sinus bradycardia and pauses

I have read the postings the last couple of months and find them quite helpful. I have a question and will try to be short.

My 17 yoa son ( a healthy and active sports kid, football, bball, track and weightlifting )had a chest pain one day and my wife made a doctors appt. to make sure it was nothing.  Well, the past history of my wife and her mother having HOCM, raised concern. He has had since all of this several ekgs, echos, 24hr holter monitors. One doc saying he needs a pacemaker/icd. This kid is in perfect shape.  I believe he has HOCM, but does he really need a pacemaker?

My questions; Is bradycardia a normal thing for atheletic people?

Are pauses on a holter monitor a cause for concern?  What duration 3,4, 5, millisecs should be a concern?

What does this mean from a echo report "significant anterolateral hyperthropy, consistent with hyperthrophic cardiomyopathy. However, no evidence for any left ventricular outflow tarct obstruction" ?  Good thing or bad thing?

My wife and I have been thru a lot the past couple months, and this is really hard to believe.  Give me some sunshine of hope.

Thank You and this is a great site!!

Carmine

[CCF-M.D.-RCJ]

Carmine,

Sorry to hear of your troubles.

The most important thing that I can tell you is to see an expert in HOCM.  Dr Harry Lever and Dr Craig Asher are the two experts at the CCF, and both are great.  Other centers have experts as well, most notably at the Mayo Clinic.

Pacemakers for patients with HOCM are usually reserved for patients with symptoms.  Pauses of up to 3 seconds may be normal in anyone, beyond that is probably too long.  However, there are some families with HOCM and associated cardiac electrical conduction problems.  You would need to ask your families if this might pertain to you.  Bradycardia is a frequent finding in athletes -- Bjorn Borg reportedly had a heart rate of 32 bpm.

The echo statement that you provided simply means that whoever was reading the echo thought that your son had HOCM.  It is certainly better to not have left ventricular outflow tract (LVOT) obstruction as it is this obstruction that often leads to symptoms.

The matter of the ICD needs the most attention.  The role of an ICD is to prevent sudden death.  Sudden death in HOCM patients has been associated with (1) an earlier age at diagnosis, (2) septal hypertrophy greater than 30 mm, (3) history of the patient passing out, (4) non-sustained ventricular tachycardia (VT) on holter monitoring, (5) sustained VT during electrophysiology testing, and (6) family history of passing out or sudden death.

The preceeding paragraphs contained the bad news.  The good news is that with good medical care and close follow-up, your son should expect to do just fine.  This is especially true given what you have told me about his ability to play sports.

To reinforce once more, seek an expert opinion.  Either Dr Lever or Dr Asher can be reached via the internet at www.ccf.org.

Hope that helps..