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Electrocardiographic Abnormalities of Acute Pneumonia and Bronchiolitis in Children

Year 2009, Volume: 16 Issue: 2, 69 - 74, 01.04.2009

Abstract

Backgrounds: This prospective study was performed to determine the frequency and characteristics of electrocardiographic abnormalities in pneumonia and bronchiolitis. Patients and method: Study included 48 children (27 male) with a mean age of 25.8 months (2-168), who were admitted due to pneumonia and bronchiolitis. Results: The most common changes on electrocardiography were prolongation in QTc interval (89.3%), rightward deviation of QRS axis (85.4%), enhance in right ventricular forces (70.5%), tachycardia (64.5%), elevation in P voltages (54.1%), and supression in T voltages (52.1%). Three patients had right axis deviation (according to age), three patients had p pulmonale (p voltage >2.5 mm) and 12 patients had QTc prolangation (QTc >440 ms) on their first electrocardiographies. Rightward deviation in QRS axis, increase in P wave voltage and elevation of V1R/S ratio were more common in infants with pneumonia compared to those with bronchiolitis. Conclusion: Electrocardiographic abnormalities are common but completely reversible in respiratory tract infections. While evaluating cardiovascular status of a child with respiratory disease, it is advisable to reinterpret the electrocardiography after recovery. Key Words Bronchiolitis, Child, Electrocardiography, Infection, Pneumonia

References

  • Seedat MA, Feldman C, Skoularigis J, Promnitz DA, Smith C, Zwi S. A study of acute community-acquired pneumonia, including details of cardiac changes. Q J Med 1993; 86: 669-75.
  • Caldera AE, Crespo GJ, Maraj S, Kotler M, Braitman LE, Eiger G. Electrocardiogram in Pneumocystis carinii pneumonia: can it be used as a prognostic variable? Crit Care Med 2002; 30: 1425-8.
  • Bogomolov BP, Mol'kova TN, Deviatkin AV. Cardio-vascular system condition in respiratory mycoplasmosis. Klin Med (Mosk) 2002; 80: 34-8.
  • Bogomolov BP, Mol'kova TN. Changes in the cardiovascular system in adenovirus infection in adults. Ter Arkh 1986; 58: 132- 5.
  • Trushinskii ZK, Striuk RI, Krasnopol'skaia SP. Prognostic significance of ECG changes in acute pneumonia. Ter Arkh 1984; 56: 74-8.
  • Manuel Alatriste V, Gustavo V, Medrano A, Vargas J, Lupi E. Electrocardiogram Electrocardiographic-hemodynamic correlation. Arch Inst Cardiol Mex 1979; 49: 1130-47. interstitial pneumonia.
  • Ilten F, Senocak F, Zorlu P, Tezic T. Cardiovascular changes in children with pneumonia. Turk J Pediatr 2003; 45: 306-10.
  • Agarwala BN, Ruschhaupt DG. Complete heart block from mycoplasma pneumoniae infection. Pediatr Cardiol 1991; 12: 233-6.
  • Rubin LJ. The electrocardiogram in chronic lung disease. In: Rubin LJ (ed). Pulmonary Heart Disease. Martinus/Nijhoff, Boston, 1984; 117-34.
  • Fishman AP. Hypoxia on the pulmonary circulation: how and where it acts. Circ Res 1976; 38: 221.
  • Leeman M, Neite R, Lejeune P, Melot C. Influence of cyclo- oxygenase inhibition and leukotriene receptor blockade on pulmonary vascular pressure: cardiac index relationships in hyperoxic and hypoxic dogs. Clin Sci 1987; 72: 717-24.
  • McDonnell TJ, Wescott JY, Czartolamna J, Voelkel N. Role of peptidoleukotriene in hypoxic pulmonary vasoconstriction in the rat. Am J Physiol 1990; 259: 751-8.
  • Perkin RM, Anas NG. Pulmonary hypertension in pediatric patients. J Pediatr 1984; 105: 511.
  • Vlahakes GJ, Turley K, Hoffman JIE. The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 1981; 63: 87.
  • Bogomol’tsev BP, Deviatkin AV. Clinical implications of impaired microcirculation and hemodynamics in acute respiratory viral infections and their pharmacological correction. Klin Med (Mosk) 2003; 81: 9-15.
  • Shann F, Macgregor D, Richens J, Coakley J. Cardiac failure in children with pneumonia in Papua New Guinea. Pediatr Infect Dis J 1998; 17: 1141-3.
  • Navarro EE, Gonzaga NC, Lucero MG, et al. Clinicopathologic studies of children who die of acute lower respiratory tract infections: mechanisms of death. Rev Infect Dis 1990; 12: 1065- 73.
  • Downing SE, Talner NS, Gardner TH. Influences of hypoxaemia and acidemia on left ventricular function. Am J Physiol 1966; 210: 1327-34.
  • Ng ML, Levy MN, De Geest H, Zieske H. Effects of myocardial hypoxia on left ventricular performance. Am J Physiol 1966; 211: 43-50.
  • Sibbald WJ, Driedger AA. Right ventricular function in acute disease state: Pathophysiologic considerations. Crit Care Med 1983; 11: 339-45.
  • Wiedeman HP, Matthay RA. Management of acute and chronic cor pulmonale. In: Scharf SM, Cassidy SS (eds). Heart-Lung Interaction in Health and Disease. Marcel Dekker Inc, New York, 1989; 915-81.
  • Rebuck AS, Read J. Assessment and management of severe asthma. Am J Med 1971; 51: 788-98.
  • Efthimiou J, Hassan AB, Ormerod O, Benson MK. Reversible T wave abnormality in severe acute asthma: an electrocardiographic sign of severity. Respir Med 1991; 85: 195-202.
  • Fakhoury KF, Seilheimer DK. Pulmonology. In: Garson A Jr, Bricker JT, Fisher DJ, Neish SR (eds). The Science and Practice of Pediatric Cardiology. Williams and Wilkins, Baltimore, 1998; 2813-32.
  • Corresponding Author: Yılmaz TABEL, MD,
  • Inonu Universitesi Faculty of Medicine
  • Department of Pediatrics
  • MALATYA-TURKEY Phone: +90 422 377 5301
  • Fax: +90 422 341 0728
  • E-mail: yilmaztabel@yahoo.com

Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler

Year 2009, Volume: 16 Issue: 2, 69 - 74, 01.04.2009

Abstract

Amaç: Bu prospektif çalışmada; pnömoni ve bronşiolitli çocuklarda elektrokardiyografik değişikliklerin sıklık ve özelliklerini araştırmayı amaçladık. Hastalar ve yöntem: Çalışmaya ortalama yaşları 25.8 ay (2-168) olan 48 alt solunum yolu enfeksiyonlu çocuk (27 erkek) dahil edildi. Bulgular: Elektrokardiyografideki en yaygın değişiklikler; QTc intervalinde uzama (%89.3), QRS aksında sağa kayma (%85.4), sağ ventrikül güçlerinde artış (%70.5), taşikardi (%64.5), P voltajında artma (%54.1) ve T supresyonu (%52.1) idi. Üç hastada sağ aks deviasyonu, üç hastada p pulmonale ve 12 hastada da QTc'de uzama gözlendi. QRS aksında sağa sapma, p pulmonale ve V1R/S oranında artış pnömonili çocuklarda bronşiolitli olanlara göre daha fazla oranda saptandı. Sonuç: Elektrokardiyografik değişikliklerin çocukluk çağı alt solunum yolu infeksiyonlarında yaygın ancak tamamen geri dönüşümlü olduğunu gösterdik. Akut alt solunum yolu infeksiyonlu çocuklarda kardiyak bulguları değerlendirirken, infeksiyon düzeldikten sonraki elektrokardiyografi ile karşılaştırılması uygun olacaktır. Anahtar Kelimeler Bronşiolit, Çocuk, Elektrokardiyografi, Infeksiyon, Pnömoni

References

  • Seedat MA, Feldman C, Skoularigis J, Promnitz DA, Smith C, Zwi S. A study of acute community-acquired pneumonia, including details of cardiac changes. Q J Med 1993; 86: 669-75.
  • Caldera AE, Crespo GJ, Maraj S, Kotler M, Braitman LE, Eiger G. Electrocardiogram in Pneumocystis carinii pneumonia: can it be used as a prognostic variable? Crit Care Med 2002; 30: 1425-8.
  • Bogomolov BP, Mol'kova TN, Deviatkin AV. Cardio-vascular system condition in respiratory mycoplasmosis. Klin Med (Mosk) 2002; 80: 34-8.
  • Bogomolov BP, Mol'kova TN. Changes in the cardiovascular system in adenovirus infection in adults. Ter Arkh 1986; 58: 132- 5.
  • Trushinskii ZK, Striuk RI, Krasnopol'skaia SP. Prognostic significance of ECG changes in acute pneumonia. Ter Arkh 1984; 56: 74-8.
  • Manuel Alatriste V, Gustavo V, Medrano A, Vargas J, Lupi E. Electrocardiogram Electrocardiographic-hemodynamic correlation. Arch Inst Cardiol Mex 1979; 49: 1130-47. interstitial pneumonia.
  • Ilten F, Senocak F, Zorlu P, Tezic T. Cardiovascular changes in children with pneumonia. Turk J Pediatr 2003; 45: 306-10.
  • Agarwala BN, Ruschhaupt DG. Complete heart block from mycoplasma pneumoniae infection. Pediatr Cardiol 1991; 12: 233-6.
  • Rubin LJ. The electrocardiogram in chronic lung disease. In: Rubin LJ (ed). Pulmonary Heart Disease. Martinus/Nijhoff, Boston, 1984; 117-34.
  • Fishman AP. Hypoxia on the pulmonary circulation: how and where it acts. Circ Res 1976; 38: 221.
  • Leeman M, Neite R, Lejeune P, Melot C. Influence of cyclo- oxygenase inhibition and leukotriene receptor blockade on pulmonary vascular pressure: cardiac index relationships in hyperoxic and hypoxic dogs. Clin Sci 1987; 72: 717-24.
  • McDonnell TJ, Wescott JY, Czartolamna J, Voelkel N. Role of peptidoleukotriene in hypoxic pulmonary vasoconstriction in the rat. Am J Physiol 1990; 259: 751-8.
  • Perkin RM, Anas NG. Pulmonary hypertension in pediatric patients. J Pediatr 1984; 105: 511.
  • Vlahakes GJ, Turley K, Hoffman JIE. The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 1981; 63: 87.
  • Bogomol’tsev BP, Deviatkin AV. Clinical implications of impaired microcirculation and hemodynamics in acute respiratory viral infections and their pharmacological correction. Klin Med (Mosk) 2003; 81: 9-15.
  • Shann F, Macgregor D, Richens J, Coakley J. Cardiac failure in children with pneumonia in Papua New Guinea. Pediatr Infect Dis J 1998; 17: 1141-3.
  • Navarro EE, Gonzaga NC, Lucero MG, et al. Clinicopathologic studies of children who die of acute lower respiratory tract infections: mechanisms of death. Rev Infect Dis 1990; 12: 1065- 73.
  • Downing SE, Talner NS, Gardner TH. Influences of hypoxaemia and acidemia on left ventricular function. Am J Physiol 1966; 210: 1327-34.
  • Ng ML, Levy MN, De Geest H, Zieske H. Effects of myocardial hypoxia on left ventricular performance. Am J Physiol 1966; 211: 43-50.
  • Sibbald WJ, Driedger AA. Right ventricular function in acute disease state: Pathophysiologic considerations. Crit Care Med 1983; 11: 339-45.
  • Wiedeman HP, Matthay RA. Management of acute and chronic cor pulmonale. In: Scharf SM, Cassidy SS (eds). Heart-Lung Interaction in Health and Disease. Marcel Dekker Inc, New York, 1989; 915-81.
  • Rebuck AS, Read J. Assessment and management of severe asthma. Am J Med 1971; 51: 788-98.
  • Efthimiou J, Hassan AB, Ormerod O, Benson MK. Reversible T wave abnormality in severe acute asthma: an electrocardiographic sign of severity. Respir Med 1991; 85: 195-202.
  • Fakhoury KF, Seilheimer DK. Pulmonology. In: Garson A Jr, Bricker JT, Fisher DJ, Neish SR (eds). The Science and Practice of Pediatric Cardiology. Williams and Wilkins, Baltimore, 1998; 2813-32.
  • Corresponding Author: Yılmaz TABEL, MD,
  • Inonu Universitesi Faculty of Medicine
  • Department of Pediatrics
  • MALATYA-TURKEY Phone: +90 422 377 5301
  • Fax: +90 422 341 0728
  • E-mail: yilmaztabel@yahoo.com
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Gülendam Koçak This is me

Yılmaz Tabel This is me

Cemşit Karakurt This is me

Yeşim Yılmaz Demirdağ This is me

Publication Date April 1, 2009
Published in Issue Year 2009 Volume: 16 Issue: 2

Cite

APA Koçak, G., Tabel, Y., Karakurt, C., Demirdağ, Y. Y. (2009). Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler. Journal of Turgut Ozal Medical Center, 16(2), 69-74.
AMA Koçak G, Tabel Y, Karakurt C, Demirdağ YY. Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler. J Turgut Ozal Med Cent. April 2009;16(2):69-74.
Chicago Koçak, Gülendam, Yılmaz Tabel, Cemşit Karakurt, and Yeşim Yılmaz Demirdağ. “Akut Pnömoni Ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler”. Journal of Turgut Ozal Medical Center 16, no. 2 (April 2009): 69-74.
EndNote Koçak G, Tabel Y, Karakurt C, Demirdağ YY (April 1, 2009) Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler. Journal of Turgut Ozal Medical Center 16 2 69–74.
IEEE G. Koçak, Y. Tabel, C. Karakurt, and Y. Y. Demirdağ, “Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler”, J Turgut Ozal Med Cent, vol. 16, no. 2, pp. 69–74, 2009.
ISNAD Koçak, Gülendam et al. “Akut Pnömoni Ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler”. Journal of Turgut Ozal Medical Center 16/2 (April 2009), 69-74.
JAMA Koçak G, Tabel Y, Karakurt C, Demirdağ YY. Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler. J Turgut Ozal Med Cent. 2009;16:69–74.
MLA Koçak, Gülendam et al. “Akut Pnömoni Ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler”. Journal of Turgut Ozal Medical Center, vol. 16, no. 2, 2009, pp. 69-74.
Vancouver Koçak G, Tabel Y, Karakurt C, Demirdağ YY. Akut Pnömoni ve Bronşiyolitli Çocuklarda Elektrokardiyografik Anormallikler. J Turgut Ozal Med Cent. 2009;16(2):69-74.