A case report of an infant after episodes of paroxysmal supraventricular tachycardia with left ventricular thrombosis and cerebral infarction

Abstract

Left ventricular thrombosis and cerebral infarction caused by recurrent episodes of paroxysmal supraventricular tachycardia (PSVT) are uncommon in infants. We present the case of a 23-month-old girl whose echocardiography revealed a left ventricular thrombus, which resolved after sinus rhythm was restored. The girl had experienced repeated systemic convulsions and high muscular tension of the left limb accompanied by movement disorder. Soon afterward, cranial magnetic resonance imaging (MRI) revealed scattered lacunar cerebral infarctions in the right lateral ventricle. The symptoms, signs, and laboratory examination satisfied the diagnosis of left ventricular thrombosis and cerebral infarction caused by recurrent episodes of PSVT. The girl was given antiarrhythmic drugs, including propranolol, esmolol, and amiodarone, intracranial pressure decreasing treatment (mannitol), heart and brain cell nutritional therapy, anticoagulant therapy, and her condition gradually improved. This case report highlights the importance of pediatric PSVT patients' clinical management and that more emphasis should be placed on early recognition and prevention of severe complications. Pediatricians should be trained early recognition of the nonspecific clinical manifestations of PSVT, make effectively and quickly diagnosis by electrocardiogram, evaluation of cardiac function and thrombosis by echocardiography, and termination PSVT as rapidly as possible.Thromboprophylaxis therapy might be considered for recurrent episodes of PSVT.

Effects of Amiodarone and Esmolol for Heart Rate and Cardiovascular Changes

“…The drug also plays an important role in vascular expansion and improving blood flow. After treatment, the patient's heart rate is significantly reduced [ 17 ]. Nevertheless, since the auxiliary of the amiodate is relatively long, the index is large, and it is necessary to reduce the amount of amiodarone in order to reduce the degree of liver function.…”

Antiarrhythmic Drug Dosing in Children—Review of the Literature

“…The duration of action is reported to be up to 30 min. Esmolol may cause arterial hypotension, confusion, nausea, vomiting, headache, agitation, or infusion site reactions including inflammation or induration, among others [24,31,36,[52][53][54][55][56][57].…”