5 year old child with congenital Complete heart block

A 5 years old female child resident of Madurai, Tamilnadu, came to JIPMER hospital emergency  with chief complaints of giddiness followed by loss of consciousness four days back, which was sudden in onset associated with one episode of vomiting but there is no history of palpitation, fever, joint pain, anorexia or weight loss. For all these complaints patient went of local goverment hospital, where ECG done suggestive of bradycardia, so patient was referred to JIPMER hosptial for further management. During evaluation in the emergency patient pulse was 50 beats per minute, BP-100/60 mmhg, ECHO done suggestive of dilated left ventricle with LVEF around 50%. ECG of the patient done is shown below.

                        ECG 1(Click on the image to enlarge it )

Descriptionn of the ECG-Complete AV dissociation seen, atrial rate 100 beats per minute, ventricular rate 50 beats per minute, QRS duration prolonged around 160 msec, LBBB morphology,QT interval 520 msec, QTc interval 475 msec, Deep T wave inversion seen inn lead I, II, avF, V2-V6, so the diagnosis of the patient is congenital complete heart block.


                                                                 ECG 2

Another ECG of the patient again showing Complete AV dissociation suggestive of complete heart block. In view of absence of any secondary causes and age of the patient (5 years) the diagnosis of congenital heart block was kept.

Patient was put on permanent pacemaker and was discharged from the hospital in  stable condition.

Thank you.