Objective: To present our experience in managing child with supraventricular tachycardia (SVT) in a rural area
Case: A 13 years old girl came in emergency room with complaints of chest pain on the left side and dyspnea since morning after exercise at school. The pain was localized and felt constantly. She had history of recurrent chest pain. Previous echocardiography record showed normal systole function with minimum pulmonary regurgitation. Her heart rate was 240/min. There was no cardiac murmur on physical examination. An ECG was done which showed heart rate of 300/min with narrow QRS complex (Figure 1). She was hemodynamically stable. There was no response to valsalva maneuver. Since there was no adenosine in our hospital, amiodarone injection at dose 5 mg/kg was given over 30 minutes followed by maintenance drip at 5 mcg/kg/min. Her heart rate was down to 108/min. A repeated ECG was performed 30 minutes after amiodarone administration and show a junctional rhythm (Figure 2). Later, hypotension (lowest blood pressure at 75/47 mmHg) and bradycardia (lowest heart rate at 46/min) were observed for 2 days. The amiodarone administration was discontinued. She was alert and stable afterwards. She was discharged with normal blood pressure and pulse pressure. No long-term medication was given. She was advised to seek to cardiologist for further evaluations.
Conclusions: Although in a rural setting hospital with no privilege on choosing ideal antiarrhythmic drug, SVT still can be managed in this case with intensive monitoring, where adverse effects were observed. Benefit and risk must always be considered in decision making.