Cardiac Arrest Case Study

ABSTRACT

Sudden cardiac arrest in the pediatric population is a rare occurrence, but it can be devastating. An understanding of the differential for the etiology of the cardiac arrest allows for more expedient and appropriate care and can lead to more favorable outcomes. Pediatric sudden cardiac arrest can occur with or without prodromal symptoms and may occur with or without exercise. The most common cause is arrhythmia that may be due to a channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include EKG, chest radiograph, and echocardiogram if available. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload and close attention to medication use that could

A teacher discovered him to be pulseless and began bystander cardiopulmonary resuscitation (CPR). After this sudden collapse, he had spontaneous return of circulation during prehospital care. Upon arrival to the emergency department (ED) he was noted to be persistently bradycardic and hypotensive and further resuscitation was performed including fluid boluses, and initiation of inotropes. Echocardiography performed in the pediatric intensive care unit (PICU) led to a diagnosis of hypertrophic cardiomyopathy (HCM).

The most common cardiac diagnosis is arrhythmia and can be due to a channelopathy, cardiomyopathy, or myocarditis.11 Arrhythmia is presumed in many cases of SCD due to no or minimal structural heart disease found in most cases.12 Despite arrhythmia being common, ventricular fibrillation is much less common in children than in adults, comparatively 4-10% versus 50% in adults.13, 14 Other cardiac etiologies include coronary artery anomalies, aortic rupture, left ventricular outflow tract obstruction, mitral valve prolapse, coronary artery atherosclerosis, arrhythmogenic right ventricle cardiomyopathy, post-operative congenital heart disease, long QT syndrome, Wolff-Parkinson White syndrome, Brugada syndrome, polymorphic ventricular tachycardia, short QT syndrome, complete heart block, pulmonary hypertension, commotio cordis, and drugs especially stimulant medications7, 15 The most common structural defects that result in SCD are HCM (36%), followed by coronary artery anomalies of wrong sinus origin (17%), followed by less commonly, myocarditis (6%), and arrhythmogenic right ventricular cardiomyopathy (4%).16 Cardiac causes that are non-structural include, long QT syndrome, Wolff-Parkinson White syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome and complete heart block.7