frequent PVC's in children

[jenbunn]

Hi! Thank you so much for answering my question.
My 14-yr.-old daughter has been unwell since Christmas-has been more tired than normal and "draggy". Thought maybe she was more tired because of the holidays or maybe anemic. She is also very pale at times. Chalked it up to burning the candle at both ends and that she just needed more rest. Then, about a month ago, she came home from school after playing badminton and was complaining she couldn't breathe.She was pale, sweaty, and diaphoretic with chest pain. Checked her pulse and it was about 200/min. I am a nurse--had her do vagal maneuvers-cough did not work but bearing down slowed her to about 110/min. Took her to ER for ECG to make certain everything was fine and she was in vent.trigeminy. Since this episode she is frequently in trigeminy and bigeminy. She does not notice these.Results of tests:ECG shows trigeminy,underlying NSR,abnormal Lt. axis deviation,low voltage,incom.RBBB, non-spec.ST-T abnorm(elevation).Elevation in 1,2,avf and precordial leads.24-hr. holter showed 121,869 total complexes,16,447 vent. ectopics (13%of total complexes),4 bigeminal cycles,3 couplets,no runs. Max HR 182, average 91bpm.CBC was normal as was thyroid panel. She does have Ehlers-Danlos Type 3. One Dr.heard murmur,one did not. Normal echo about 4 years ago(screening on all my kids due to EDS).She has been advised not to engage in strenuous activities for now. Also, grandfather had EDS and died at 34 from Rt.side heart failure. My questions:
What can cause this in children/adolescents?
Can frequent PVC's like this lead to later problems? ie Lt.vent enlargement/failure?
What tests should I insist cardiologist do? (we go next week)
Thank you so much. Jennifer

[Forum-M.D.-bkj]

Jenbunn,

I think a pediatric cardiologist or your EDS specialist would have better answers to your questions.  I do not have much experience with pediatric or inherited conditions, but given your significant family history, I would imagine this is probably playing some roll in her symptoms.  

I cant think of any specific test I would add base on the information you provide other the start with a repeat echo. I think the most important thing is for you to sit down with a physician and review her full case.

sorry not to be of more help.

good luck

[jenbunn]

Well, thanks for answering (and so sorry I pushed post twice!) Obviously I am worried and the fact that she gets worse with exercise makes me nervous as well. So no gym for now. I am sure the ped cardiologist will do an echo at the least, I am also hoping for a stress test of some sort. Meanwhile we wait...she feels well otherwise so it is hard for her to understand when the doctor says no strenuous activity.
Thanks alot and have a good day!
Jennifer

[LukeL]

While I am not a docotr and have no formal medical training to speak of, I have spent many hours researching cardiac conditions out of fear for my own health due to PVCs and other palpitations.

With that said, since your daughter has an IRBBB and ST segment elevation in V1 and V2, Brugada Syndrome should be investigated no mater how rare the condition is. An EP specialist could be of more help in this situation.

[jenbunn]

Thanks LukeL. Looked up Brugada but her elevation does not have the same characteristics (thank goodness).Brugada seems to have a pretty specific appearance and hers does not appear like the examples I saw. Thanks for your interest and reply, I appreciate it!
Jennifer