drnono

Many thanks Dr. Rehman and of course Dr Manzar.. it is really a great TRAINING sourcs as Dr Stefan said.. I have understood from the PALS algorithm that they start with Adenosine in wide complex regular tachycardia only to differentiate between SVT and VT ( SOMETIMES DIFFICULT ). "Adenosine also has a differential diagnostic ability with both narrow- and wide-complex regular tachycardia because of the absence of adverse hemodynamic effects. Adenosine transiently blocks the AV conduction and sinus node pacemaking activity . It terminates SVT but is not effective for nonreciprocating atrial tachycardia, atrial flutter or fibrillation, and ventricular tachycardia. OF COURSE it is not recommended in irregular (polymorphic) tachycardia" (PARK CARDIOLOGY 5ed ). As mentioned in neonatal cardiology 2nd ed :A wide QRS tachycardia should always be treated as ventricular tachycardia until a definite diagnosis is made.The authers prefer to start with Amiodarone which is efficacious for both SVT and ventricular tachycardia making it a reasonable choice if the diagnosis is uncertain. Lidocaine blocks fast sodium channels thereby shortening action potential duration and the refractory period primarily in Purkinje fibers and in ventricular myocytes. Giving the clearence of the strip as wide regular (monomorphic) tachycardia, the 1st possible diagnosis still ventriculat tachycardia so I beleive that LIDOCAINE is still the best choice for Q2..

me too.. drnono73@gmail.com

thanks alot ad very pleased for your reply VD is muscular and 4.1 mm with predominent RT to LT hunt ASD is about 5 mm with LT to RT shut PDA is 3.7 mm with large LT to RT shunt there is mild pulmonary stenosis we have consulted a Prof. in pediatric cardiology he sayed that the baby is stable and the PDA i not hemodynamically significant and the mild pulmonary stenosis i not relevent and is protective. he advised for continuation of laix and captopril and weigt for some time to do another echo and reassess to take adecision he also advised for increase caloric intake the baby has gaied only 20 gm in the last week despite of 140 Kcal/Kg/day and er HR is always 150/min, not distressed this is the situation now we have no great experience in cases with triple shunt. she is the 1st case in our unit. if anyone has experience please to participae our plan for this case. as i promied you i will send you the echo report but now the father has got it to consult another pediatric cardiologist. when he comes back i 'll sed it.

thanks again for interest for sorry i dont have clip for the case but i can send you he images taken by echo again my quesion about the less compliant RT venricle (the dominant and thicker one in fetal life), could this participate in this situation of the baby?

thaks prof. alot but aother interestig thing in this case is that the presence of predominent right to left shunt at the ventricular level with no evidence of Rt ventricular outflow obstruction, there was also Lt to Rt shunt at PDA . What is your explanation to this Rt to Lt shunt in this preterm 1400 gm baby . Is less compliant Rt ventricle suggested to cause so ?

hi all it is the 1st thread for me we have an intereting cae in our unit 14 d old pt (1400 gm) with vsd, asd, ad pda he tolerate full oral feedig now already on lasix and capoten stable general condition, normally thrivig despite of tachycardia what about idomethacin for pda closure now? any one has experience? waiting for reply