Differential diagnosis of cardiac arrhythmias in infants with whooping cough

Introduction . Cardiac arrhythmias have not been considered as complications of whooping cough so far. The relevance of the study is conditioned by the need to improve the tactics of management of infants with whooping cough, having the most severe course of the disease, taking into account the identified arrhythmias, as well as the lack of study of this problem. Aim . To develop an algorithm for the differential diagnosis of cardiac arrhythmias in infants with whooping cough to determine the tactics of their treatment and follow-up, taking into account the presumed pathogenesis of arrhythmias. Materials and methods . The study included infants (n = 56; 55.4% – male) infants with whooping cough hospitalized in the intensive care unit of Federal Research and Clinical Center for Infectious Diseases. Using functional methods of diagnostics in cardiology and results of 24-hour recording from the intensive care unit monitors we have for the first time compared the heart rhythm with episodes of respiratory rhythm disturbance affected by this disease. Results . In 83.9% of patients with whooping cough, the ECG parameters were normal. Apnea due to spasmodic coughing was observed in 23 children (41.1%) and was accompanied by desaturation and bradycardia. According to Holter ECG monitoring, all children had sinus bradycardia, atrial rhythm episodes, and extrasystoles. Five patients (8.93%) had sinus arrest with a maximum rhythm pause of 3020 milliseconds. No pathological arrhythmias were detected in the absence of respiratory rhythm disturbance. We suggested a connection between asystole and apnea with parasympathetic hyperactivity, increased sensitivity of the heart to vagal influences, and identified two main groups of patients with whooping cough based on the possible pathogenesis of cardiac arrhythmias. Conclusions . The identification and differential diagnosis of cardiac arrhythmias in infants with whooping cough is important in determining their treatment and follow-up. Further research is needed to study this issue.