The normal heartbeat is regular and the intervals between heartbeats are basically equal. If a sudden early heartbeat occurs, it is medically known as premature beat, or premature beat. Premature beats are the most common cardiac arrhythmia in pediatrics and are a common symptom and complaint in pediatric cardiology clinics. They can be classified as atrial, junctional and ventricular premature beats and are clinically seen in children without organic heart disease.
Premature beats can be caused by fatigue, mental stress, anxiety, fear, shock, fever, and improper use of medications due to unstable vegetative nerve function, underdeveloped heart anatomy and conduction system. However, premature heartbeat in children is not equal to “myocarditis” or organic “heart disease”, so parents should be sure to identify the right and wrong with the help of a doctor and not to panic; Don’t let your child carry too much mental burden.
Once a child is found to have premature beats, he or she should be sent to the hospital for a comprehensive cardiac examination such as cardiac enzymes, electrocardiogram and cardiac echocardiogram to rule out organic heart disease.
Etiology
It is common in children without organic heart disease. It is caused by fatigue, stress, and vegetative instability, but can also occur in children with myocarditis, congenital heart disease, or rheumatic heart disease. In addition, drugs such as sympathomimetic amines, digitalis, quinidine poisoning, hypoxia, acid-base imbalance, electrolyte disorders (hypokalemia), cardiac catheterization, cardiac surgery, etc. can cause premature beats. About 1-2% of healthy school-age children have premature beats.
Symptoms
Premature beats are caused by impulses from ectopic foci of excitation in the heart and are the most common arrhythmia in pediatrics. Ectopic foci can be located in the atria, atrioventricular junction or ventricular tissue, causing atrial, junctional and ventricular premature beats, respectively, with ventricular premature beats being the most common.
Diagnosis
1. Electrocardiographic features of atrial premature beats.
(1) The P wave is advanced and may overlap with the T wave of the previous heartbeat;
(2) P-R interval in the normal range;
(3) Incomplete compensatory gap after premature beats;
(4) If there are deformed QRS waves, they are due to intraventricular differential conduction.
2. Electrocardiographic features of premature junctional beats.
(1) The QRS waves are advanced, and the morphology and time frame are basically the same as those of normal sinus;
(2) Retrograde P waves before or after the QRS waves generated by premature beats, with P-R <0.10s. Sometimes the P waves may overlap with the QRS waves, which are not recognizable;
(3) The compensatory interval is often incomplete.
3. Electrocardiographic features of premature ventricular contractions.
(1) QRS wave is advanced, and there is no ectopic P wave in front of it;
(2) QRS waves are wide and distorted, and T waves are in the opposite direction of the main wave;
(3) Premature beats are often followed by complete compensatory intervals.
Treatment
If the number of premature beats is not high and there are no conscious symptoms, or if the beats are frequent and associated with a rhythm, but the pattern is consistent and decreases or disappears after activity, antiarrhythmic drugs are not necessary. In some children, premature beats can last for many years, but most of them eventually subside on their own. In children with premature contractions based on organic heart disease or those with spontaneous symptoms and multiple sources on the electrocardiogram, antiarrhythmic drugs should be used.
According to the different types of premature beats, you can take beta-blockers such as cardioplegia or cardiac stimulants; if atrial premature beats are not effective, you can use digitalis instead; if necessary, you can use lidocaine, chronic heart rhythm and ethomorphine for ventricular premature beats.
For functional premature beats, some parents can take it easy, while others are anxious, panicked, and fidgety, trying to find doctors to prescribe some anti-arrhythmic drugs. Some clinicians may confuse functional premature beats with organic premature beats, exaggerate their harmfulness, hospitalize the child, prescribe second- and third-line drugs that have better effects on controlling premature beats but also have greater side effects, and blindly pursue the disappearance of premature beats by increasing the dose of drugs or combining drugs.
The above practices do more harm than good, increase the mental burden of parents and children, cause the abuse of antiarrhythmic drugs, and increase the number of cases of arrhythmia caused by theoretical application of antiarrhythmic drugs. The principle of treatment for benign premature beats in pediatric patients with no organic heart disease is to eliminate the cause, and the use of antiarrhythmic drugs is generally unnecessary. Most of the premature beats disappear on their own with the elimination of the cause and have a good prognosis as long as observation and follow-up are paid attention to.
In children with benign premature beats, the frequency is usually higher in the evening and lower in the morning, and there may be chest tightness or no symptoms. Some children may have premature contractions when they have a fever, but after the fever subsides, the contraction decreases, because these benign premature contractions are caused by the underdevelopment of the pediatric vegetative nervous system and therefore do not require special treatment.
If the child is compliant, he or she can take some oral myocardial nutrients to promote myocardial development and maturity, and improve care and resistance to infection. There is no need to be too nervous, you can follow up with the hospital regularly, usually once every three to six months, and do simple tests such as electrocardiogram first, and then echocardiogram if it suggests pathology; make sure to tell your child that this is a health checkup, and don’t easily let your child carry the psychological burden of “heart disease”.