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

Evaluation of arterial stiffness and carotid intima-media thickness in children with primary and renal hypertension

Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18 years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children

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