BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.
Benign Paroxysmal Positional Vertigo ; Brain ; Child ; Dizziness* ; Electrocardiography ; Hematologic Tests ; Humans ; Hypotension, Orthostatic ; Incidence ; Magnetic Resonance Imaging ; Medical Records ; Meniere Disease ; Methods ; Migraine Disorders ; Pathology ; Physical Examination ; Postural Orthostatic Tachycardia Syndrome ; Retrospective Studies ; Tilt-Table Test ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis

Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.
Atrioventricular Node ; Humans ; Pre-Excitation Syndromes ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 +/- 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 +/- 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.
Aged ; Atrial Fibrillation/epidemiology/mortality/*pathology ; Atrial Flutter/*epidemiology/mortality/pathology ; Atrial Premature Complexes/*epidemiology/mortality/pathology ; Disease Progression ; Echocardiography ; Female ; Heart Atria/pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Tachycardia, Ectopic Atrial/*epidemiology/mortality/pathology ; Tachycardia, Paroxysmal/*epidemiology/mortality/pathology ; Thromboembolism/epidemiology/mortality ; Treatment Outcome

Cholestasis ; etiology ; Gestational Age ; Humans ; Hydrops Fetalis ; physiopathology ; Infant, Newborn ; Liver Function Tests ; Male ; Tachycardia, Paroxysmal ; complications ; embryology ; physiopathology ; Tachycardia, Supraventricular ; complications ; embryology ; physiopathology

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.
Angiography ; Arrhythmias, Cardiac ; Coronary Vessel Anomalies ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Humans ; Multidetector Computed Tomography ; Myocardial Infarction ; Myocardial Ischemia ; Sinus of Valsalva ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.
Angiography ; Arrhythmias, Cardiac ; Coronary Vessel Anomalies ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Humans ; Multidetector Computed Tomography ; Myocardial Infarction ; Myocardial Ischemia ; Sinus of Valsalva ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.
Anesthesia, General ; Atrial Fibrillation ; Blood Pressure ; Bradycardia ; Glycopyrrolate ; Injections, Intravenous ; Nasal Bone ; Propanolamines ; Recovery Room ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Verapamil

In recent 10 years, using radiofrequency catheter ablation, our medical center has treated 4865 cases of paroxysmal supraventricular tachycardia (PSVT). To improve clinical practice, a retrospective analysis of this group was made. In this group, 2092 cases were atrioventricular reentry tachycardia (AVRT), including 1415 left accesory pathway and 677 right accesory pathway, and 2773 cases were atrioventricular nodal reentry tachycardia (AVNRT). The total success rate of radiofrequency treatment is 99.71%; the recurrence rate after half a year 1.73%; the total complication rate 1.25%. In conclusion, radiofrequency ablation is a safe and effective treatment for tachycardia with high rate of success and low rate of complication.
Adult ; Catheter Ablation ; Female ; Humans ; Male ; Retrospective Studies ; Tachycardia, Paroxysmal ; surgery ; Tachycardia, Supraventricular ; surgery ; Young Adult

We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Cardiomyopathies ; Cesarean Section ; Dyspnea ; Dyspnea, Paroxysmal ; Emergencies ; Female ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Peripartum Period ; Postpartum Period ; Pregnancy ; Recovery Room ; Tachycardia

We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Cardiomyopathies ; Cesarean Section ; Dyspnea ; Dyspnea, Paroxysmal ; Emergencies ; Female ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Peripartum Period ; Postpartum Period ; Pregnancy ; Recovery Room ; Tachycardia