ECGs in the ED

摘要

A 6-year-old boy was referred to the emergency department by his pediatrician who noticed an irregular heart rate on examination during a routine well-child check-up. The child has been asymptomatic. He denies palpitations, chest pain, shortness of breath, dizziness, or syncope. The mother denies observing cyanosis, pallor, respiratory distress, or altered mental status. He is an active boy without exercise limitations. The past medical history is noncontributory. The child has had normal growth and development. He has been seen regularly during childhood and there has been no prior concern regarding the heart rate or rhythm. He takes no medications and has no known drug allergies. The family history is noncontributory for congenital heart disease or sudden death. There are two healthy older siblings. The boy attends first grade and is a good student. In the emergency department, the patient is acyanotic and in no distress. The weight is 21 kg. The heart rate is 64 bpm and irregular. The respiratory rate is 20 per minute. The blood pressure is 96/54. The head and neck exam is normal. There is no thyromegaly detected. The chest is clear to auscultation. The cardiac exam has a normally active precordium with a slow, irregular rhythm. There is a normal first heart sound and a soft, physiologically split second heart sound. There is no click or gallop. There is no murmur. The pulses are full and equal. The abdomen is soft and without masses or organomegaly. The extremities are warm and well-perfused. The neurologic exam is nonfocal.