ABSTRACT
Cardiac tamponade is a life-threatening condition that disrupts normal hemodynamics, limits the adequate filling of the heart cavities, and occurs with sudden and/or excessive fluid accumulation in the pericardial cavity. Cardiac tamponade is rare in pediatric patients and requires early diagnosis and urgent intervention. Herein, we present an 11-month-old boy with Down syndrome who developed pericardial tamponade associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and acute respiratory distress syndrome. An 11-month-old boy with Down syndrome was admitted to the pediatric infection service due to cough and respiratory distress. Pericardial effusion was detected in the follow-up of the patient whose SARS-CoV-2 polymerase chain reaction test was positive. Ibuprofen treatment was started for pericardial effusion. During the follow-up, the patient who developed respiratory distress was transferred to the intensive care unit, intubated and mechanically ventilated. In the intensive care unit, the patient developed hypotension and cardiac tamponade. An emergency pericardiocentesis was performed. Despite pericardiocentesis, the patient’s hypotension persisted. The patient died due to acute respiratory distress syndrome. Coexistence of cardiac tamponade and Coronavirus disease-2019 (COVID-19) in children has been rarely reported. We do not have enough knowledge about the course of COVID-19 in patients with Down syndrome. This case is presented in order to ensure the early recognition of similar cases in the SARS-CoV-2 pandemic and to be more careful in ARDS due to COVID-19 infection in patients with Down syndrome. © Telif Hakkı 2021 Çocuk Acil Tıp ve Yoğun Bakım Derneği.
ABSTRACT
Objective: Multisystem inflammatory syndrome in children (MIS-C) may cause cardiovascular involvement and dysrhythmia. Although a variety of arrhythmias may be seen, sinus bradycardia was rarely reported. The aim of this study is to determine the frequency and clinical course of bradycardia in children with MIS-C. Material and Methods: Medical records of patients who were diag-nosed with MIS-C between August 2020 and March 2021 were retro-spectively evaluated. MIS-C diagnosis was made according to US Cen-ters for Disease Control and Prevention (CDC) criteria. All patients who had sinus bradycardia were included in the study. Results: Transient sinus bradycardia was observed in 7 of 40 (17.5%) patients (2 girls, 5 boys) with MIS-C. The median age was 10.8 years (range, 5.4-13.8 years). All patients were initially treated with intravenous immu-noglobulin (IVIG) and six out of the seven patients also received intravenous methylprednisolone (MPZ). Sinus bradycardia developed a median of four days (range, 2-6 days) after MIS-C diagnosis and continued for a median of four days (range, 2-6 days). In six of the seven patients, bra-dycardia was detected a median of 42 hours (range, 11-74 hours) after MPZ treatment and resolved a median of 36 hours (range, 20-50 hours) after tapering MPZ dosage. Electrocardiogram (ECG) of patients showed sinus bradycardia. All patients were asymptomatic and awake when bra-dycardia was observed. No patients had any underlying structural heart defect or electrolyte abnormalities. Bradycardia episodes resolved without any specific intervention. Conclusion: Sinus bradycardia may occur due to the cardiac involvement of MIS-C itself or as a possible side effect of MPZ therapy, which can resolve without any specific treatment.