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Volume 8
Pediatrics & Therapeutics
ISSN: 2161-0665
Pediatrics and Pediatric Gastroenterology 2018
March 21-22, 2018
16
th
Annual World Congress on
3
rd
Annual World Congress on
March 21-22, 2018 | New York, USA
PEDIATRICS
PEDIATRIC NUTRITION,
GASTROENTEROLOGY & CHILD DEVELOPMENT
&
A “sick” rhythm alerts onset of serious vascular disease
Guillermo Torres Viera
University of Puerto Rico, USA
E
arly detection of cardiac allograft vasculopathy (CAV) presents a challenge to pediatricians since symptoms of myocardial ischemia
(eg, classic angina pectoris symptoms) are typically absent or atypical. Although rhythm disturbances are related to CAV, sick
sinus syndrome (SSS) remains an elusive sign of vasculopathy. The case study begins with an 18 year old male with history of heart
transplant on 2011 secondary to myocarditis and associated dilated cardiomyopathy, presented to our pediatric emergency room due
to chest tightness and shoulder pain on exertion without associated fevers, cough, leg swelling, or increased abdominal girth. Cardiac
enzymes and electrocardiography (ECG) performed at that time were found within normal limits and patient was discharged home.
Three days later, patient awoke from sleep with shortness of breath and dizziness, stating episodes of “slow beats” and near-syncope
during the previous days precipitated during hot showers. He returned to ER where cardiac monitoring placed and noted with
tachycardia/bradycardia paroxysms without ST segment changes on ECG. BNP and Panel Reactive Antibodies were sent and found
elevated, therefore patient was transferred to Cardiovascular Center for suspected transplant rejection, allograft vasculopathy, and
associated sick sinus syndrome. He was taken to cardiac angiography which revealed severe (>90%) stenosis of multiple segments of
right coronary artery requiring bare-metal stent placement with immediate evidence of appropriate revascularization. SSS is defined
by ECG abnormalities (eg, bradycardia, sinus pauses, sinus arrest) that occur in association with clinical signs and symptoms. It should
be widely recognized and alarm primary physicians of serious underlying vasculopathies, particularly in the pediatric population.
guillermo.torres@upr.eduPediatr Ther 2018, Volume: 8
DOI: 10.4172/2161-0665-C1-049