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(Circulation. 1995;92:268-273.)
© 1995 American Heart Association, Inc.

Articles

Episodic Tachycardia in a 12-Year-Old Girl

Anne Hamilton Dougherty, MD; George Schroth, MD; Roma L. Ilkiw, MD

From the Departments of Internal Medicine and Pediatrics, University of Texas Medical School, Houston.

Correspondence to Anne Hamilton Dougherty, MD, Division of Cardiology, Department of Internal Medicine, University of Texas Medical School, Houston, PO Box 20708, Houston, TX 77225.

Key Words: methemoglobinemia • clinicopathological conferences • tachycardia

	Case Presentation

 
A 12-year-old girl first presented to her family physician in January 1991 with an episode of tachycardia and dyspnea. Her mother described the patient's appearance during the event as "like a statue," extremely pale, gray, and lethargic. An ECG at that time showed sinus tachycardia with a rate of 143 bpm and T-wave inversion in lead III (Fig 1). Oxygen was administered in the office, and a trial of propranolol 10 mg/d was begun.

View larger version (42K): [in this window] [in a new window]   Figure 1. ECG obtained in office of family physician as symptoms were resolving.

The girl's symptoms had first occurred 6 months earlier and were of variable duration and severity. Tachycardia would persist for several hours and be associated with dyspnea and pallor. During the episode, she would develop generalized myalgia, weakness, and fatigue and then sleep for 2 to 7 hours. There was no associated chest pain, dizziness, or presyncope. Episodes occurred one to three times per week, in the afternoon, and were unrelated to activity. She had decreased exercise tolerance compared with her peers.

She was referred to a pediatric cardiologist for further evaluation. A Holter recording was normal. Her cardiac examination was normal; however, an echocardiogram reportedly showed discontinuity of the atrial septum, with left-to-right flow across the interatrial septum by pulsed Doppler and color flow Doppler. The diagnosis of secundum atrial septal defect was made and a cardiac catheterization recommended, but the family declined. Propranolol was discontinued, in part because of a history of asthma. Verapamil was started but was soon discontinued . . . [Full Text of this Article]