On November 9, Wang Yiyi, a 9-year-old girl living in Enshi, had symptoms of cough, sore throat and fever. Unexpectedly, on November 14, Yiyi's symptoms not only did not ease, but he appeared vomiting, fatigue, sweating and other symptoms, and was rushed to a local hospital. At this time, the heart rate is about 200 beats/min, which is nearly twice as high as the regular heart rate of 70-100 beats/min of 9-year-old children. After first aid, the heartbeat was restored one by one, but the condition is still very unstable.
On the evening of the 14th, Wuhan Yaxin General Hospital received a referral request from Yiyi's parents, and at the same time, the local hospitals that visited him one by one sent an invitation to Yaxin General Hospital to guide ECMO treatment (extracorporeal cardiopulmonary assist device). On the 15th of this plan, the ECMO team arrived in Enshi with equipment on the air rescue helicopter Yaxin-1, but it was rainy all day and unsuitable for airflow. On the 16th, the Asian General Air Rescue flew 465 kilometers to Enshi and carried out emergency transport of the children one by one.
After the successful transfer to Wuhan Yaxin General Hospital with the assistance of ECMO, the Department of Cardiovascular Medicine and Surgery, the Department of Intensive Care Medicine, the Department of Cardiopulmonary Bypass, and the Department of Pediatrics started the MDT multidisciplinary consultation again, and discussed the physical condition of Yiyi: although ECMO temporarily stabilized the child's vital signs, Yiyi's condition was still not optimistic, and the heart failure was extremely serious, combined with mycoplasma pulmonary infection. Why does the child's heart continue to cause tachycardia, and even induce cardiac arrest? Why is it that even with high-dose cardiotonic drugs, blood pressure is still low and circulation is still uncontrollable?
Looking at the red critical values and the alarm signals of the rescue instruments, the Department of Pediatrics urgently invited Professor Ouyang Feifei, a famous electrophysiologist from Germany, to participate in a multidisciplinary discussion. Professor Ouyang, Director Tang Cheng of the Department of Cardiovascular Medicine, Director Ren Haibo of the Department of Intensive Care Medicine, and Director Liu Yang of the Department of Pediatrics asked about the medical history in detail, carefully examined the body, carefully checked each index, and comprehensively evaluated and analyzed the condition.
Combined with the examination reports of the small patients one by one, under the joint discussion of multidisciplinary experts, they were finally diagnosed with endless atrial tachycardia, which induced tachycardia cardiomyopathy, and recent lung infection led to acute heart failure, cardiogenic shock, and cardiac arrest.
"The heart is like a two-bedroom house, and there are many electrical systems distributed inside the house, and the sinus node of the heart is like a circuit gate, which conducts electricity to each room through wires and directs the whole heart to beat normally. When an additional power station is added in addition to the normal power lines, the entire electrical system becomes deranged, causing tachycardia to occur. When we accurately capture this additional power station and process it, the heart's beating will return to normal. Director Liu Yang illustrated it figuratively.
After the diagnosis was confirmed, cardiovascular experts Professor Ouyang Feifei, Director Tang Cheng, and Dr. He Tongda were ready to perform intracardiac electrophysiological examination + radiofrequency ablation surgery one by one, and at the same time made an emergency plan for radiofrequency ablation surgery under ECMO-assisted circulation. During the operation, the femoral vein blood vessels should be punctured, and the catheter should be sent to the heart to search for abnormal pacemakers. Left atrial appendage, right atrial appendage, pulmonary vein?...... After careful exploration step by step, the ectopic "excitement point" was finally detected in the high septum of the right atrium, and the discharge ablation began, and the child immediately returned to normal heartbeat.
After the operation, with the close cooperation of the heart center, pediatrics, intensive care medicine and other disciplines, they recovered quickly, and were transferred to severe illness on November 24, and their condition improved and they were discharged from the hospital on December 7.
For 9-year-old Yiyi, it seems to be a serious illness caused by a cold, but speaking of this child, Professor Ouyang said that maybe Yiyi should be grateful for this cold.
"End-stopping atrial tachycardia is a disease that many patients do not have obvious manifestations because the patient's heart beats at a rate of 120 to 140 times a day. In the long run, the heart will be depleted of energy, gradually enlarged, and then heart failure symptoms such as swollen feet, inability to sleep, and gasping for breath when going upstairs will appear. But it was precisely because of the cold that Wang Yiyi aggravated heart failure, made the symptoms of the disease more obvious, and made this hidden disease nowhere to hide. Once heart failure drags on for too long, it will definitely be life-threatening, beyond a certain limit, even if the cause of tachycardia is removed, the heart function will not be able to return to normal," added Professor Ouyang Feifei.
On the one hand, the parents were able to detect the child's abnormality and send it to the hospital in time, and it was also the efficient and close cooperation of the multidisciplinary team of Asia Heart General Hospital to turn the child into a safe place. At present, the child has returned to school and returned to normal life. Parents should be reminded that once they find that their child's heart rate continues to be fast even when they are asleep (heart rate >> 140 beats per minute for children under 3 years old; 120 beats per minute for children over 3 years old), they must be sent to a professional cardiology department as soon as possible.
Financial Media Reporter: Yaqi
Correspondent: Xu Weiping