DOI: 10.1097/PEC.0b013e31819c7d12

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PMID: 19225384

Issn Print: 0749-5161

Publication Date: 2009/02/01


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ECGs in the ED

Ronn E. Tanel

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Author Information: ronn.tanel@ucsf.edu

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A 2 mo infant girl presents to the Emergency Department with tachypnea. She is known to have Down syndrome and congenital heart disease, and is scheduled to have surgery in 1 month. Her mother has noticed five days of an increased respiratory rate. Her respiratory effort has not changed and there has been no cyanosis. She has not been taking her feedings as well recently, but she has been having her usual number of wet diapers. There has been no fever, vomiting, diarrhea, or rash. She was born at full term and has had slow growth due her cardiac diagnosis. She has no other medical problems. Her medications are digoxin and furosemide. She has no known drug allergies. She has received the immunizations due at 2 months of age, including an immunization for respiratory syncitial virus. The family history is noncontributory for congenital heart disease. She lives with her parents and older sibling who is well.
In the Emergency Department, the infant is pink and tachypneic. She has subcostal and intercostal retractions but no grunting. The temperature is 97.8°F. The heart rate is 128 bpm, the respiratory rate is 58 per minute, and the blood pressure is 82/46. There are physical stigmata of Down syndrome. The head and neck exam is significant for a flat anterior fontanelle, moist mucous membranes, clear tympanic membranes, and a clear oropharynx. The chest has bilateral breath sounds that are clear throughout all lung fields. There are no rales. The cardiac exam has a hyperdynamic precordium with a normal first heart sound and an increased, narrowly split second heart sound. There is a gallop rhythm present. There is a II/VI systolic ejection murmur. There is no diastolic murmur. The pulses are full and equal. The abdomen is soft with the liver edge palpable 3 cm below the right costal margin. The extremities are warm and well-perfused.
An electrocardiogram was performed (Fig. 1).
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