Le urgenze cardiologiche in età perinatale: Parte seconda. Disturbi del ritmo e cardiomiopatie

Continued postnatal development of the conduction system and of the sympathetic nervous system of the heart may predispose the newborn to arrhythmias and conduction disturbances that are not seen in older children. In addition, unfavorable environmental factors, such as a maternal disease state, pharmacologic agents given to the mother or neonate, and postnatal difficulties of the newborn (hypoxia, acidosis, hypothermia, metabolic disturbances, electrolyte imbalance) all can contribute to the rhythm disturbance. The different types of disrrhythmias are analized, particularly the supraventricular tachycardia (SVT)(1:10.000 in newborn) and complete atrioventricular block (AV block) (1:20.000). In SVT, if the patient is unresponsive to vagal stimulatory maneuvers, to adenosine and is in congestive heart failure, cardioversion may be performed. Congenital complete heart block can be associated with congenital heart diseases. Maternal lupus erythematosus or other connettive tissue disease has a frequent association with congenital AV block. The three types of cardiomyopathies (hypertrophic, dilated and restrictive) are functionally different from one another, and the demands of therapy are also different. The myocarditis may be caused by an infectious agent or immune mediated process. A diagnostic and therapeutic protocol for management of the myocarditis in children is reported.