Dizziness and a Rapid Pulse in the Pediatric Emergency Department

You are leading the care team in the pediatric emergency department. An 11-year-old child weighing 30 kg reports that their heart suddenly began racing while they were sitting in class. The child became lightheaded but did not lose consciousness. The child has a history of repaired congenital heart disease and takes no antiarrhythmic medication.

The child is alert and answers questions appropriately. The airway is open, breathing is unlabored, respiratory rate is 22/min, and oxygen saturation is 98% on room air. The pulse is rapid and regular. Blood pressure is 104/66 mm Hg, peripheral pulses are palpable, capillary refill is 2 seconds, and the skin is warm.

A nurse, respiratory therapist, emergency physician, and medication clinician are present. Pediatric cardiology consultation is available.