Case-Based Reasoning for Diagnosis Heart Failure in Children

Review Article

Austin Cardiol. 2016; 1(1): 1005.

Case-Based Reasoning for Diagnosis Heart Failure in Childrens

Ochoa A¹*, Hernandez A², Ponce J³ and Herrera AM4

¹Department of Cardiology, Juarez City University, Mexico

²Department of Cardiology, Universidad Autonoma del Estado de Morelos, Mexico

³Department of Cardiology, Universidad Autónoma de Aguascalientes, Mexico

4Department of Cardiology, Universidad Autónoma de Queretaro, Mexico

*Corresponding author: Alberto Ochoa-Zezzatti, Department of Cardiology, Juarez City University, Mexico

Received: September 09, 2016; Accepted: December 29, 2016; Published: December 30, 2016


This paper presented a research as a system using Case-Based Reasoning helping diagnose Heart failure in children specially tachycardia. First, we mention the importance of the relationship between medicine and information technology separate many mistakes related with this sickness. Second, we discuss about what Heart failure in children is and which the criteria of this sickness will be recognized. Furthermore, various tools or instruments to aid the diagnosis of this health disorder are mentioned. Finally, we show how CBR can be applied to detect this sickness, so we can make some recommendations.

Keywords: CBR; Heart failure in children


The use of technology has made a lot of progress in the health field, resulting in their increased use. One of its purposes is to create tools that support communication and transmission of information by electronic means to improve the quality of life of people [1]. Medical care is an important part in the lives of citizens because these require frequent care information activity. It can perform various tasks, whether therapies, disease prevention and diagnostic procedures for detection, and the gather, use, communication and storage of information [1]. That is why it is necessary to implement new technologies to distribute and make available information about citizen’s health.

Heart Failure in Children

Paroxysmal Supraventricular Tachycardia (PSVT) is one of the several causes of heart failure in children, which can occur in different ages and can be associated with or without underlying heart disease). The most common cause of PSVT is re-entry in the Atrioventricular Node (AV node) which accounts for 60% of such cases and is one of the most common forms of tachycardia with narrow QRS complex. Other causes include re-entry through the accessory pathway [explains 25% of cases and is part of Wolf- Parkinson-White (WPW) syndrome], sinus node re-entry, re-entry of kind ITE (In-Training Examination), when is an annual review with hereditary gens or biological conditioners to develop this sickness and increased automaticity. Paroxysmal Supraventricular Tachycardia (PSVT) is also the most common cause of emergency cardiovascular arrhythmias in children. Its incidence in the general population without heart disease is about 0.1% [2].

Although tachycardia is a common symptom in pediatrics, it requires us to rule out a cardiac problem. Sometimes, it is the only prominent symptom at presentation while other symptoms are vague.

In neonates and infants, tachycardia occurs up to 50% of patients with clinical heart failure [2], the majority of cases are related with next symptoms and specific causes: tachycardia, paleness, irritability and rejection decision sometimes admitted to hospital with suspected sepsis as partial symptoms. When the infant has high heart rate, it can manifest as vomiting and irritability. Up to 25% of cases, tachycardia is detected during a routine clinical examination in an asymptomatic infant [2]. Sometimes the tachycardia is discovered in the foetus and if uncontrolled through the treatment of the mother or there are early signs of heart failure, delivery is induced to treat the child.

In older children, the aforementioned symptom is sometimes referred as “the heart goes quickly”. In adolescents, sinus tachycardia may be secondary to stress or exercise or other causes.

Like the vast majority of tachycardia in pediatrics population, supraventricular tachycardia by re-entry typically has an abrupt onset and offset unrelated to exercise and usually occurs when the child is calm, on rising, during bedtime or while watching TV on the couch. These children are otherwise healthy and the presence of tachycardia presupposes the existence of an accessory pathway usually atrioventricular, either a sickness Wolf-Parkinson-White or a hidden beam that is we do not see in the EKG base in sinus rhythm, tachycardia occur re-entrant being the AV node anterograde and retrograde accessory beam. Itself re-entry means that a single wave stimulation and arousal can to reactivate the same tissue from which and requires three more commonly conditions: (via double, conduction delay, unidirectional block).

Besides re-entry may be an increased automaticity as a tachycardia mechanism. We have reflected here tachycardia rates by place of origin and likely mechanism.

Although frequently used terms Supraventricular Tachycardia and Ventricular Tachycardia (VT) are practical starting points for describing a tachyarrhythmia, they lack specificity. While Supraventricular Tachycardia includes any fast-paced rhythm originating in the Atrium (A), Atrio-Ventricular (AV) bundle or an accessory pathway, VT refers to arrhythmia that arise at any point or points in the heart located below the bundle of His bifurcation.

These terms are vague and do not provide specific information about the origin and mechanisms of tachycardia. PSVT can occur with few or no symptoms and may not require treatment. If symptoms recur especially in the presence of any underlying heart disease, treatment may be necessary. People who have an episode of PSVT may try to interrupt with a Valsalva maneuver, which involves holding your breath and straining (i.e., to press the abdomen to cause a bowel movement) or coughing while sitting with upper body bent forward. Some people have reported that it is helpful Splashing ice water on the face. People who have an episode of paroxysmal supraventricular tachycardia therapy can provide them to interrupt the arrhythmia and convert it to a normal sinus rhythm. In the emergency room, a doctor may massage the carotid arteries in the neck to try to interrupt the arrhythmia. Be careful, you do not try to do this at home! This technique can cause severe decrease in heart rate.

In many cases, electrical cardioversion (shock) is effective in the conversion of paroxysmal supraventricular tachycardia in normal sinus rhythm. Another way to quickly convert this tachycardia is the administration of intravenous medications, including adenosine and verapamil. Also, one can use other drugs such as procainamide, betablockers, and propafenone. In addition to treating isolated episodes of PSVT, some patients may require long-term maintenance therapy or ablation of the arrhythmia focus for prevention from future recurrence. Paroxysmal supraventricular tachycardia is usually not lethal, unless other heart disease is present, although there is a higher risk of heart failure with persistent tachycardia. Based on the impact it has had in the last three years in the Pediatric Intensive Care Unit (PICU) of the Provincial Children’s Hospital of Sancti Spirits, we decided to emphasize on this issue in order to raise the knowledge of our professionals and thus improving the quality of life of the children in our community.

Criteria for the Diagnosis of Supraventricular Paroxysmal Tachycardia (PSVT)

In children Palpitations or tachycardia is not uncommon in pediatrician emergency. Most cases are due to physiological situations or banal processes (fever, pain, nervousness, etc.), but can also be caused by serious illness that can endanger the child’s life. It is likely that at the time of the consultation the child is asymptomatic, so an accurate medical history and a thorough physical exam will allow us to assess whether the patient can be managed on an outpatient basis or requires consultation with the pediatric cardiologist.

First of all asymptomatic child who refers symptoms suggestive of tachycardia (palpitations, fast-paced, etc.) should be performed: