Respiratory Distress in an Infant: An Uncommon Cause for a Common Complaint.

BACKGROUND: Respiratory distress and tachycardia are common presenting complaints in infants and young children, and evaluation typically focuses on respiratory infections. Tachydysrhythmias causing heart failure are rare and can be difficult to diagnose in young children, but are reversible if recognized and treated early.

CASE REPORT: We discuss a 7-week-old female infant who presented with respiratory distress and persistent tachycardia. Evaluation revealed severe cardiac dysfunction with an underlying atrial flutter discovered on electrocardiography after adenosine administration. Rate control by synchronized electrocardioversion resulted in resolution of symptoms and restoration of cardiac function, confirming the diagnosis of atrial flutter-induced cardiomyopathy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Persistent or inappropriate tachycardia in a young child should not be dismissed and underlying dysrhythmia should be considered.