Pvcs in a child how many are too many

[Pskl]

My son has recently complained of extreme fatigue and blacking out right after he feels his heart skipping beats.  He has a history of sinus breathing arythmias and a blood pressure that does not go up when his heart rate goes up that was causing syncope while playing soccer 2 years ago.  I took him back to the cardiologist with this new complaint and the EKG shows about 15000 pvcs a day.  His echo was normal and his pvcs decreased during the stress test. and he is wearing an incident monitor for the next month to hopefully document another incident where he can actually feel his heart doing something.  Right now, he is unaware of the frequent pvcs and has yet to have another occurrence of fatigue or blacking out.   I worry that when he actually feels faint, he may be having vt.  My question is , if this only amounts to the pvcs, isn't 15000 a day too many and how are they usually treated on a 15 year old?

[JuliaKD]

I'm brand new here, and reading through these I am starting to stress out! My 7 year olds latest holter showed over 51,000 pvcs in a 24 hour period. Did your son have pvcs at an earlier age, or are they new? Her doctors aren't concerned either...

[Pskl]

I am waiting to hear what his cardiac output is but want to thank you for drawing the correlation between that and his bp during exorcize.  His echo was normal but I too wonder if having 2 different arythmias effect cardiac function long term.  I forgot to mention in my previous post that he has been under the care of an endocrinologist for constitutional growth delay for the past 10 years.  He keeps falling off growth scales and they don't know why.  Right now they are not treating him, just following him.  I hope the cardiologist can shed some light on this when I talk to her this week with the follow up from some of his tests.  Thanks again

[tom_h]

My electrophysiologist explained that my all of my SVT event were initiated by a single PVC occuring at precisely the right moment.

High rate SVT could cause insufficient filling of the ventricles and result in poor circulation and possible syncope.  Extremely high rates can be seen in adolecents.  Mine was once clocked in the hospital at 312 bpm.

[Pskl]

Thank you for your input.   He just had an echo which was unremarkable.  He has not had the tilt test but I will mention it to his cardiologist when I talk to her this week when she calls with the verdict from his stress test.  He seems very stress free and denies being under stress but I will keep a watchful eye.  I will also watch diet.  He does not take caffeine or cold medicine.  I still am curious about his serum mineral levels and will request labs.  I hope we get to the bottom of this as well.

[is_something_wrong]

Your concerns seem very appropriate.

15.000 PVCs is a lot. The PVCs themselves are not necessarily dangerous, but PVCs (unlike PACs) can affect cardiac output and cause low blood pressure. PVCs, in the absence of heart disease, are (according to my cardiologist) treated if:

- Cardiac output is affected, or
- If the experience of PVCs are ruining life quality.

However, PVCs alone should NOT cause fainting. This makes me fear, just like you, that he may have runs of PVCs (ventricular tachycardia). Supraventricular tachycardia (as mentioned above) is also possible. But supraventricular tachycardia is rarely initiated by PVCs, and it rarely causes fainting in an otherwise healthy young boy. Ventricular tachycardia is more likely to (for the same reason as I mentioned earlier, atrial activity is making the heart pump more efficient than ventricular activity).

The fact that his blood pressure doesn't increase during exercise (blood pressure not increasing when heart rate increases in the absence of physical activity is not that much of a concern) does sound concerning to me. For example, my blood pressure will increase from a resting 110/70 to  160-170 systolic during cardio exercise, to 200 systolic at peak exercise, when my heart rate is in the high 190s (when exercising, my systolic BP is roughly similar to (or slightly higher than) my heart rate). A cause must be found, it's hard to say if the cause is cardiac related or caused by dysautonomia. It may be both, or one condition affecting the other.

The fact that he feels palpitations before fainting, strengthens the fear that his heart may be involved. It's great that he is wearing an event monitor, but if he is experiencing fainting along with palpitations, he must see a doctor immediately.

I hope you will find the cause and that he gets treatment.

[MichelleP_3811]

I partly wonder if maybe your son also has an svt.  I had svt my whole life and it would be triggered by a skipping beat.  The svt would cause shortness of breath and I would become very light headed.  If I tried to stand it would feel as though I would pass out.  If a person is on the move when this occurs I could see them almost passing out.  Though the key here is almost.  Most svt will make a person feel as though they will pass out but they will not cause a person to fully pass out.  And whenever I had an svt episode afterwards I would feel an increase in the amount of pvcs and pacs I was having so I do hope they can catch one of his fainting episodes so they can see if it is being caused by some sort of svt as opposed to vt.  Has your son had an echo to check the structure of his heart?  If he hasn't then I might limit his physical activity and push to get one done to make sure his heart is healthy.  I would then check into the condition Dysautonmia which is characterized bp by issues which it sounds like your son already has.  There is medicine that may be able to help your son regulate his autonomic nervous system that may be part of his issue with passing out. Did your son have a tilt table test when he was being evaluated 2 years ago?  That I believe is the test they use to determine if dysautonmia is an issue.  If it is adding sodium to his diet and wearing compression socks as well as the meds I mentioned may help.  Some other things to evaluate is whether or not your son is prone to stress and anxiety.  If he is hiding a lot of stress and anxiety it could be causing an influx of the pvcs stress being a major trigger.  As well as stomach issues can also cause an influx of pvcs/pacs especially after eating with a particular trigger being carbs.  So I would say see what the doctor says about his monitor results to make sure he isn't falling into vt but I would not rush into an ablation as ablations for pvcs are met with mixed results and can cause more problems than good and at his young age it might not be worth the risk yet until all avenues have been evaluated.  I also think 20,000 or more is really when they start to consider an ablation anyways unless your son is indeed falling into vt and passing out because of it.  But I wouldn't fear that until it was actually document.  It is more likely something more simple so really do push to get the other possible angles I mentioned diagnosed and addressed to see if that helps his situation.  If your son really does have bp regulation issues you may want to think about addressing those first by seeing a dysautonomia specialist first to see if that helps before agreeing to any medical procedures or bp meds especially if he tends to low bp and again seeing a gastroenterologist to get his stomach evaluated as well as having a frank discussion with him about his stress levels.  Well good luck.  I do hope you can get to the bottom of this and it is something simple to correct or manage.  Take care and keep us posted on how he is.  

[Pskl]

Thank you for your reply.  I agree 70 years is a long time and I also worry about using a beta blocker long term on a child who still has an immature liver.  Ablation is scary to think of also and I'm still waiting to hear  where exactly his pvcs are originating from.  I also will demand blood testing at our next appointment to make sure he isn't deficient in any minerals which I hear can cause the pvcs.  Until then, I look forward to any advice people can give me.  I'm usually pretty laid back and conservative in my approach to medicine but this thing with my son is causing me to lose sleep.  Thanks again for your response.

[Jerry_NJ]

While we wait for someone who has direct experience and better recall of what they've read than I, I offer.

15,000 is a lot.  I think it is not uncommon in those who so suffer, but is enough to cause problems.  Remember an average person has more than 100,000 heart beats per day (if I did my arithmetic correctly), so 15,000 is about 1 in six.  If they each interfere with a portion of the blood pumping that could add up to some symptoms even if the person doesn't explicitly feel each PVC.

I believe the treatment for a 15 year old would be the same as for an adult with more emphasis on trying to stop the PVC than to medicate it.  I believe Beta Blocker are used to help manage PVC problems, but I for one would hate to accept taking  a medication for the next 70 years as would be the case for a 15 year old.

I'm not up to speed on PVC, but I think ablation is a possible method of cure.