Female, 10 years old. History: Two days with emesis, diarrhea, palpitations and thoracic pain.
Cardiovascular examination. 32 kg weight, heart rate: 250 beats/min, respiratory frecuency 64 breaths/min, Temp: 36ºC, BP: 120/100 mmHg. Diagnosis: Supraventircular tachycardia. She received adenosine 0.1 mcg/kg for 3 doses without response, then it was administrated esmolol in bolus 100 mcg/kg following for another bolus with 500 mcg/kg until 15 mg as a total dose and then 25 mcg/kg/min as a infusion until 50 mcg/kg/min. Tachycardia reverts to sinus rhythm without cardiac failure and patient continues with amiodarone 150 mg oral, daily.
Chest X ray: minimus cardiomegaly.
Elecrocardiogram: Supraventricular tachycardia, QRS narrow, Heart rate 250 beats/min.
Sinus rhythm, Heart rate 80 beats/min, AQRS +45º, rS in V1-2, R in V4-6. Delta wave in DII and V3 with short PR, it sugests Accessory pathway.
Evolution: consciousness, without cyanosis or precordial deformity, protosystolic left paraesternal murmur I/VI with normal second sound and normal peripheric pulses.
Echocardiography: M-mode, 2D, Doppler echocardiography and color flow imaging: situs solitus, AV and VA concordance, mild degree tricuspid regurgitation, pulmonary annulus 14 mm, bicuspid aortic valve, peak aortic valve velocity 1.47 m/s. Aortic root 19 mm, LA 19 mm, IVS 8 mm, PW 7 mm, LVDD 39 mm, LVSD 28 mm, EDLVV 56 ml, ESLVV 33 ml. EF 52% SF 26%. It was descarted mitral valve prolapse and Ebstein anomaly.
Conclusion: Preexcitation syndrome tipe Wolf-Parkinson-White through Kent pathway. Bicuspid aortic valve. Mild tricuspid regurgitation.