Right Ventricular Hypertrophy

[Jorgensen]

I have a 15 year-old, who over the past 4 years has passed out 3 separate occasions, 4 years ago they said vaso vagal (he was passed out for approx. 15 mins. before we found him (no warning), 2006 he passed out again, walking across the kitchen floor getting ready to leave the house for football practice, passed out for approx. 45 mins when my husband found him and woke him up ( slurred speech and blurred vision), and back to himself after about 1hr-45 mins (no warning). In September 2007 again he passed out after having finished his breakfast (slight headache;otherwise no warning).  March 2007 stress test - no findings, and has been to CHOP (Children's Hosp. of
Philadelphia) had multiple neurological testing, now we're back to cardio and recent EKG diagnosis noted as Right Ventricle Hypertrophy. Dr. Hansrote (Heart Center - Lehigh Valley Hospital, Allentown, PA), so back to CHOP we're going.  What are the chances he actually may have it, and would a "tilt table" test be the recommended test to determine whether he has this condition or not.
Not knowing if and when it's going to happen again has stopped his football playing days...for now, and he feels like a freak.  He is not overweight at all and eats well and stays hydrated.  We're beside outselves at this point.  Suggestions...recommendations are very much appreciated.

[RCA7591]

"and would a "tilt table" test be the recommended test to determine whether he has this condition or not."

^quote

No, a tilt-table test would be of no value in the diagnosis of right ventricular hypertrophy. He needs to be evaluated by a cardiologist for congenital heart defects. Syncope with focal neurologial deficits (blurred vision, slurred speech, headache) suggests right-to-left shunting and TIA phenomena (mini-strokes).

The first step would be to obtain a standard echocardiogram with bubble study. This test is non-invasive. The echo would give an estimation of the chamber sizes, wall thicknesses, assessment of valves, estimation of pulmonary pressure, etc. The bubble study portion is useful for revealing shunting at the atrial or ventricular levels. Congenital defects such as a large Patent Foramen Ovale, Atrial Septal Defect, Ventricular Septal Defect, Patent Ductus Arteriosus, etc could explain your son's finding of RVH. Given his age, this is the most plausible explanation.

If warranted based on the results of the standard echo, a Transesophageal Echocardiogram (invasive test) may be utilized to better define congenital abnormalities. Right-heart catheterization (invasive test) may be utilized to measure oxygen saturations in the right heart chambers, SVC, IVC, and pulmonary artery. Any mismatch between the oxygenation levels suggests shunting (a communication between the left and right side of the heart). Depending on the type of shunt, pulmonary hypertension may also be present, which would explain the RVH.

Also, given the neurological deficits, an autoimmune work-up may prove valuable. Hypercoagulable State in combination with a septal defect increases the risk of TIA. I would mention this to the neurologist. One very specific test is Anticardiolipin Antibodies IgM/IgG (simple blood test).

Any family history of congenital heart disease, Lupus, etc?

I would suggest visiting a pediatric cardiologist who specializes in congenital heart defects. Good luck to your son.

Best regards,

Ryan

[worrier10]

Am curios as to what the outcome was? Does he have rvh?