ECGs in the ED

摘要

A 9-year-old girl is referred to the Emergency Department for evaluation of bradycardia. She has a history of congenital complete heart block due to maternal systemic lupus erythema-tosus. A transvenous ventricular pacemaker was implanted at 6 years of age when heart rates during sleep were documented in the low 30s. The patient has been in her usual state of good health. She was seen by her pediatrician for routine well-child care. The pediatrician noted a heart rate lower that the programmed lower rate limit of the pacemaker. The girl denies chest pain, palpitations, shortness of breath, or syncope. Her parents think that she has had a decreased energy level over the last month. There is no history of trauma to the pacemaker site. There have been no recent fevers, intercurrent illnesses, headaches, or vision changes. The past medical history is otherwise noncontributory.