Toddler pauses in heart beat

[steph9803]

My son is 20 months old and has had many health issues due to delay in myelination in his brain. He was also diagnosed with moderate Atrial Septal Defect when he was 6 weeks old. Last June he was discharged from the cardiologist who said the ASD was down to 2mm's and that it should close up the rest of the way by itself. He's always had apneas and on his last monitor download it shows his heart beating very irregular at times. It's having 2 and 3 second pauses causing his apnea monitor to go off. Of course I'm having to wait for a doctor to call back...so I'm wondering if anyone knows what might cause something like this? Could it be from his ASD even though he hasn't had this problem from it in the past? Any advice would be greatly appreciated!

[steph9803]

When I was talking to the nurse yesterday at his Cardiologist she said it's either the 24 hour or a 30 day test where you have to push a button every time he has an event. The thing is that he's only 1 and delayed so I have no way of knowing how he's feeling. He's used to being hooked up to numerous things from ph probes to video EEG's. So I guess I will wait for the pediatrician to call back with the appt and ask if we can repeat it if it doesn't show any episodes.

He's quite the medical anomaly and I just want to make sure I do my best at trying to keep on top of the things that I have control over. This was one thing I really don't know much about so thank again :)

[Jerry_NJ]

The Holter is defined as a 24 hour test, I don't know of any reason it couldn't be repeated or extended to catch the episode.

I suspect there is concern about a young person dealing with or  accepting  the monitor, I can't guess of any other reason, it is a passive device and has no affect on the body other than having to wear it.  

[steph9803]

Thank you both so much! That explanation helped me to feel more at ease. His geneticist told me today that we're moving on to mitochondrial testing. She explained to me that it could effect any or all organs including the heart. Still no date for the Holter Monitor and I'm having to leave town for 5 days for my own health issues

Question though...since they will only do a 24 holter monitor on children here what if it doesn't show up in that one day? His monitor does not go off every single night, but at least a few nights a week.

[itdood]

Jerry makes some great points!

Also, our hearts have backup built in case the normal way of firing the ventricles doesn't work.  A true "pause" can have a few different causes.  Either the node that fires the beat didn't initiate, or it did initiate and either didn't reach the AV node or it was blocked in the AV node.  You need to catch it on an EKG to figure this out.

The good news is the backup system I mentioned.  It's so important for the ventricles to beat that nature built in several ways to back it up.  These backup pacer cells will fire a beat on their own if they don't receive a signal to beat from the SA node.  This is usually a 3-5 second threshold.

When the backup kicks in it's called "escape rhythm".  They would see this on an EKG if it occurs.

My son was born premie, I worried so much.  I worried much more intensely for his issues than I ever did for my own body.    We are here to help out if you need help.

[Jerry_NJ]

Sorry to read of you child's physical battles, it is especially hard to see children suffer.  I'm so old I don't remember what a 20 month old is capable of doing, but I think it is too young to expect them to help much in the diagnosis or alarms.

Given your doctor doesn't see it as an emergency (from what I read in your post) it seems best to be try to accept that and go forward with contacting the pediatrician.  

I would also be have a plan/ability to get to the hospital emergency room if something unusual happens.

[steph9803]

Thanks...It was on his apnea monitor. I was looking at the download with his respiratory therapist and we saw it repeatedly coinciding with his low heart rate (60 bpm) and apnea alarms going off. I talked to his Cardiologist today who said to get the holter monitor done through his pediatrician then he would read it. I wish that they were moving a little faster though. Could it be okay to have some pauses like that?

His last EKG came back okay in June. This is all something that's just started. He's been on this apnea monitor since he was 6 weeks old and it's never showed this on a download. I tape his leads on the sticky itself and the wires to ensure he doesn't pull them in his sleep.

[itdood]

I think it would take a decent EKG to figure out an actual heart pause, and  what happened to resolve the pause (eg., was it followed by an escape beat or sinus beat?)

Was this caught on an EKG monitor?  were his leads attached OK?  is his O2 sat being monitored too, if so what did that read?

I've been on this board for a while, I haven't seen any discussion on ASD and heart pauses for what that's worth.