Vasospasms in Children

  I recently wrote to you about my 7 year old having vasospasms.  You asked whether the dilatizem was helping and what her cardiac cath showed.  The doctors diagnosis was, that Kaitlin has some very worrisome symptoms with exercise and a markedly abnormal treadmill test and dobutamine stress echo.  Her intracardiac pressures are remarkably low with no evidence of impaired hemodynamics.  They were suspicious that her coronary arteries might appear abnormal, but that was not the case.  The coronary angiograms were reviewed with an adult cardiologist who concurrred that they looked entirely normal.  The biopsy had nonspecific changes that were not helpful in making a diagnosis.  They ,therefore, began treatment with Diltiazem and will continue to restrict her activity as her evaluation continues.  She has had about 8 episodes in the last 4 to 5 weeks with medication.  Are there any patients in your peds cardiology clinic with any of these symptoms? Should we be worried about her chest pains or of the non-specific changes in her heart tissues that were taken by the biopsy?

Dear Bonnie:
If coronary vasospasm is really occurring, diltiazem usually (but not always) helps. There are specific tests that can be done during a cardiac catheterization that can diagnose vasospasm by provoking it during the catheterization. The non-specific changes seen on biopsy are not worrisome, and are not helpful. Until the issue of chest pains are resolved, you should take her complaints seriously.
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.