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What should I do about a sinus arrhythmia in an 8 year old?
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What should I do about a sinus arrhythmia in an 8 year old?

My 8 year old son complained on his "heart hurting", and feeling dizzy and out of breath on several occasions so I took him to our family practice physician. She diagnosed sinus arrhythmia and the EKG confirmed.  She said its nothing to worry about. He has bad allergies and takes 10mg of Zyrtec daily. She said this didn't cause it. Why did this suddenly develop and howdo I know its not serious? Should I limit his activity, and does he need to see a Cardiologist just to be sure that the diagnosis is correct? I am an RN and when I listened to his heart at the time he was complaining, he had an extremely irregular HR with slow beats and then runs of tachycardia along with skipped beats. Later when he was okay, he had a HR of 64-87 still with the "skipped beats".
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Sinus arrhythmia is also called heart rate variability (HRV) and is a normal function of the heart.  HRV was first noted by the Chinese in about 1000 BC.  HRV is due to a complex interaction of the autonomic nervous system, blood return to the heart and the effects of breathing.  Studies have demonstrated that an increased HRV is a marker for decreased mortality.  There is no need to limit activity or see a cardiologist for HRV.  Hope this helps.
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Felecia,
If he were my son, I'd make sure he got an echocardiogram just to rule out any congenital heart disease.  My daughter had similar symptoms at eight years old, and her murmur was so faint that her regular doctor never heard it.  One night I took her to the ER and an intern there heard it.  One thing led to another and finally she had an echo, and a rare coronary anomaly was found.  She had surgery three weeks later and is doing pretty well now.  Without the surgery, things could have been different.  I don't want to scare you, as I said it's very rare, only one in 300,000 have this anomaly, but an echo can tell you what is or is not going on and you will feel a lot better if you know for sure that he's okay.
Bev
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Felecia,
If he were my son, I'd make sure he got an echocardiogram just to rule out any congenital heart disease.  My daughter had similar symptoms at eight years old, and her murmur was so faint that her regular doctor never heard it.  One night I took her to the ER and an intern there heard it.  One thing led to another and finally she had an echo, and a rare coronary anomaly was found.  She had surgery three weeks later and is doing pretty well now.  Without the surgery, things could have been different.  I don't want to scare you, as I said it's very rare, only one in 300,000 have this anomaly, but an echo can tell you what is or is not going on and you will feel a lot better if you know for sure that he's okay.
Bev
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I have a 7 year old daughter who has just started experiencing her chest hurting her, she would stop what she was doing and tell me that i hurts bad.  Last night i finally was able to listen to her chest when it happened and she had additional beats, irregular rythmn.  we were laying down at the time reading.  sarah was just hospitalized 5 wks ago with a severe virus that gave her l05+ temps for 6 days.  i would be curious to see what you find out we are in the beginning stages of understanding it
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sinus arrythmia???
its a contradiction of terms!!!
find another doc...its probably psvt
and if testing (ecg, eco-cardio, stress) rule
out ventricular dysfunction, its benign (and controlable)
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i agree with concerned. (Hrv) is a condition where the interaction between the vagal nerve branch and the conduction system of the heart can temporarily speed up and slow heart rate), most people have this condition, its natural....if you hold your breath for a second, your heart rate will speed up and slow down when you exhale....but just for a few seconds....this is HRV. i dont think this has anything to do with what your son is experiencing...especially when complaining of syncope and shortness of breath....in my opinion, he needs a workup by an internist or cardio. it could be something as simple as a thyroid problem (it commonly develops around that age) that is triggering short burts of atrial fib/psvt!!
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thanks for all the replies. But now I am confused... Is it the "feeling he is going to pass out", and "hard to breath", part that is the warning sign?? Should sinus arrhythmia be w/o any symptomology, a totally benign condition?
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I have sinus arrhythmia, and I have for many years.  I can't say that the sinus arrhythmia has caused any symptoms.  When you breath in the heart rates slows and when you breath out the heart speeds back up.  If you are checking the pulse at the same time you can feel it in the pulse.  It don't happen every time you take a breath, but every so often.  I don't know if that is what is causing your childs symptoms.  If you are concerned I would get a opinion from a Pediatric Cardiologist.  I have some conginital heart disease that I was born with, ASD (hole in the heart) and some Hypertrophic Cardiomyopathy, that I just found out about last year.  I am 29.  It was missed all through out my child and young adult hood.  For piece of mind if nothing else I would seek out that opinion, but be assured sinus arrhythmia is nothing to be concerned about, it is better to have than not have.

Good Luck to you..

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I have an 8 year-old son who after a bout of fever for a week developed Tachycaria only on exsertion. He runs all the time and everytime he runs his heart pounds out of his chest. This is all new. He is very athletic and up to this point never had any symptoms. No chest pain and no shortness of breathe. He has no symptoms except the pounding and rapid pulse. He has had a  normal EKG and a normal Echocardiogram. Tomorrow is the stress test and I just wonder if anyone out there has the same problem with their child.
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ive never even heard the term sinus arrythmia
and im a med student!!!
Hrv has probably replaced the term and thats what the doc
was talking about....hrv is benign and symptomless (unless you count the small temporary effect on heart rate. in fact, it has been documented that people with a higher level of hrv are healthier!!! but it definately shouldnt be causing syncope (fainting) and definately not shortness of breath!!! only a sustained arrythmic event would cause shortness of breath due to decrease ventricular function. i would definately get a second opinion...
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To all the parent here reporting that your child has been thru a bout with a virus and then started having problems that are apparently heart related, i urge you all to get them to a cardiologist right away without anymore delay. There are introvirus' that can and do affewct the heart and can cause death. I dont want to alarm you but the facts are that these virus' are very bad for children.
  God bless and good luck
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If you don't know what Sinus Arrhythmia I suggest you get a refund back on your education.  It is the most common arrhythmia there is.  You say only "only a sustained arrythmic event would cause shortness of breath due to decrease ventricular function."  That is not true either, there are several things that cause shortness of breath.  I know this and I am not even in the medical field.  Try a search on this site for sinus arrhythmia, you might learn something today.
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Okay people, she did not say her son experienced "syncope", she said dizziness. There is a difference.

Felecia, I would get a second opinion. Chances are he does have sinus arrythmia but it's totally unrelated to the symptoms he's having. He may have something in addition to HRV which hasn't been found- yet. Insist on the proper tests, dizziness and SOB can't be "benign" in an 8 yr. old. It may not be related to the heart at all, but best to rule it out anyway. Good luck to you and your son.
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to the putz who is climbing my tree,
if you are referring to sinus tachycardia or sinus bradycardia when you mention "sinus arrythmia" then i see what you are referring to. but, then again the use of "sinus" (or a normal pattern, remember high school) and the word "arrythmia" when referring to a heart rythm that is perfectly normal electically except for being fast or slow is rediculous. sinus tachy is fine. people live for years with it! medicating it is easy!....bradycardia is not that bad either. in my book, by themselves, neither is an arrythmia, because electrophisiologically, the PQRST pattern is stable. but then again maybe we are talking about 2 seperate things entirely. as far as the shortness of breath. i was speaking in light of the other symptoms that the child was experiencing you putz!...could be panic...yes! could be some kind of bronchial constriction due to asthma,....fliud on the lungs....could be anything you looser if you want to split hairs!!!
Just thought i would defend myself a little....
p.s. i got your refund.......swinging right here
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to felicia, i apologize for my behavior, and that of others...
i still feel that you need a second opinion though....at least some transtelophonic monitoring for 3 or 4 weeks to shed some light on the subject.
best wishes
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Well, everyone thanks so much for the concerns and helpful if somewhat confusing info.  I am an R.N. and diagnosed him with sinus arrhythmia before even going to the doc. (and yes the term does sound contradictory but IT IS in my med/surg book)What worries me is how he described 2 of the occurances. 1."sometimes my heart hurts" (at the time the HR was VERY irregular with bradyc, skipped beats then runs of tachyc. and  what sounded like a systolic murmur) 2. Clutching his chest and saying my heart hurts (again), then laying down saying, "I feel like I am going to pass out, and taking gulps of air saying "its hard to get my breath".  And that COULD be anxiety...but in an 8yr old??  He does have rather bad allergies, chronic cough, enlarged tonsils etc, but no asthma/bronchospasms so far. The virus thing is interesting because he did come down with a bad flu-like bug a week or two after he first told me about it.  Could be coincidence or maybe not. I think you all are right and I will take him to a Cardio just to make sure!!! Will let you know how it turns out. And no more fighting:)
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I think it is wise that you do get him checked out a little further by a cardiologist.  Sinus Arrhythmia is an arrhythmia, here is the definition of of this site "SINUS ARRHYTHMIA - An increase in heart rate during inspiration. A normal physiologic response; more pronounced in children.".  I am surprised the concerned medical student didn't know this.  From my experience Anxiety can begin in a child, so that is still a possibility, my niece who is 11 has cronic (chronic) anxiety, and has for about 5 years.  But given the fact he was sick, and you here a murmur, it is really best to check it out.  I hope your son turns out to be fine.  I will say a prayer for him.

To the Concerned Medical Student, your attitude is not that stable.  I hope your bedside manor improves before you become a doctor.  As someone who has cronic (chronic) Tachycardia, it is not always "ok", yes it is a "sinus" rhythm but even that is an arrhythmia.  I guess if someone who is in bradycardia beating at 20-30 bpm, is okay too because the complexes are all regular.  I think that is wrong.  They need quick intervention.  Good Luck to you if you go into Cardiology let me know, so I can stay away.
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i did not say that it was alright to be tachy or brady although A LOT of people live their whole lives "outside the norms"....but in most cases, either is easily treatable ...atenolol for tachy for example (brady might be harder because of the possibility of a block etc.) my manor is vey good thank you...there are even some people who like me. oh by the way, a little research has brought to my attention that not many people in the buisness use the tern "sinus arrythmia" anymore. it is now referred to simply as HRV or sinus tachycardia. i was only trying to help by offering a few words. defending myself after being picked on by you may have been a mistake (but probably not). you should be ashamed of yourself for tearing at people like that.
sorry i couldnt be of help. i wont bother you or this forum again
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Give me a break.  I really thought a lot of this forum before reading the personal arguments in this reply column!  My only comment is sympathy for those of us in the world, adults and CHILDREN, that live with chronic tacch and bracch.  Just last week I was at UVA, where my cardiologist assured me that I'm perfectly healthy, even though I wake up every few weeks with my heart beating 200 beats a minute.  It takes hours to decrease - which I understand is characteristic of sinus tacch, since true arrythmias (irregular beats, SVT)can stop abruptly and the tacch doesn't gradually decrease.  The med student is right about meds.  My 50 mgs per day of Toprol XL make me feel like a sane person again!
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Yes, sinus arrythmia by itself is a benign condition that is not unusual in children, what does concern me is the complaint of chest pain, dyspnea and vertigo. I suppose the runs of tachycardia, if they last long enough could cause those symptoms, but I doubt that sinus arrythmia by itself would cause such symptoms. You would need to get an EKG while he was having the symptoms to see if he was having long runs of PSVT, and that would probably be impossible to get in the clinical setting. How long do these episodes last? Is he hyperventilating when these happen? Let me know!!!!!!!! Love Granma
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Dear Med student-
I am sure you were just trying to help, sorry people got offened by your reply. But I to have heard the term sinus arrythmia quite often, infact i heard it the other day from a doctor who couldn't have been more than 30 years old.
Maybe you just need to do a little more research before you reply.
Again, i am sure you were trying to help. Sorry if you were offended.
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My son is 11 years old. About 6 months ago he had chest pain with shortness of breath and also felt very dizzy.It came on sudden one morning as he was getting ready to go to school. He continued to complain so I took him in to see his Dr. They did a quick check up on him and because he also has Ehlers Danlos syndrom (syndrome) which is a connective tissue disorder they decided to send him for a chest x-ray,it was fine. Although his syndrome is very mild it can effect the heart muscles, so I'm told. The concern I have is that after reading up a bit on different web sites that address causes of chest pain in children, I have come to learn that a chest x-ray would do little to nothing in offering an explanation into his symptoms. I was sent home after the x-ray and told it was probably gas. This never sat well with me. I often wonder should he have had some more work up. This was right in the middle of basketball season and I have heard of underlying heart problems surfacing during times of sports. He has had a couple of episodes the same prior to this but we did not take him to a doctor until the last time it happened because this last time it lasted much longer. I was told by my HMO I should find a new Dr. I am interested to know how your son is now, did he recieve further testing? and if yes, how it turned out. Joyce
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On this past Tue. I took my son to a new Dr. for a well check up and she is now sending him to a cardiologist because of his symptoms. Also because he has a cousin on his fathers side who was diagnosed with (White Parkinson Wolff) when she was about 16 years old. I am going to assume you have heard of that. well anyway she had to have surgery to correct it and the Dr. tells us that it occurs more often in children aged around that of my sons and older, and that it can run in families. We go the end of July to the heart Dr. Fingers crossed it's not true. I don't even know if you read my last post but if you did, I'm still thinking of you and your son, hope all is well. Joyce
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Your all a bunch of tossers...except of course for the worried mothers
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My daughter (almost 8) was recently (October 2000) diagnosed with Respiratory Sinus Arrhythmia - RSA (apparently still a very common term and diagnosis).  She did not and never has complained of chest pain.  In fact she is very athletic and healthy.  According to my research RSA is very common and may even be an indication of "fitness". It seems that RSA and chest pains are two different things which do not necessarily correlate.  I'm just saying that in my daughter's case the RSA is not accompanied by other "symptoms" and I could easily see how her respiratory fitness resulting from her very regular soccer activities might lead to RSA.
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I have been doing research on sinus arrhythmias. (or Hrv.. I also now know it as).  I am a student nurse ..when just playing around with my stethoscope found my son to have a very irregualar heart rhythm.(He is 6) His sisters is completely regualar) His symptoms are a VERY rapid rate upon inspiration and slowing on expiration.  I found this  when he was sleeping.  It seems to be LESS pronounced when he is awake.. although still present.  It does go away for the most part when he is physically active.  Does this make sense to anyone???
I have seen from the above postings that the the tachy/brady on inspir/expir. to be normal.. what about the fact that it is more pronouced when in a resting state??  Is it because this condition is related to the Parasympathetic nervous system?? I know that with Sinus arrhythmias during inspiration the parasympathetic tone falls and the heart rate quickens.. on expiration the heart rate falls.  Does anyone have anymore information.  I hear this is common in children.  When can I expect it to go away?  Thanks!  Kathleen
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To Felisha and all mother's, and wives, or anyone else who seeks help for loved ones or themselves,

I really don't think anyone should be putting anyone down for their response on this site....Nor do I think they mean too....Some people seek help, some respond and offer help , love, and hope....And yes we even pray for those to which we don't even know. I am new to this also, Sinus arrhythmia and got alot of information about it just reading all of your posts....So I say thankyou to u all, and also would like to say whenever anything deals with any vital organ, and u have any concern, even the smallest of concerns, u seek it out to the fullest and don't stop till you are 100 percent possitive that it is ok, and if it is needed.... a second oppinion is always nice.

Thanyou again, to all....God Bless
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To Felisha and all mother's, and wives, or anyone else who seeks help for loved ones or themselves,

I really don't think anyone should be putting anyone down for their response on this site....Nor do I think they mean too....Some people seek help, some respond and offer help , love, and hope....And yes we even pray for those to which we don't even know. I am new to this also, Sinus arrhythmia and got alot of information about it just reading all of your posts....So I say thankyou to u all, and also would like to say whenever anything deals with any vital organ, and u have any concern, even the smallest of concerns, u seek it out to the fullest and don't stop till you are 100 percent possitive that it is ok, and if it is needed.... a second oppinion is always nice.

Thanyou again, to all....God Bless
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I have the exact same problem with my son as the student nurse. The funny thing is I am also a student nurse and found it on my three year old when I was practicing listening to apical pulses. His is also more dominant at night. We went for an EKG today that the radiologist said looked like sinus arrythmia. I have not heard from the cardiologist yet, but I will be following up with appts. I will keep you posted.
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A related discussion, im interested on what happened to Felicia's son??? was started.
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A related discussion, im interested on what happened to Felicia's son??? was started.
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