Rate dependent QS pattern in an acute Kawasaki disease

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Infectious Diseases

Background:

• Kawasaki disease (KD) is a significant cause of acquired heart disease in children, often presenting with pancarditis.
• Coronary artery (CA) inflammation is a primary concern in KD management.
• Electrocardiographic (ECG) abnormalities can occur but require careful interpretation.

Observation:

• A severely ill pediatric patient with Kawasaki disease presented with a transient and intermittent first-degree atrioventricular block and a QS pattern on the ECG.
• This specific ECG pattern is unusual in the context of Kawasaki disease.
• The presentation prompted a differential diagnosis investigation.

Findings:

• The observed QS pattern on the electrocardiogram was determined to be a transient conduction disturbance.
• This finding was attributed to acute myocarditis, a common manifestation of Kawasaki disease.
• It was differentiated from an immediate coronary artery complication, which is a more typical concern in KD.

Implications:

• This case highlights the importance of recognizing rare ECG findings in pediatric cardiology.
• Understanding that transient QS patterns can reflect myocarditis in KD is crucial for accurate diagnosis.
• It underscores the need for a broad differential diagnosis when interpreting ECGs in critically ill children with Kawasaki disease.