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

Area of Science:

• Pediatric Cardiology
• Dermatology
• Pharmacology

Background:

• Propranolol is the established first-line therapy for infantile hemangioma (IH).
• It demonstrates a favorable risk-benefit ratio in clinical practice.
• The increasing use of propranolol necessitates a comprehensive understanding of its safety profile.

Observation:

• A toddler undergoing propranolol treatment for IH experienced cardiac arrest during a viral infection.
• The event involved neurally-mediated syncope progressing to asystole.
• Contributing factors likely included dehydration, beta-blockade, and heightened vagal hyperactivity, evidenced by a history of breath-holding spells.

Findings:

• This case illustrates a rare but serious adverse event associated with propranolol in IH management.
• Concurrent viral illness and dehydration may potentiate the risk of cardiovascular events in susceptible individuals.
• Vagal hyperactivity, suggested by breath-holding spells, could play a role in propranolol-related syncope.

Implications:

• Sharing clinical experiences is crucial for refining the safety profile of propranolol in pediatric patients.
• Healthcare providers should maintain vigilance for potential cardiovascular complications, especially during intercurrent illnesses.
• Further research may be warranted to identify specific risk factors for adverse events in children treated with propranolol for IH.