Fast heart beats, dizziness and chest pains in a young boy

Your question:About 5 years ago, my now 11 year old son, was diagnosed with pvc's. Not because he had symptoms but because the Dr. heard it one day on a check up. We went to the cardiologist had the halter monitor, echo, and exercise. With exercise they went away. The alarming part is the halter showed he experienced an average of 954 pvc's per hour. No I am not saying it wrong. The number is correct. He never felt them or had any problems. He was cleared from any issues. Then today, some 5 or so years later, at the very beginning of football practice he dropped down saying it felt like someone was knifing his chest. He was sweating profusely. By the time I got him in the air conditioning and checked his pulse it was 130. (At rest he is normally 80 bpm). I listened to his heart and could hear pvc after pvc. His heart was beating so hard and fast it felt like it was going to pop through his chest. He was crying and saying it hurt and how dizzy he felt. He kept taking deep breaths because he said it was a little hard to breath. After resting about 30 minutes he still felt a little dizzy but wanted to watch the rest of his practice. I have called his cardiologist and can't get into see him for 17 days. In the mean time we have pulled him from practice until we see the peds cardio doc. I work for a local hospital as a respiratory therapist. I know that 3 or more pvc's with a HR over 100 is considered a run of v-tach. I know he showed the symptoms. I am worried. I find all kinds of information about pvc benign without symptoms and how usually it is nothing but can't find any info with these symptoms. I understand echos, ekg's, why he was sob with such a high HR and all that. I guess I am just looking for more info.....what exactly are we looking at here. I know this is not normal. I know it's not the pvc it is probably some underlying problem. My son is a football fanatic. He eat sleeps and breaths football. He hopes to play for the NFL one day. He was the starting quarterback when this happened. He is in all honors classes. This is devastating to him. He doesn't understand how he was cleared and now this happened. Any information would be helpful to get us through until the 31st.Answer:From what you have told me these symptoms are not benign. You are correct that this needs evaluation with repeat tests of all the studies done before. 

From what you have told me these symptoms are not benign. You are correct that your son needs urgent evaluation with repeat tests of all the studies done before.

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Causes include:
1. A variety of underlying cardiac conditions, including coronary artery disease, cardiomyopathy, mitral valve prolapse, etc.
2. Abnormal levels of electrolytes (minerals) in the blood. Decreased potassium and/or magnesium are the most common associated abnormalities of electrolytes. Both may be caused by the use of diuretics (water pills), among other reasons.
3. There are unusual congenital (familial) causes of ventricular arrhythmias.
4. Abnormal conditions such as increased thyroid hormones, and others.
5. Toxins, including alcohol.
6. Stimulants such as
    Caffeine Nicotine and/or Cocaine can cause serious ventricular arrhythmias.
    Some over-the-counter medications and herbal/natural formulations contain important stimulants
7. Infection, inflammation or degeneration of the heart muscle.
8. Infections at other sites in the body.
9. They are often worse with lack of sleep, or stress.
10. There are also other causes.
Meanwhile, keep him away from any exertion and avoid stimulants.
The first thing to find out is whether his heart is healthy otherwise, so he needs to have some blood tests (including Thyroid), an EKG and 24 hour monitoring. That will determine the basics.

If your son still has symptoms, you should ask for him to be seen now, go to the ER or ask for another cardiologist.
Just remember however that for most the outcome is that everything is fine!

Hope this helps,
Dr T


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