LVH, MVP, HTN, BBB, Tachycardia in otherwise healthy althetic male teen

My nearly 15 y/o son has had unexplained HBP x1 yr. first detected at onset of severe Epstein-Barr/strep C. Highest 168/128 following stress in court from father suing us. Average 150/92 . Echo=LVH, mild MVP, mild tricuspid insufficiency, occasionally tachy-highest 140. "Mild" murmur now noted. EKG=right BBB, nonspecific ST-T changes. Stress test good-BP resting 150/88, peak exercise 200/80, 5 min. after 140/78. Worked up good sweat at end of test-no symptoms produced. Renal scan normal. Child totally asymptomatic, 5'11, 192 lbs. pure muscle, excellent physical condition, extremely athletic in 3 sports (until now), secondary to condition. Ped. cardiologist only allowing bicycling in moderation, walking, golf in cooler weather until further w/u. What next? Ped. cardio ruled out coarctation of aorta by feeling pulse in left femoral artery, no pressures taken. Is this enough? One cardio who read echo stated "this is what we find at autopsy on these young athletes that drop dead" and this sounds true to me from what I find on internet. I'm terrified-child wants to play fall baseball (excellent player), return to weight training (did quit football on own 1 wk. prior to all this) and continue activities. Please give me some advice. I'll take him anywhere I need to. Ped. cardio is from Hope at Christ Hospital, Oak Lawn IL. Thanks!

[Cleveland Clinic, MD]

Dear Kathy,

Topic Area: Hypertension

High blood pressure, or hypertension (HTN) , is defined in an adult as a blood pressure
greater than or equal to 140 mm Hg systolic pressure or greater than or equal to
90 mm Hg diastolic pressure. Blood pressure is measured in millimeters of
mercury (mm Hg). High blood pressure directly increases the risk of
coronary heart disease (which leads to heart attack) and stroke (or brain
attack), especially along with other risk factors.

High blood pressure can occur in children or adults, but is particularly prevalent in
blacks, middle-aged and elderly people, obese people, heavy drinkers and women who are taking oral
contraceptives. Individuals with diabetes mellitus gout or kidney disease have a higher frequency of
hypertension.  

High blood pressure may be primary (essential) or secondary.   If the  hypertension is secondary there may be a treatable cause.  Most of these causes are relatively rare (i.e. renal artery stenosis, pheochromocytoma).  If no secondary cause is found then the high blood pressure is said to be primary.  The vast majority of cases of HTN are  primary.  The main cause of primary HTN is genetic.

Coarctation is a possibility and can be better evaluated by checking blood pressures in both arms and legs and looking for differences.  (the leg blood pressure requires a special cuff).  The thickening of the heart may or may not be significant.  

My best advice would be to continue with the evaluation for secondary causes of the high blood pressure and to work on lifestyle changes.  The high blood pressure should not significantly limit his activities but the thickening of the heart may be a limiting factor until it is better evaluated.

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/hbp.html
http://www.ihr.com/medreprt/articles/bloodpr.html
http://www.musc.edu/iash/
http://www.am-osteo-assn.org/ccoop/hibldprs.htm
http://www.mco.edu/whl/know.html
http://www.bloodpressure.com/
http://www.mediconsult.com/hypertension/
http://www-med.stanford.edu/school/DGIM/Teaching/Modules/HTN.html
http://www.merck.com/!!uYfKE0uiyuYfKE0uiy/pubs/mmanual/html/khgnjgcd.htm
http://www.aafp.org/afp/091596/special.html
http://pharminfo.com/disease/cardio_db.html
http://www.pslgroup.com/HYPERTENSION.HTM

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.