Published Oct 14, 2004
I am a nurse, however, have never done cardiac nursing...so am going to pick brains. First, background, son was in gradeschool (3rd grade age 8/9) when s/s began. Had episodes of tach (>300bpm), diaphoretic, nausea, sob... would last approx 3-10 min. each time. Came close to passing out several times, luckily his teacher would make him lay down rather than let him fall. It would occur at anytime, regardless of activity. No caffeine intake. He saw a pediatric cardiologist, who ran all the reg tests which showed absolutely nothing, EKG's, echo, all normal. His symptoms went away, ped. cardiologist said to see if he would "grow out of it".
Fast forward to now, age 16. Began having s/s again this past summer/fall. He is seeing an EP doc...currently wearing a 30 day event monitor. His 12 lead EKG was normal, echo normal (again). I was hoping it was WPW, but it is not. His 24 holter caught one episode at 2 am where he went from 50's pulse to 170's within a few seconds, it continued for several minutes, then he apparently rolled over, and it dropped back to 50. His avg. pulse during the 24 hr was 52. His lowest was during school, 38 bpm. We tried to "induce" tach with exercise, and it just got up to around 150.
EP doc said we likely will need to do an EP study if the 30 day doesn't show him exactly what is going on. Any thoughts? We have another week of the 30 day before going back to doc.... Thanks. noso
Your son's case sounds interesting. I am no expert in cardiology but I will respond with interest to your son's condition.
I have attended symposiums on pediatric cardiology which included congenital heart defects and conditions and therapies. SVT and ablation therapy was of great interest to me during that symposium!
The first thing that comes to mind after reading your son's S/S's is symptomatic Paroxysmal Supraventricular Tachycardia (PSVT). It is good news to hear that he has had nearly 8 non-episodic years of this event reoccuring. Apparently, it hasn't gone away.
Another point of interest is your son's resting heart rate while sleeping of 38 - 52 bpm. Unless your son is a exceptional athlete (or a young U.S. Marine!) his heart rate should be higher than 52 bpm. This would direct my thinking to a problem with his pacemaker, the Sinoatrial (SA) node. If his SA node is not functioning his inherent heart rate would be 40-60 bpm which could be driven by his Atrioventricular (AV) node.
Sick Sinus Syndrome is another condition that comes to mind. This condition is uncommon and usually appears in the ederly but is also of interest because it's signs and symptoms mimic those of your son's., especially the bradycardia / tachycardia syndromes. It has presented itself in children as well. One website that I found is: http://www.nlm.nih.gov/medlineplus/ency/article/000161.htm. I hope this is of help to you.
Sounds like your son needs an EP study to see whether or not the arrhythmia is reproducible in the lab.
The fact that he had these symptoms at an early age would sugges the possibility of a congenital abnormality.
There are several congenital tachy-arrhythmias which are curable. What is necessary is an EP study to see if an irritable focus can be identified and whether or not it would be amenable to radio frequency abblation.
nosonew, BSN, RN
Actually, they did do the EP study and he did have an extra electrical pathway they were able to get rid of. That was last year...and 8-9 months later he has had NO more symptoms nor any side effects from the procedure!
The EP doc stated he is "cured" and should not even list this issue on ANY medical forms or insurance forms from here on out.
Thanks for all of the insight... WHEW!
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