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Heart Disease (Expert Forum)
Re: EKG abnormality on teen
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Re: EKG abnormality on teen
by CCF CARDIO MD DLB, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD - DLB on November 14, 1998 at 22:07:44:
In Reply to: EKG abnormality on teen posted by mommydee on November 14, 1998 at 19:46:22:
My daughter at age 12 had a mystery illness. One of the symptoms was migraines and she also had some nerve pain and leg weakness. Neurologist did find some bulging disks. She prescribed Elavil to prevent migraines and reduce pain. Prior to starting Elavil, she had to have an EKG, which was abnormal. The spike which follows the tall spike was very high, close to 3/4 the height of the tall spike. She then had an echo which was normal, so they let her start the elavil. But told me if she ever had cardiac symptoms bring her right in. The ped. cardiologist told me the abnormality was not a fluke, nor a problem with the machines, it was a real abnormality but since she had no cardiac symptoms we should just take a wait and see attitude.
Last year, about a year after the abnormal EKG, she began experiencing rather frequent episodes of chest pain with exercise. Usually, but not always, exercise is what set it off...on a few occasions it happened first thing in the morning in the absense of exercise. She has had Graves' Disease since age 8, back then she had severe tachycardia, resting pulse as high as 165, but ever since she has been on antithyroid drugs she has been fine, she only needed cardiac med to slow heart rate for one month at age 8 (6 yrs ago). All recent thyroid test have shown current level of antithyroid medication is good. This current chest pain does not seem to correlate to a fast pulse. It does however, sometimes make her short of breath. She will complain that it hurts to breath. Last summer at age 13, she was having lots of pain so we went back for one year follow up a little early. This time, the EKG was normal. Because of the pain and shortness of breath, she had a normal echo, a normal exercise stress test with
normal pulmonary function test (although some pain was replicated), and a normal 30 day loop event monitor. Since all these tests were normal, they said there is absolutely nothing cardiac going on with her, and that the previous EKG must have been a fluke because this one was normal (although his partner the year before said it was no fluke). They said she should come back in one year for repeat EKG. The cardiologist did theorize that she was having chest wall pain related to possible lupus. She has a low positive ANA but has high positive antidsDNA....these values have been repeated several times even with Crithidian method...her highest was 165, her last one was the lowest it was 50...anything over 10 was considered positive. He described arthritis type pains in the little joints of the chest wall.
Now it has been some months later. The episodes of chest pain and difficulty breathing are increasing in frequency and intensity. A couple of weeks ago I ended up taking her in great distress to ER....the pain had been severe for hours, it hurt to breathe and she refused to breathe deeply, she was very frightened. She never cries from pain...she is one tough cookie, and hates to go to hospitals, but this time she begged me to go to ER. They put her on oxygen right away to help her breathe, and did an EKG immediately. The EKG was fine, so they gave her a shot of a sedative and said it was likely pneumonia or pleurisy so they did a chest xray, which was normal. So once again, our only diagnosis was chest wall pain. I was kind of embarassed that we had gone to ER just for pain, but I had never seen her in such great distress....the ER people were great and told me it was ok to bring her in again if ever the pain was that bad again. they gave her prescription for Naprosyn, which did seem to help keep the
pain level down enough for her to handle it. We went to pediatrician for follow up and he said he suspected GERD. He set us up with appointment for gastroenterologist, but I have to say I doubt it is GERD. I have tried on many occasions giving her various kind of antacids and they seem to have no effect on the pain level at all. Nor will they prevent pain. Nor does the chest wall pain seem to correlate to food in any way. Of course, we will still keep this appointment to rule this out for sure....but I doubt they will be able to help her much. The doc at the ER said it was very unlikely to have a cardiac basis since the EKG was ok, and since she had an ECHO in May 98, which was normal.
My daughter is a competitive swimmer, and sometimes the pain makes it impossible for her to compete....or at a minimum slows her down because she is short of breath. Since they told her it wasn't her heart, she tries to keep going through the pain....but sometimes she can't. She loves school and is a straight A student, she refuses to miss school but will go to the school clinic for ibuprofen when she hurts bad. The naprosyn was only a five day supply and it was gone fast. She really doesn't let it slow her down too much, but sometimes she starts looking bad while she is exercising, and I start to worry a bit. Sometimes her coach notices and stops her and will ask me if I'm sure the doctors said she could work out hard....which the doctors all said was fine because her heart was fine.
Is there anything they could have missed? Could that one abnormal EKG have meant anything at all? Or is this more than likely the same chest wall pain described from the cardiologist as arthritis type pain in the little chest joints? Will she have to learn to live with it, or is there anything we can do for her?
Is checking her EKG yearly enough now that she has had the other tests normal?
Her current meds are Elavil (amitriptyline) 75 mg at night, Tapizole 5 mg a day, and Ibuprofen as needed.
She does not have a confirmed diagnosis of lupus....although the pediatrician and several other specialists seem to feel she does, the pediatric rheumatologist would not diagnose her as having lupus, just a post viral infection when she had the mystery illness and was in a wheelchair for a few months...However she meets the following criteria: positive ANA, positive antidsDNA, recurrent mouth ulcers, she had at least one WBC of 4000 during a time when she was supposed to have had an infection, joint pain and stiffness (but no swelling nor redness). She has also had muscular weakness which currently is resolved, and frequently gets blushing across nose and cheeks especially with sun exposre but his has not been confirmed by a doc.
What do you think the next step is? Is she were your patient (or your daughter even better) what would you do?
Sorry this is long, but thank you for answering it!
---------------------------------------------------------------------------------------------------
Dear dee
It sounds like your daughter has had a mega workup. I would definitely keep the appointment with the gastroenterologist, though I also doubt it is GERD. However, with that appointment I think your daughter will have seen every major specialist, except a psychiatrist. I would not put much weight on one abnormal EKG, especially since subsequent ones have been normal. Autoimmune disease is a definite possibility and is what cardiologists and other specialists will suggest when there is no other obvious answer; Graves disease makes this more likely. The rheumatologist is the most qualified to make the diagnosis of autoimmune disease, however. If it is autoimmune disease, time should tell. Finally, I would complete the round of specialists with a psychiatric evaluation, so as to leave no stone unturned.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.
In Reply to: EKG abnormality on teen posted by mommydee on November 14, 1998 at 19:46:22:
My daughter at age 12 had a mystery illness. One of the symptoms was migraines and she also had some nerve pain and leg weakness. Neurologist did find some bulging disks. She prescribed Elavil to prevent migraines and reduce pain. Prior to starting Elavil, she had to have an EKG, which was abnormal. The spike which follows the tall spike was very high, close to 3/4 the height of the tall spike. She then had an echo which was normal, so they let her start the elavil. But told me if she ever had cardiac symptoms bring her right in. The ped. cardiologist told me the abnormality was not a fluke, nor a problem with the machines, it was a real abnormality but since she had no cardiac symptoms we should just take a wait and see attitude.
Last year, about a year after the abnormal EKG, she began experiencing rather frequent episodes of chest pain with exercise. Usually, but not always, exercise is what set it off...on a few occasions it happened first thing in the morning in the absense of exercise. She has had Graves' Disease since age 8, back then she had severe tachycardia, resting pulse as high as 165, but ever since she has been on antithyroid drugs she has been fine, she only needed cardiac med to slow heart rate for one month at age 8 (6 yrs ago). All recent thyroid test have shown current level of antithyroid medication is good. This current chest pain does not seem to correlate to a fast pulse. It does however, sometimes make her short of breath. She will complain that it hurts to breath. Last summer at age 13, she was having lots of pain so we went back for one year follow up a little early. This time, the EKG was normal. Because of the pain and shortness of breath, she had a normal echo, a normal exercise stress test with
normal pulmonary function test (although some pain was replicated), and a normal 30 day loop event monitor. Since all these tests were normal, they said there is absolutely nothing cardiac going on with her, and that the previous EKG must have been a fluke because this one was normal (although his partner the year before said it was no fluke). They said she should come back in one year for repeat EKG. The cardiologist did theorize that she was having chest wall pain related to possible lupus. She has a low positive ANA but has high positive antidsDNA....these values have been repeated several times even with Crithidian method...her highest was 165, her last one was the lowest it was 50...anything over 10 was considered positive. He described arthritis type pains in the little joints of the chest wall.
Now it has been some months later. The episodes of chest pain and difficulty breathing are increasing in frequency and intensity. A couple of weeks ago I ended up taking her in great distress to ER....the pain had been severe for hours, it hurt to breathe and she refused to breathe deeply, she was very frightened. She never cries from pain...she is one tough cookie, and hates to go to hospitals, but this time she begged me to go to ER. They put her on oxygen right away to help her breathe, and did an EKG immediately. The EKG was fine, so they gave her a shot of a sedative and said it was likely pneumonia or pleurisy so they did a chest xray, which was normal. So once again, our only diagnosis was chest wall pain. I was kind of embarassed that we had gone to ER just for pain, but I had never seen her in such great distress....the ER people were great and told me it was ok to bring her in again if ever the pain was that bad again. they gave her prescription for Naprosyn, which did seem to help keep the
pain level down enough for her to handle it. We went to pediatrician for follow up and he said he suspected GERD. He set us up with appointment for gastroenterologist, but I have to say I doubt it is GERD. I have tried on many occasions giving her various kind of antacids and they seem to have no effect on the pain level at all. Nor will they prevent pain. Nor does the chest wall pain seem to correlate to food in any way. Of course, we will still keep this appointment to rule this out for sure....but I doubt they will be able to help her much. The doc at the ER said it was very unlikely to have a cardiac basis since the EKG was ok, and since she had an ECHO in May 98, which was normal.
My daughter is a competitive swimmer, and sometimes the pain makes it impossible for her to compete....or at a minimum slows her down because she is short of breath. Since they told her it wasn't her heart, she tries to keep going through the pain....but sometimes she can't. She loves school and is a straight A student, she refuses to miss school but will go to the school clinic for ibuprofen when she hurts bad. The naprosyn was only a five day supply and it was gone fast. She really doesn't let it slow her down too much, but sometimes she starts looking bad while she is exercising, and I start to worry a bit. Sometimes her coach notices and stops her and will ask me if I'm sure the doctors said she could work out hard....which the doctors all said was fine because her heart was fine.
Is there anything they could have missed? Could that one abnormal EKG have meant anything at all? Or is this more than likely the same chest wall pain described from the cardiologist as arthritis type pain in the little chest joints? Will she have to learn to live with it, or is there anything we can do for her?
Is checking her EKG yearly enough now that she has had the other tests normal?
Her current meds are Elavil (amitriptyline) 75 mg at night, Tapizole 5 mg a day, and Ibuprofen as needed.
She does not have a confirmed diagnosis of lupus....although the pediatrician and several other specialists seem to feel she does, the pediatric rheumatologist would not diagnose her as having lupus, just a post viral infection when she had the mystery illness and was in a wheelchair for a few months...However she meets the following criteria: positive ANA, positive antidsDNA, recurrent mouth ulcers, she had at least one WBC of 4000 during a time when she was supposed to have had an infection, joint pain and stiffness (but no swelling nor redness). She has also had muscular weakness which currently is resolved, and frequently gets blushing across nose and cheeks especially with sun exposre but his has not been confirmed by a doc.
What do you think the next step is? Is she were your patient (or your daughter even better) what would you do?
Sorry this is long, but thank you for answering it!
---------------------------------------------------------------------------------------------------
Dear dee
It sounds like your daughter has had a mega workup. I would definitely keep the appointment with the gastroenterologist, though I also doubt it is GERD. However, with that appointment I think your daughter will have seen every major specialist, except a psychiatrist. I would not put much weight on one abnormal EKG, especially since subsequent ones have been normal. Autoimmune disease is a definite possibility and is what cardiologists and other specialists will suggest when there is no other obvious answer; Graves disease makes this more likely. The rheumatologist is the most qualified to make the diagnosis of autoimmune disease, however. If it is autoimmune disease, time should tell. Finally, I would complete the round of specialists with a psychiatric evaluation, so as to leave no stone unturned.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.
