Accelerated Idioventricular Rhythm: A Rare Case of Wide-Complex Dysrhythmia in a Teenager |
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| Authors: | Brandon Kappy Laurie Johnson Tyler Brown Richard J. Czosek |
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| Affiliation: | 1. Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;2. Division of Emergency Medicine, Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;3. Division of Cardiology, Cincinnati Children''s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio;1. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York;2. Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York;1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;2. University of Maryland School of Medicine, Baltimore, Maryland;1. Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy;2. Critical Care Nursing Master Course, Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy;3. Emilia Est Dispatch Center, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy;1. Oakland University William Beaumont School of Medicine, Rochester, Michigan;2. Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan;3. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan;1. Harvard Medical School, Boston, Massachusetts;2. Department of Emergency Medicine, Brigham and Women''s Hospital, Boston, Massachusetts |
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| Abstract: | BackgroundAccelerated idioventricular rhythm (AIVR) is an uncommon and typically benign dysrhythmia with similarities to more malignant forms of ventricular tachycardia (VT). It is often seen in adults after myocardial infarctions, although it also arises in the newborn period, as well as in children with and without congenital heart disease.Case ReportWe describe a presentation of AIVR in an otherwise healthy 13-year-old girl, discovered on arrival to the pediatric emergency department in the setting of post-tonsillectomy bleeding. The case reviews the diagnostic criteria of AIVR, associated symptoms, the pathophysiologic origin of AIVR, and potential treatment strategies.Why Should an Emergency Physician Be Aware of This?Given its morphologic similarities to life-threatening forms of VT, AIVR can be misdiagnosed in the emergency department or primary care settings. With an understanding of the dysrhythmia's unique features, emergency physicians can avoid unnecessary interventions and provide the correct diagnosis, workup, and management of AIVR for pediatric patients. |
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| Keywords: | accelerated idioventricular rhythm pediatric dysrhythmia ventricular rhythm benign dysrhythmia pediatric emergency medicine |
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