Tachycardia In 12Yo?

[Friedbrain]

I've been trying to research online tachycardia in children, but feel frustrated by the vague definition, which is that "normal" is anywhere between 60-100 bpm (with kids under 11 being up to 130 as normal). That seems like a HUGE range. So I thought to ask here for help.

Starting a few weeks ago, my son started complaining about the feeling that his heart was racing. It was the middle of the night, so we blew it off, thinking it was either from a nightmare or the fever he had. A few days later, the school nurse called. Ds, who is almost 12, said that while at recess, he'd experienced a sudden feeling like he'd been kicked in the chest with a soccer ball. Hard to breath, intense pain. Back in the classroom, his heart was racing so he went to the nurse. For like 30 minutes, while lying there, it continued to remain between 118 and 105. Took him straight to the doc's office, and his hr was still over 100 (so this was at minimum, over an hour of this). She sent us for an EKG; by two hours later, at the EKG, it was finally ~80. Still, they had us follow up with a cardiologist.

Cardio did a full work-up and concluded that his heart is structurally fine. He had a 24hr holter monitor with no arhythmias, with an average of like 88 (and this included a full-night's sleep, so did NOT make me feel any better and, in truth, made me suspicious that it was a complete waste of time if it didn't differentiate any "tachycardia episodes"!!!) His heartrate, lying on the bed, was 100 and he didn't even notice, which makes me wonder how often his heartrate is elevated and he's unaware. She suggested he go back to famdoc for testing, which we're doing (thyroid, or something else maybe). In filing away a report, I noticed that a previous doc report from Jan said his pulse was 97, bp 116/73. (in contrast, a doc report from 2008 was bp 86/60 pulse 88) Is this strange? He's also recently had constipation and bleeding (cause and effect, docs aren't sure; we're still watching that).

He's only reported one other episode of chest pain (in the car); he had a headache at school and didn't feel well, but his pulse was 80 (per school nurse, who didn't take his bp...doh).

Any thoughts? I want to do my own research to know what's normal and what's not. Any thoughts, or directions to send me to do more reading/thinking? Thank you for any and all help! For me, spells of tachycardia come and go (I'm more the low bp/postural hypotension type, but there are periods of time when my heart will race instead; I'm HOPING that ds does not already have some dysautonomic problems!!)

[shoegal]

did they do an echo? my IST was already in full swing at that age, I couldn't do sports due to it

[paona]

Did they do his heart rate lying down, then sitting, then standing? My daughter had her first ECG at age 7 years because she told us her heart was beating so fast and along with this she had nausea and looked very pale. Her ECG was normal lying down and we didn't know to have it tested while she was standing for a bit. We figured she had a rather benign inherited tachycardia that some family members had. We didn't do any further testing but had I known about POTS I would have. She did not receive holter monitor testing until age 15 and it did show tachycardia but nothing more was done. When she was younger we thought the feeling of chest tightening and pain was a form of asthma from seasonal allergies and treating her with homeopathic remedies seemed to help but now we feel that most of her reported symptoms back then were from POTS. She did not get diagnosed with POTS until last May at the Mayo at age 16. She has times when she will report feeling like her heart is racing but when her pulse is taken it is normal. She can sometimes be lying down, sit-up and stand-up in the doctor's office and her heart rate is normal but she feels terrible. Other times she will have a blood pressure of 80/40 and a heart rate in the upper 40's while sitting and feel fine. She has had testing though with the heart rate increasing from 35-50 points going from lying down to standing. I guess what I'm trying to say is there can be fluctuation with blood pressure and heart rate and sometimes you have to keep taking readings to catch it. At age 17 her blood pressure now remains very low most of the time and when she is fighting an allergic reaction or virus it worsens. I think what really made us take notice in more recent years was how this really gutsy kid was telling us how she was frightened by the chest pain (not uncommon with POTS). We lucked out when she was sick at home and happened to be watching a taping of the House TV show and they mentioned low blood pressure and tachycardia and I asked her what condition the patient had. They were checking the patient for POTS. I immediately looked up POTS on the Mayo website and realized there was a good chance that she had this going on. All these symptoms we had separately treated were mentioned. We also got a good blood pressure cuff to take readings when she reported chest pain or the feeling of tachycardia. Sometimes it showed significant changes, sometimes it didn't but we had enough to show the Mayo when we got in 6 months later. Having a blood pressure monitor at home can help you see what their average heart rate is and how much it deviates from that. Since my daughter's heart rate was fairly low to begin with by the time it was in the 100's she could really feel the difference. The dinet site has excellent information to help you sort through this. You might want to google Dr. Fischer and POTS since he is a pediatric specialist in that area (Rochester Mayo) and has lots of usedful information about children and POTS.

[Friedbrain]

Thank you for the replies. You'd think I would've thought of that, but I didn't which is why this board is helpful No, the cardio didn't take multiple measures. In hindsite, I'm even more frustrated. I guess because ds complained of the intense pain accompanied by the tachycardia, maybe that signaled to her to look out for arrhythmias.....but since the nurse and doc's offices were concerned about the tachycardia, I wish the holter monitor had done a better job of addressing that. I do have a home bp/pulse monitor, so I can test him myself sitting/standing. Good idea.

In fact, this reminds me of the time I went to the cardiologist to look into dysautonomia. He put me on a multi-week monitor. I thought it would be a good idea to test out my hypothesis that I could provoke an "episode" by not drinking my 2x electrolyte water while I exercised. Sure enough, I almost ended up in the ER. Dh had to meet me in the parking lot with salt and water and sit with me until I calmed down from a violent shaking episode. I called the nurse to find out if they'd gotten the "call in" on the holter; she cheerily told me it was "normal, no arrhythmias!". Omg, I was so mad. If the holter monitor is only good for arrhythmias, then that's NOT what I needed and I'd risked my health for nothing. (well, cardio said it caught tachycardia and I should salt load, doh)