From the Guidelines
Persistent tachycardia in a 2-year-old without fever who is not on high-flow nasal cannula requires prompt evaluation and management to identify and treat the underlying cause, as no specific drug treatment is required for sinus tachycardia itself, but rather therapy directed toward the underlying cause 1. When evaluating a 2-year-old with persistent tachycardia, it is essential to consider the age-related upper rate of sinus tachycardia, which can be calculated as approximately 220 beats per minute, minus the patient’s age in years, to determine if the heart rate is within the expected range for the child's age 1. Key steps in the initial assessment include:
- Obtaining vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation
- Assessing for signs of dehydration, pain, anxiety, or respiratory distress
- Evaluating the child's overall clinical condition to determine the need for immediate intervention Further investigation should be guided by the child's presentation and may include:
- Complete blood count to rule out anemia or infection
- Electrolyte panel to check for imbalances, particularly potassium
- ECG to evaluate for arrhythmias
- Chest X-ray to rule out occult pneumonia or cardiac enlargement If the child appears unstable with poor perfusion, immediate fluid resuscitation with 20 mL/kg of normal saline should be administered, and consideration should be given to consulting pediatric cardiology for further guidance on management, especially if the tachycardia persists or is unexplained 1.
From the Research
Persistent Tachycardia in a 2-Year-Old
- Persistent tachycardia in a young child should not be dismissed and an underlying dysrhythmia should be considered 2
- Tachydysrhythmias causing heart failure are rare and can be difficult to diagnose in young children, but are reversible if recognized and treated early 2
Potential Causes and Treatments
- Atrial flutter is a potential cause of persistent tachycardia in children, and cardioversion can be an effective treatment 3
- Pharmacological cardioversion using medications such as ibutilide, propafenone, and sotalol may also be effective in treating atrial flutter 3
- Beta-blockers such as propranolol can be used to suppress electrical storms and control heart rate 4, 5
- Amiodarone is an effective antiarrhythmic medication that can be used to treat both ventricular and atrial arrhythmias, but requires routine monitoring for side effects 6
Considerations for Treatment
- The choice of cardioversion method depends on the patient's comorbidity profile, antiarrhythmic drug onset of action and side effect profile, and the need for a physician with experience in sedation or anaesthetics support 3
- Clinicians should have a thorough understanding of the indications, contraindications, dosing, side effects, and interactions of antiarrhythmic medications such as amiodarone 6