PALS 2020 ARRHYTHMIAS | Questions with 100% Verified
Answers | Latest Update 2026/2027
Question: Whenever a child has an abnormal heart rate or rhythm, you
must quickly determine?
Answer: Determine if the arrhythmia is causing hemodynamic instability or other signs of
deterioration.
Question: What are the signs of instability in a patient with arrhythmias?
Answer: Respiratory distress or failure
Shock with poor end-organ perfusion, may occur with or without hypotension
Irritability or decreased level of consciousness
Irritability or decreased level of consciousness
chest pain or vague feeling of discomfort in older children
sudden collapse
Question: Priorities in initially managing arrhythmias are?
Answer: The same as they are for all critically ill children: Support ABC and treat underlying
cause
Question: Bradycardia
Answer: A heart rate that is slow in comparison with a normal heart rate range for the childs
age,
level of activity and clinical condition
Question: What is the leading cause of symptomatic bradycardia in
children?
Answer: Tissue hypoxia
Question: Symptomatic Bradycardia
Answer: Heart rate below 60/min associated with cardiopulmonary compromise
Question: Cardiopulmonary compromise
Answer: * Hypotension
* Acutely altered mental status
* Signs of shock
Question: Bradycardia is an ominous sign of?
Answer: Sign of impending cardiac arrest in infants and children. Especially if hypotension or
poor
tissue perfusion is present
Question: Children with severe cardiovascular compromise from
pulmonary embolism, what treatment should be considered?
Answer: Fibrinolytic agents
, Question: What is the initial treatment of pediatric bradycardia with
cardiopulmonary compromise?
Answer: Bag mask ventilation with 100% O2
Question: Fibrinolytic agents
Answer: tissue plasminogen activator, streptokinase, reteplase tenecteplase
Question: Primary bradycardia
Answer: A result of congenital or acquired heart conditions
Question: Causes of primary bradycardia
Answer: Congenital abnormality of the heart pacemaker or conduction system
Surgical injury to the pacemaker or conduction system
Cardiomyopathy
Myocarditis
Question: Secondary bradycardia
Answer: Result of noncardiac conditions that alter the normal function of the heart (Slow sinus
node pacemaker or slow conduction)
Question: secondary bradycardia causes
Answer: Hypoxia
Acidosis
Hypotension
Hypothermia
Drug effects
Question: ECG characteristics of Bradycardia
HR
P wave
QRS complex
Pwave and QRS complex
Answer: HR Slow compared with normal heart rate for age
P wave May or may not be visible
QRS complex Narrow or wide
Pwave and QRS complex: may be unrelated
Question: Sinus Bradycardia
Answer: Bradycardia associated with a disturbance called bradyarrhythmia. Sinus Bradycardia
is
not necessarily problematic. Present in children at rest when metabolic demands of the
body are low (during sleep)
Question: When is sinus bradycardia present?
Answer: Often present in healthy children at rest when metabolic demands of the body are
relatively low (During sleep). because they have high stroke volume and vagal tone
Answers | Latest Update 2026/2027
Question: Whenever a child has an abnormal heart rate or rhythm, you
must quickly determine?
Answer: Determine if the arrhythmia is causing hemodynamic instability or other signs of
deterioration.
Question: What are the signs of instability in a patient with arrhythmias?
Answer: Respiratory distress or failure
Shock with poor end-organ perfusion, may occur with or without hypotension
Irritability or decreased level of consciousness
Irritability or decreased level of consciousness
chest pain or vague feeling of discomfort in older children
sudden collapse
Question: Priorities in initially managing arrhythmias are?
Answer: The same as they are for all critically ill children: Support ABC and treat underlying
cause
Question: Bradycardia
Answer: A heart rate that is slow in comparison with a normal heart rate range for the childs
age,
level of activity and clinical condition
Question: What is the leading cause of symptomatic bradycardia in
children?
Answer: Tissue hypoxia
Question: Symptomatic Bradycardia
Answer: Heart rate below 60/min associated with cardiopulmonary compromise
Question: Cardiopulmonary compromise
Answer: * Hypotension
* Acutely altered mental status
* Signs of shock
Question: Bradycardia is an ominous sign of?
Answer: Sign of impending cardiac arrest in infants and children. Especially if hypotension or
poor
tissue perfusion is present
Question: Children with severe cardiovascular compromise from
pulmonary embolism, what treatment should be considered?
Answer: Fibrinolytic agents
, Question: What is the initial treatment of pediatric bradycardia with
cardiopulmonary compromise?
Answer: Bag mask ventilation with 100% O2
Question: Fibrinolytic agents
Answer: tissue plasminogen activator, streptokinase, reteplase tenecteplase
Question: Primary bradycardia
Answer: A result of congenital or acquired heart conditions
Question: Causes of primary bradycardia
Answer: Congenital abnormality of the heart pacemaker or conduction system
Surgical injury to the pacemaker or conduction system
Cardiomyopathy
Myocarditis
Question: Secondary bradycardia
Answer: Result of noncardiac conditions that alter the normal function of the heart (Slow sinus
node pacemaker or slow conduction)
Question: secondary bradycardia causes
Answer: Hypoxia
Acidosis
Hypotension
Hypothermia
Drug effects
Question: ECG characteristics of Bradycardia
HR
P wave
QRS complex
Pwave and QRS complex
Answer: HR Slow compared with normal heart rate for age
P wave May or may not be visible
QRS complex Narrow or wide
Pwave and QRS complex: may be unrelated
Question: Sinus Bradycardia
Answer: Bradycardia associated with a disturbance called bradyarrhythmia. Sinus Bradycardia
is
not necessarily problematic. Present in children at rest when metabolic demands of the
body are low (during sleep)
Question: When is sinus bradycardia present?
Answer: Often present in healthy children at rest when metabolic demands of the body are
relatively low (During sleep). because they have high stroke volume and vagal tone
