Bucks Montgomery Physician Spring 2021 - 10

FEATURE

Pediatric PSVT
Presenting with
Blindness and
Paresthesia
by Yang Song DO, Ankush Gupta, MD, Sanu Paul, MD, Eldia
Delia, MD, Mathew Mathew, MD, and James McHugh, MD
Suburban Community Hospital, East Norriton PA

Background
Narrow complex tachycardia, particularly supraventricular
tachycardia (SVT), is a prevalent pediatric cardiac rhythm
pathology estimated to occur in 0.1-0.4% of children. A
heart rate of 220-320 beats/minute has been recorded
in infants with paroxysmal SVT (PSVT), and 160-280
beats/minute in older children. Symptoms of poor
appetite, fatigue, pallor, cyanosis, irritability, dizziness,
emesis, and chest pains, as well as chest fluttering/
palpitations have been exhibited by children with SVT,
with eventual self-resolution in seconds or days. SVTs
originate from heart tissue at or above the Bundle of His.

Case Report
A ten-year-old male with past medical history of
congenital umbilical hernia, abdominal migraines, cyclical
vomiting syndrome, and recurrent otitis media, was
accompanied by his mother to the emergency department
(ED). Per mother, patient had a two-day history of four
15-20 second episodes of heart palpitations associated
with headaches, numbness, tingling, and loss of sensation
of lower extremities, and vision blacking out bilaterally,
which self-resolved as the heart symptoms self-obliterated.
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BUCKS/MONTGOMERY PHYSICIAN

spring 2021

The patient also complained of loss of appetite and
fatigue in the past two days, which deviate immensely
from his baseline norm. In the ED, a CT scan of the brain
without contrast did not show any hemorrhage or mass
effects. Workup included a urine drug screen, urinalysis,
CBC with differential, CMP, Protime INR, CK, and
Troponins, which all demonstrated unremarkable results.
While in the ED, the patient had one episode of SVT
that was captured on his rhythm strip showing heart rate
in the 220s, partially reproducing his symptoms, which
abruptly resolved after 20 seconds. Patient was discharged
on a prescription of atenolol and was referred to a
pediatric cardiologist, who proceeded to order a pediatric
echocardiogram which showed a structurally intact heart
with good ventricular function, albeit a small patent
foramen ovale (PFO) with left to right shunt and atria of
normal sizes. Since discharge, recurrence of symptoms
has transpired. The pediatric cardiologist suggested the
most likely cause of the SVT to be a concealed accessory
pathway, possibly within the PFO, and recommended
management with vagal maneuver, antiarrhythmic therapy,
and consideration of catheter ablation to achieve freedom
from pharmacologic dependence for symptomatic control.
Bucks Montgomery Physician Spring 2021

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