Congenital junctional ectopic tachycardia is a rare arrhythmia that occurs in patients without previous cardiac surgery. In this report, we wanted to present a 6-hour-old newborn with congenital junctional ectopic tachycardia resistant to conventional anti-arrhythmic medications, who was successfully treated with ivabradine and amiadarone combination.

A six-hour-old newborn girl was hospitalised in neonatal ICU because transient tachypnoea of the newborn. She was tachycardic, and supraventricular tachycardia was noticed. There was no answer to the adenosine esmolol treatment; even synchronised direct cardioversion intravenous amiodarone was started. Junctional ectopic tachycardia was diagnosed. We have added propranolol to the treatment and followed patient for 2 days. On the fourth day, junctional ectopic tachycardia rhythm still persisted; therefore, ivabradine treatment was added to the treatment. On the following day, the heart rhythm was slowed to 110/min, and propranolol was stopped; intravenous amiodarone treatment was changed to the oral form. The rhythm turned into sinus; two days after starting ivabradine and oral amiodarone.

Tachyarrhythmia originating in the atrioventricular node and atrioventricular junction including the bundle of His complex are junctional ectopic tachycardia. Congenital junctional ectopic tachycardia is rare, and it is mostly resistant to the conventional treatment.

Ivabradine is a new anti-arrhythmic agent, used extensively to decrease sinus rate in the treatment of cardiac failure. Ivabradine may be an option for the resistant congenital ectopic tachycardia

This is a presentation of the FEP of a 23 y.o. patient. The patient had a Duration of Untreated Psychosis (DUP) of 6 months and Duration of Untreated Illness (DUI) of six years. The therapeutic response and the adverse effects of Paliperidone are being described.

To investigate the tolerance of Paliperidone in a patient with FEP.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments and investigations took place.

Upon admission the patient appeared guarded. She also presented with weight loss and dehydration. Initial PANSS score was 173, positive subscale 41. The patient was initially treated with monotherapy 6mg of Paliperidone. However, the heart rate was around 100 bpm culminating as high as 156 bpm. The ECG indicated sinus tachycardia. The patient presented with serious EPSs and diarrhea. Simpson-Angus Scale score 10. Metoprolol 25mg was prescribed twice a day. The clinical team proceeded in cross titration replacing Paliperidone with Olanzapine. A brain CT scan was also performed, unremarkable. After 10 days of therapy the PANSS score reduced to 102, positive subscale 21.

Initial sinus tachycardia is a common adverse effect of Paliperidone. However in this case the tachycardia was refractory in time even after the 7th day, making an alternative SGA trial necessary.

No significant relationships.

Post-surgical bleeding after tonsillectomy occurs in 2–7 per cent of cases. This study examined whether heart rate and haematocrit changes are associated with the amount of bleeding.

In this retrospective analytical study, data were collected from the medical charts of patients admitted with post-surgical bleeding.

Over the course of 10 years, there were 218 cases of post-operative bleeding in children aged under 18 years. There was a significant increase in heart rate after the bleeding had started, and a significant decrease in both haemoglobin and haematocrit levels (p < 0.05). There was no significant correlation between the differences in haemoglobin and haematocrit and changes in heart rate.

No correlation was found between the differences in haemoglobin and haematocrit levels and the changes in heart rate from before the surgery to after the bleeding had started. The monitoring of paediatric patients’ heart rate after tonsillectomy surgery solely for the purpose of predicting acute blood loss is therefore discouraged.

Since clinical practice suggests that panic disorder may not be a homogeneous condition, a study was carried out to test the possible existence of different groups or subgroups of panic patients.

Thirty-two panic patients (DSM-III-R) underwent lactate challenge in our laboratory and were assessed for heart rate, blood pressure, sweating and Acute Panic Inventory.

During the lactate challenge, patients complaining mainly of ‘cardiorespiratory’ symptoms (N = 12) showed tachycardia and localized sweating. Conversely, patients complaining mainly of ‘pseudoneurological’ symptoms (N = 16) showed bradycardia and generalized sweating. In both groups, Acute Panic Inventory scores were significantly higher during than before the panic attack, but the distribution of the scores was markedly different.

The results suggest that panic disorder may be a heterogeneous condition. Implications of these results to other phobic disorders, to Klein’s false suffocation alarm theory and to the ‘extended amygdala model’ are discussed.

After reading this article you will be able to:

• • understand the relative incidence of cardiotoxic side-effects of the various SGAs

• • perform preliminary investigations to diagnose the common cardiotoxic side-effects of SGAs

• • understand the treatments for these cardiac side-effects and the role of cardiologists involved the care of these patients.

Radiofrequency catheter ablation is standard treatment for children with re-entrant supraventricular tachycardias. Autonomic changes have been noted after such ablation for atrioventricular nodal re-entry tachycardia, but not as well documented with atrioventricular re-entry over an accessory pathway.

In 10 normal paediatric volunteers and 12 children referred for electrophysiologic testing and radiofrequency ablation of supraventricular tachycardia, non-invasive autonomic function tests and tilt-table testing were performed, and the variability in 24-h heart rate was analysed. Patients with supraventricular tachycardia underwent these tests both 24–72 h before and 24 h after ablation. Patients with tachycardia underwent additional autonomic testing to assess the sensitivity of baroreceptors and the intrinsic heart rate with autonomic blockade immediately before and after ablation. One non-invasive autonomic function test, namely handgrip, demonstrated significant differences (p < 0.05) in diastolic blood pressure before and after ablation, though these values did not differ from controls. Significant decreases were noted in two indexes of the variability of heart rate before and after ablation (p < 0.05). Certain tilt test variables also demonstrated significant differences between controls and those with tachycardia subsequent to ablation. Intracardiac testing demonstrated changes (p < 0.05) in sinus cycle lengths, effective refractory periods and/or blood pressures at baseline and during testing of the sensitivity of baroreceptors before and after ablation. These changes were consistent with increased sympathetic or decreased parasympathetic tone. With autonomic blockade, these differences were abolished.

Catheter ablation of accessory pathways in children was associated with changes consistent with increased sympathetic or decreased parasympathetic tone. These autonomic changes persisted 24 h after the ablation procedure.

To confirm the efficacy of pre-hospital administration of adenosine, using a 6 milligram (mg) initial dosing regimen, for the treatment of paroxysmal supraventricular tachycardia (PSVT).

Urban, suburban, rural emergency medical services (EMS) system in Clark County, Washington with advanced life support (ALS) patient transports. Concurrent, paramedic Medical Incident Report (MIR) review was conducted for 102 patients receiving prehospital adenosine during a 42-month period. Patients were administered 6 mg of adenosine using an intravenous (IV) bolus followed by 10 ml of balanced salt solution flush. If the patient's rhythm remained unchanged, the dosing regimen was increased to 12 mg followed by a 10 ml flush. This was repeated once more if the rhythm remained unchanged, to a total maximum dose of 30 mg. Medical direction for administration of adenosine was in the form of standing orders rather than direct (on-line) medical control.

Seventy-four of 102 patients had PSVT as determined by physician analysis of the initial six-second electrocardiographic rhythm strip (ECG) recording. Sixty-six of these patients converted their cardiac rhythm from PSVT using adenosine; 46 (70%) converted with the initial 6 mg bolus. Fifteen patients converted after receiving the second dose (12 mg); and five patients required 30 mg.

These results show that for paramedics, adenosine is an effective treatment for PSVT. An initial bolus of 6 mg converts the majority of cases. Eighty-nine percent of cases of confirmed PSVT converted with adenosine administration.