Cardiac arrest in a toddler treated with propranolol for infantile Hemangioma: a case report

Alvise Tosoni,Stefano Sartori,Giorgio Perilongo,Mario Cutrone,Andrea Pettenazzo,Maurizio Dalle Carbonare

doi:10.1186/s13052-017-0421-5

Alvise Tosoni, Stefano Sartori + Show 4 more

Open Access

https://doi.org/10.1186/s13052-017-0421-5

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Abstract

BackgroundPropranolol has become the first-line treatment for complicated Infantile Hemangioma (IH), showing so far a good risk-benefit profile.Case presentationWe report the case of a toddler, on propranolol, who suffered cardiac arrest during an acute viral infection. She had a neurally-mediated syncope that progressed to asystole, probably because of concurrent factors as dehydration, beta-blocking and probably individual susceptibility to vaso-vagal phenomena. In fact a significant history of breath-holding spells was consistent with vagal hyperactivity.ConclusionsThe number of patients treated with propranolol for IHs will increase and sharing experience will help to better define the safety profile of this drug.

Highlights

BackgroundInfantile hemangiomas (IH) are the most common vascular tumors of childhood affecting about 5% of infants
Propranolol has become the first-line treatment for complicated Infantile Hemangioma (IH), showing so far a good risk-benefit profile
We report the case of a toddler who suffered a cardiac arrest while on treatment with propranolol for IH

Summary

Background

Infantile hemangiomas (IH) are the most common vascular tumors of childhood affecting about 5% of infants They are benign tumors that usually appear in the first few weeks of life and they go through a rapid proliferative phase that lasts several months before a slower involution phase begins. For its position the lesion was uncomfortable and exposed to possible trauma as well as pressure and rubbing when the child was laying on the back (Fig. 1a) Even if she was not an infant anymore, she was deemed to meet the criteria for medical treatment in order to avoid possible complications and a spontaneous involution with potentially aesthetical damages. ECGs, ECGHolter, echocardiogram were confirmed to be normal She tested negative for known mutations in a panel of 86 genes causing cardiomyopathies and channelopathies implicated in arrhythmias (Table 1). She was discharged from the hospital 55 days after the event with poor neurologic outcomes as spastic tetraparesis, epilepsy and severe cognitive impairment

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