[Cardiac arrhythmia in amitriptyline poisoning in children]. / Tulburari de ritm cardiac in intoxicatia cu antideprin la copil.

UNLABELLED: Amitriptyline (Antideprin) determines severe intoxications, especially because of its cardiac side effects. METHOD: We studied 8 children (2-14 years old) admitted with signs of amitriptyline intoxication. RESULTS: The clinical picture revealed altered general status, generalized hypertonia, arterial hypotension up to collapse, mydriasis, coma and cardiac arrhythmia. ECG monitoring showed ventricular premature beats, isolated, couplets and triplets, ventricular tachycardia and torsade des points, severe ventricular repolarisation disturbances with diffuse subendocardial ischemia. The treatment consisted in: gastric lavage with activated charcoal, alkalinisation with sodium bicarbonate, antiarrhythmic drugs and sustained vital functions. All cases recovered in 4-6 days. CONCLUSION: The severity of amitriptyline intoxication requires continue clinical and ECG monitoring, for early detection of some life threatening cardiovascular events. Thus, the treatment will be started early and will alleviate the severe prognosis of this intoxication.

Etiological, clinical and pathomorphological aspects of acute respiratory distress syndrome in children.

Acute respiratory distress syndrome (ARDS) is the result of severe injuries of different etiologies of the capillary system in patients with previously healthy lungs, resulting in noncardiogenic pulmonary edema. The authors studied 42 infants in whom the histopathologic aspects were suggestive for ARDS. The etiologic factors of this syndrome were: severe gastroenteritis with hypovolemic or endotoxic shock (13 cases), sepsis (9 cases), fulminans purpura (2 cases), severe neurological disorders (13 cases), pulmonary infections (5 cases). In such conditions, if the infant presents hyperpnea followed by generalised cyanosis, refractory to oxygen therapy, and if there are clinical and radiologic signs of acute pulmonary edema, the diagnosis of ARDS must be considered and a complete intensive care therapy is compulsory in order to alleviate the severe prognosis of this syndrome.

Value of intravenous ATP in the diagnosis and treatment of tachyarrhythmias in children.

Actual researches show that adenosine and its forerunner, ATP, can realise a nodal block in intravenous (i.v.) administration. This effect, even if transient, is of particular usefulness in the therapy of paroxysmal supraventricular tachycardia (PST) in children and adults. 1 mg/kg ATP was administered i.v. to 51 children (aged 3 months to 15 years) admitted to the Intensive Care Unit for severe regular paroxysmal tachyarrhythmias with clinical and ECG symptoms. In 31 cases, the P wave was absent on ECG. In 6 of 31 cases in whom wide QRS complexes were found (over 0.10 sec), a WPW syndrome (4 cases) or bundle branch block (2 cases) was associated. Rapidly i.v. administration monitored electrocardioscopically was followed by ending of PST in 43 children, including those with wide QRS complexes. The highest effectiveness was in junctional tachycardia by re-entering mechanism. The drug was well tolerated, had no side effects or hemodynamic disturbances and this is very important, because in 12 infants already existed symptoms of congestive cardiac failure at their admission. The use of i.v. digoxin with/without propranolol was necessary in 8 cases, in which the repeated ATP administration was ineffective. We consider that i.v. ATP administration in regular tachyarrhythmias in children is very useful for the proper diagnosis of the types with wide QRS complexes and/or when the P wave did not appear on the ECG, and also for the treatment, because ATP has a high effectiveness and an excellent tolerance.

[Myocardial infarct in children. The anatomicoclinical aspects]. / Infarctul de miocard la copil. Consideratii anatomo-clinice.

Nine cases of myocardial infarction in the newborns (8 cases aged between 7 days and 6 months) and infants (1 case aged 12 years and 6 months) were followed up for 15 years. The etiology was different: mediocalcosis of the coronaries, congenital abnormalities of the heart marked hypertrophy of left ventricular myocardium (endocardial fibroelastosis or nonobstructive hypertrophic cardiomyopathy) severe hypoxia (severe acute bronchopneumopathies), and AAR, cardioarticular form, with multiple attacks in the infant. The ECG aspects were not specific in most children and clinically the prevailing finding was severe decompensated cardiac failure. The main etiologies and the inducing mechanisms of myocardial infarction in children are presented.