Complete heart block in the pediatric patient.

Care for the pediatric patient with CHB focuses on signs and symptoms associated with respiratory failure and shock. Differences in size among pediatric patients--and in anatomy, physiology, and possible causes--should be considered. In children, cardiac arrest is usually secondary to respiratory arrest. Respiratory arrest should be anticipated in a pediatric patient with (1) decreased level of consciousness, (2) poor muscle tone, (3) increased respiratory rate or respiratory effort (nasal flaring, intercostal, subcostal, and suprasternal retractions); or (4) cyanosis. Shock is the failure of the cardiovascular system to perfuse vital organs adequately. Organ perfusion is determined by cardiac output, which in turn results from the heart rate times stroke volume. In CHB the slowing of heart rate can significantly decrease cardiac output, so the signs and symptoms of shock--especially level of consciousness, peripheral circulation, and blood pressure--must continually be reassessed.