Pedi Cardiac Question

[rat115]

Sorry I've not been around much lately. This year has been crazy for me. This post comes from some of the stuff that I'm dealing with personally.

I have a 12 y/o son who was dx with WPW in April after running SVT for over 2 hrs and having to be given adenosine to stop the SVT. He had a cath ablation done May 10th. On May 22, he ended back in the ED with short runs that went as high as 306 bpm. Since then, he's not had any recorded events like that.

My son had to go to WY for the summer, so I wasn't able to check up on him like I would have liked and dad didn't take him in for the checkup that he needed over the summer with the cardiologist. He returned home on August 7th. Since then, he's complaining at least 2-3 times a week that he's having cp, h/a, SOB, nausea, and dizziness. We ended up with him in the ED on Sept 6, and the doc said he was in a NSR with ST elevation. On Sept 11, he got dizzy while taking a shower and ended up slipping and getting a concussion due to an episode.

Last night, he was with me at a football game where I was working on the ambulance when he started c/o "the normal". I could feel the irregularity in his pulse, so I got him on a monitor and had the ALS provider that I was able to get out there to take a look at the strip. He said it was a sinus arrythmia with the hr ranging between 54-88 bpm, and it didn't change with O2. With the hx and the fact that the kiddo was A&OX4 and tired, the ALS provider suggested I take him home and watch him. By this morning, he was back in a normal rhythm. He had an 11 am appt because of the concussion, and I took the strip in. The PA looked at the strip and listened to what's been going on. She then had a 12 lead done (NSR with ST elevation again) and a CT and chest x-ray (both normal).

It seems that his heart is showing the dysrhythmias more in the evening the closer to bedtime we get. He's getting extremely grouchy and acting depressed. It's making it almost impossible to get homework or chores done in the evening. He's even lying to me about having homework to the point of getting an F in math because he's just to tired to want to do it.

Besides getting him into the docs here, I have been in contact with the cardiology dept at Children's. The 1st available appt was Sept 21, so we'll be going up then. I also leaned on them about wires getting crossed and an event monitor not getting sent out at the end of May. We should have an event monitor Monday evening and be able to start tracking the episodes with that.

Has anyone heard of kids having problems post ablation for reentrant tach problems like this? Anyone ever heard of this proceedure causing sinus arrythmias? Suggestions on ideas that I can use to weed out if this is an attempt to get out of homework and chores instead of actual cardiac problems? TIA!!!

[crotchitymedic1986]

Was his cath done at a pediatric or adult facility ?

[ERDoc]

Sorry I've not been around much lately. This year has been crazy for me. This post comes from some of the stuff that I'm dealing with personally.

I have a 12 y/o son who was dx with WPW in April after running SVT for over 2 hrs and having to be given adenosine to stop the SVT. He had a cath ablation done May 10th. On May 22, he ended back in the ED with short runs that went as high as 306 bpm. Since then, he's not had any recorded events like that.

My son had to go to WY for the summer, so I wasn't able to check up on him like I would have liked and dad didn't take him in for the checkup that he needed over the summer with the cardiologist. He returned home on August 7th. Since then, he's complaining at least 2-3 times a week that he's having cp, h/a, SOB, nausea, and dizziness. We ended up with him in the ED on Sept 6, and the doc said he was in a NSR with ST elevation. On Sept 11, he got dizzy while taking a shower and ended up slipping and getting a concussion due to an episode.

Last night, he was with me at a football game where I was working on the ambulance when he started c/o "the normal". I could feel the irregularity in his pulse, so I got him on a monitor and had the ALS provider that I was able to get out there to take a look at the strip. He said it was a sinus arrythmia with the hr ranging between 54-88 bpm, and it didn't change with O2. With the hx and the fact that the kiddo was A&OX4 and tired, the ALS provider suggested I take him home and watch him. By this morning, he was back in a normal rhythm. He had an 11 am appt because of the concussion, and I took the strip in. The PA looked at the strip and listened to what's been going on. She then had a 12 lead done (NSR with ST elevation again) and a CT and chest x-ray (both normal).

It seems that his heart is showing the dysrhythmias more in the evening the closer to bedtime we get. He's getting extremely grouchy and acting depressed. It's making it almost impossible to get homework or chores done in the evening. He's even lying to me about having homework to the point of getting an F in math because he's just to tired to want to do it.

Besides getting him into the docs here, I have been in contact with the cardiology dept at Children's. The 1st available appt was Sept 21, so we'll be going up then. I also leaned on them about wires getting crossed and an event monitor not getting sent out at the end of May. We should have an event monitor Monday evening and be able to start tracking the episodes with that.

Has anyone heard of kids having problems post ablation for reentrant tach problems like this? Anyone ever heard of this proceedure causing sinus arrythmias? Suggestions on ideas that I can use to weed out if this is an attempt to get out of homework and chores instead of actual cardiac problems? TIA!!!

Sinus arrhythmia is just the normal change in the heart rate due to breathing. It happens to everyone, just more pronounced in some more than others. You can have recurrent SVT, even after ablations. The Holter or event monitor should tell a lot, but when he is having one of these episodes, feel his pulse or listen to his heart and you can get an idea if there is something going on.

[medicgirl05]

Is he on meds to prevent the SVT? We have a pre-teen patient who has episodes of SVT when she is noncompliant with her meds due to family that would rather smoke coarettes than buy her the meds. Her SVT always happens around 7PM which I've never thought about before...She is otherwise asymptomatic. Complains of her chest feeling "funny" but denies pain. I'm wondering if it may be a similar situation?

Is he on meds to prevent the SVT? We have a pre-teen patient who has episodes of SVT when she is noncompliant with her meds due to family that would rather smoke coarettes than buy her the meds. Her SVT always happens around 7PM which I've never thought about before...She is otherwise asymptomatic. Complains of her chest feeling "funny" but denies pain. I'm wondering if it may be a similar situation?

[firemedic37]

I would think that the ablation was not done correctly, it's still causing an abnormal arrhythmia. An ablation is 90% effective, your son might be in the 10%. The good news is that there is still more that they can do. Some times WPW syndrome has multiple electrical pathways and ablation might not get them all. Surgery might be the next thing, this is close to 100% effective.

The 12-lead is probably showing ST segment elevation de to the ablation, it is difficult to know how the electrical impulses are traveling and may not be following the correct pathway thus causing the ST elevation. I would definitely insist on electrophysiologic testing. This will tell you if your son has multiple pathways or not.

It is best to take it easy and see what is causing this problem before it does become a bigger problem.

[1EMT-P]

It sounds to me like he is having an arrhythmia. I would contact his primary care provider ask them to do a complete physical & labs maybe a CBC, Basic Metabolic Panel, Magnesium & TSH level. I would also ask them to order an Echocardiogram to check his hearts function & ask them to contact a Pediatric Cardiologist.

[rat115]

Sorry, been juggling stuff.

Mike's heart cath was done at a pedi facility. The doc there is one of the top in the nation. (I checked her out.) We're 3 weeks through the month with the monitor. He's had less days where he needed to use the monitor than he's made it sound like, but we won't know for sure what's going on for a while. The PCP has done a complete blood workup the last time we ended up with him in the ED (Sept 6th). The cardiologist did an echocardiogram at the end of May (after the ablation). We've also put him in counseling to try to combat some of the stuff that his dad's pulling.

[captainstandup]

Was his cath done at a pediatric or adult facility ?

If it was done in an adult cath lab, they had better da*$#d well been certified to perform pediatric heart caths and immediate access to a CV surgeon capable of emergency pediatric surgery.

Sorry I've not been around much lately. This year has been crazy for me. This post comes from some of the stuff that I'm dealing with personally.

I have a 12 y/o son who was dx with WPW in April after running SVT for over 2 hrs and having to be given adenosine to stop the SVT. He had a cath ablation done May 10th. On May 22, he ended back in the ED with short runs that went as high as 306 bpm. Since then, he's not had any recorded events like that.

My son had to go to WY for the summer, so I wasn't able to check up on him like I would have liked and dad didn't take him in for the checkup that he needed over the summer with the cardiologist. He returned home on August 7th. Since then, he's complaining at least 2-3 times a week that he's having cp, h/a, SOB, nausea, and dizziness. We ended up with him in the ED on Sept 6, and the doc said he was in a NSR with ST elevation. On Sept 11, he got dizzy while taking a shower and ended up slipping and getting a concussion due to an episode.

Last night, he was with me at a football game where I was working on the ambulance when he started c/o "the normal". I could feel the irregularity in his pulse, so I got him on a monitor and had the ALS provider that I was able to get out there to take a look at the strip. He said it was a sinus arrythmia with the hr ranging between 54-88 bpm, and it didn't change with O2. With the hx and the fact that the kiddo was A&OX4 and tired, the ALS provider suggested I take him home and watch him. By this morning, he was back in a normal rhythm. He had an 11 am appt because of the concussion, and I took the strip in. The PA looked at the strip and listened to what's been going on. She then had a 12 lead done (NSR with ST elevation again) and a CT and chest x-ray (both normal).

It seems that his heart is showing the dysrhythmias more in the evening the closer to bedtime we get. He's getting extremely grouchy and acting depressed. It's making it almost impossible to get homework or chores done in the evening. He's even lying to me about having homework to the point of getting an F in math because he's just to tired to want to do it.

Besides getting him into the docs here, I have been in contact with the cardiology dept at Children's. The 1st available appt was Sept 21, so we'll be going up then. I also leaned on them about wires getting crossed and an event monitor not getting sent out at the end of May. We should have an event monitor Monday evening and be able to start tracking the episodes with that.

Has anyone heard of kids having problems post ablation for reentrant tach problems like this? Anyone ever heard of this proceedure causing sinus arrythmias? Suggestions on ideas that I can use to weed out if this is an attempt to get out of homework and chores instead of actual cardiac problems? TIA!!!

As you are aware, WPW is to say the least elusive and requires extensive mapping to locate the aberrent focus. I agree with one of the other posts on here that RF ablation is about 90% effective in resolving this. Since it seems to be recurring it makes me wonder if there were additional pathways that were missed.

One question i have for you, is he on any anticoagulant medications? It seems prudent that he would need prophlactic meds to prevent the possibility of an episode creating an embolus. his of course carries its own set of challenges for a young person and especially an active young person but is manageable.

Edited October 10, 2011 by captainstandup

[medic_texas]

Sometimes they have to do another ablation. A guy I worked with had 2 done locally then had to go to another facility in Houston before getting it fixed. I'm not sure why that is the case but that's the facts. He's doing fine since then.

[croaker260]

As a side note: Some of the symptoms your son is manifesting also sound stress/depression related. Having a major medical condition, the repeated MD visits, and decreased activity (plus what sounds like some inter-parental strife...just assuming here).. these are all issues that even grown adults have problems with. ….any one of this can contribute to the math issues, the lying, the fatigue, the vague symptomology..sounds like a little counseling may be in order on top of the ongoing medical follow up.

Edited October 14, 2011 by croaker260