Premature Ventricular Contractions - Site of Origin

 RVOT origin - 70-80 %

    Pulmonary valve sinus origin - ~4 %

LVOT origin - 15-25 %

    Aortic valve sinus origin - ? %

Ref: Anderson RD, et al. Circulation: Arrhythmia and Electrophysiology. 2019;12:e007392. DOI: 10.1161/CIRCEP.119.007392.

Anti-Arrhythmic Medications Classification

 

Prolonged PR Interval (First-degree AV Block)

 

Long QT - types, characteristics

Modified from that citation.

 

EKG: Normal Value Tables

(All Tables were taken from Myung Park's "Pediatric Cardiology for Practitioners")

Anomalous Aortic Origin of Coronary Arteries: Intramural length correlates with symptoms.

Kaushal S. et al. Ann Thorac Surg 2011;92:986-992. N = 27. Cleveland Clinic.

Opposite conclusion by Balasubramanya S, et al. World J Pediatr Congenit Heart Surg 2017;8:445-452. (Backer CL is author in both papers).

n=66. Northwestern, Chicago.

Length of intramural course were 8.6 mm +/- 2.5 vs. 8.9 mm +/- 2.8 (symptomatic vs. asymptomatic)!

 

Lp(a) false laboratory values

 From European Atherosclerosis Society Consensus Statement

Eur Heart J 2022;43:3925-46.

(Click on the image to enlarge)

Apixaban - for post-cardiac surgery children

Apixaban

(Eliquiss®)

General principles of use in children (post-cardiac surgery)

Dose is weight-based.

For an adult size person, 5 mg BID may be used.

Under some circumstances 7.5 mg BID may be used.

Dose is adjusted for renal and hepatic dysfunction.

Monitoring: 

Check peak level, about 3-4 hrs after morning dose, after 4 doses.

For post-cardiac surgery children, Anti-Xa (Apixaban-specific) level is kept at 100-300 ng/ml.

For a 3-mo course (short course), repeat peak level once about 2-3 weeks later.

After that, repeat peak level is done if the dose is changed or bleeding occurs.