar symptom burden compared to older patients