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intermittent 2:1 heartblock.
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intermittent 2:1 heartblock.

My daughter (6 years old)  was diagnosed recently with second degree heart block. She has intermittent sinus rhythm and intermittent 2:1 heartblock. There are no long pauses and there is no complete heartblock.

Q1. Is her condition benign or serious and can be classified as higher degree heartblock?

Q2. How long is she likely to live without a pacemaker if she needs one in future?
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My daughter would have several dizzy spells every day; sometimes she would be pre-syncopal as well. Her awake resting EKG rates were in the 30s range. When the heart rate is that low, the heart can stop beating. She had several different electrical problems with her heart as well as a hypertrophic cardiomyopathy which is where the muscle of the heart is diseased. The reason they put the pacer in was because her Sinus Node (Sick Sinus Syndrome) did not function well, she also had a Right and Left Bundle Block so there was a block of the impulses in both of the ventricles. They gave her a duel chamber pacer to cover both of those problems. Probably the two main symptoms you will see from your daughter are the two that I have already mentioned: dizziness and presyncopy. She is certainly old enough to tell you about those problems so if she has said nothing, that's probably not a problem for her.I would not start asking her about this because children feed off of their parent's anxiety and then in time, the parent's anxiety transfers over to their child. You do not want that to happen to your daughter. She could become scared over every little thing and start to image things are happening to her heart. The tiredness she has can be a result of many different things. The number one reason children are tired is because they do not get enough sleep. At her age she should be getting at least 10 hours a night, more would be better. Look at the foods she is eating. If she is eating things high in sugar, for example, her blood sugar levels will raise very quickly and then they could drop like a rock. If that happens, she will be very active while she is on a sugar "high" and then she'll crash as that level drops. For the most part, parents are pretty intune with their children's health, they have an instinct for it. If your daughter was having symptoms, you would know and so would she, she's old enough for that. Take care    
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I would think her cardiologist would be in the best position to answer Q1 because they would be able to analyze more data.  Perhaps getting a more than one opinion (from Cardiologists) would be a good idea.

I think what you mean by Q2 is that if a time comes where she needs a pacemaker (complete, 3rd degree block), how long will she live without one?  That's a tough question, I'm not sure anyone could predict that outcome.  If the AV node fails to conduct completely, the ventricles will usually go into "escape rhythm", where the ventricles will initiate a beat on their own.  I have no idea how long someone can live like that, sorry I can't give a more definitive answer.

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Does she have Morbitz type I or type II heart block?

Second degree Heart block, Type I is typically considered begin and does  not require treatment.  However, if she has symptoms (or ever develops symptoms) such as dizziness, exercise intolerance, feeling faint etc. that accompany the heart block then treatment options are available.  I have Morbitz type I and was told I do not need treatment for it but to look out for new symptoms because then treatment may be required - I was not told what the odds are for this progressing but from what I have read, there is a small chance.
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Also, as itdood says a complete heat block (3rd degree) requires a pacemaker.  Morbitz II may or may not require a pacemaker, it depends on symptoms.
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Hello itdood, Thank you for your valuable comments.
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Hello spade22,

Thanks for your reply. If you don't have any symptoms how did they find out about your heartblock? When I took my daughter to a hospital for fever they found out accidently when they checked her pulse.

2:1 AV block is a type of second degree heartblock. This could be either morbitz I or morbitz II.

I am hoping to hear from someone who has similar condition. The good news (in sad news) is that her block is intermittent.

I don't want her to get a pacemaker at least until she reach 20. I hope in 5-10 years time pacemaker implantation become very effective and easy procedure. Future pacemakers might be without battery and leads and heartbeat may power pacemakers...
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Hi,

I have experienced palpitations on and off for about 17 years ( I thought it was normal for a very long time).  I recently got a new dr and mentioned this to her and she ordered a 30 day event monitor and was then referred to a cardiologist who told me I had a secondary heart block.  The cardiologist said I likely had type I and would never have to see her again unless I had other symptoms, especially palpitations during exercise.  Since then I have had them during exercise and have some other electrical "issues" with my heart that the cardiologist is concerned about and are being followed-up on.  
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Will your daughter be having a stress test?  That will help with a type I or type II diagnosis.  I will be having one next week.
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They say she is too small (only 6) to have a stress teat.
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There is a way to do a stress test on a 6 year old.....what they did with my daughter (she was 6 at the time) was to run her up and down the hallways with the doctor watching her. You would be surprised at how well that works! My daughter recieved a duel chamber pacer when she was 8.
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Avatar_m_tn
Thanks for your message. Did your daughter showed any symtoms (symptoms) when she received a pacer? Why the doctors decided to give a pacer? we find it it difficult to differentiate between normal tairedness and tairedness related to her condition.
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we think that she is not showing any symptoms..may be we are wrong..
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My daughter would have several dizzy spells every day; sometimes she would be pre-syncopal as well. Her awake resting EKG rates were in the 30s range. When the heart rate is that low, the heart can stop beating. She had several different electrical problems with her heart as well as a hypertrophic cardiomyopathy which is where the muscle of the heart is diseased. The reason they put the pacer in was because her Sinus Node (Sick Sinus Syndrome) did not function well, she also had a Right and Left Bundle Block so there was a block of the impulses in both of the ventricles. They gave her a duel chamber pacer to cover both of those problems. Probably the two main symptoms you will see from your daughter are the two that I have already mentioned: dizziness and presyncopy. She is certainly old enough to tell you about those problems so if she has said nothing, that's probably not a problem for her.I would not start asking her about this because children feed off of their parent's anxiety and then in time, the parent's anxiety transfers over to their child. You do not want that to happen to your daughter. She could become scared over every little thing and start to image things are happening to her heart. The tiredness she has can be a result of many different things. The number one reason children are tired is because they do not get enough sleep. At her age she should be getting at least 10 hours a night, more would be better. Look at the foods she is eating. If she is eating things high in sugar, for example, her blood sugar levels will raise very quickly and then they could drop like a rock. If that happens, she will be very active while she is on a sugar "high" and then she'll crash as that level drops. For the most part, parents are pretty intune with their children's health, they have an instinct for it. If your daughter was having symptoms, you would know and so would she, she's old enough for that. Take care    
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Avatar_f_tn
Forgot to mention: when you are referring to "intermittent sinus rhythm" are you referring to: "sinus arrhythmia"?

Also, just to let you know: MedHelp also has a Pediatric Cardiology Forum for the support of families dealing with heart issues in their children; you are more than welcome to join us over there on that site. Also there is a Expert Pediatric Cardiology Forum where doctors from CHOP answer parent's questions. (There may be a small fee involved on that site, I'm not sure).
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Thank you for your advice which is 100% true and we noticed that our  daughter. So we are not going to talk about her condition at home anymore. However we have to take her for a checkup again in 6 months time. So it is very difficult to hide from her.

The cardiologist mentioned in her report that the 24 hour hotler showed that she has intermittent sinus rythm and intermittent 2:1 heartblock, no pause and  no complete block.
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You'll be fine. Children's ability to gauge time is different than an adult; to your daughter, six months feels more like a year. Don't make a big deal about the appointment and she will not think too much about it. Make a big deal about it and it will start to become a big focus in her life. When that happens, everything becomes a problem with her heart, as far as she sees it, and in the long run it will become a "cry wolf" senerio. That is exactly what you do not want because then you will lose the ability to determine if there is a real problem going on with her. I was very lucky that we did not go through this with my daughter, but I have worked in the cardiology field as well as have spent countless nights on a pediatric floor and in ICU's to have seen a lot of situations like this. One of the things you have mentioned in your posts have been "intermittent sinus rhythm". What do you mean by that? I am taking it that what this actually means is: "intermittent sinus arrhythmia". This is normal and is seen a lot in EKGs, especially in children. When a person breathes in, the heart rate speeds up and when they exhale, the heart rate slows down. Take care
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Avatar_f_tn
You'll be fine. Children's ability to gauge time is different than an adult; to your daughter, six months feels more like a year. Don't make a big deal about the appointment and she will not think too much about it. Make a big deal about it and it will start to become a big focus in her life. When that happens, everything becomes a problem with her heart, as far as she sees it, and in the long run it will become a "cry wolf" senerio. That is exactly what you do not want because then you will lose the ability to determine if there is a real problem going on with her. I was very lucky that we did not go through this with my daughter, but I have worked in the cardiology field as well as have spent countless nights on a pediatric floor and in ICU's to have seen a lot of situations like this. One of the things you have mentioned in your posts have been "intermittent sinus rhythm". What do you mean by that? I am taking it that what this actually means is: "intermittent sinus arrhythmia". This is normal and is seen a lot in EKGs, especially in children. When a person breathes in, the heart rate speeds up and when they exhale, the heart rate slows down. Take care
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Avatar_m_tn
Today we took our daughter out at 1 pm and let her play in a park until 3 pm. When we came back she looked taired and down. One stage she cried and said she wanted to lie down..before she went to sleep she ask her mother " mummy everything ok?" I am worried.....She sleeps with her brother and he wakes up 2-3 times in the nights for milk..Her teacher says during the play-time she looks fine at school.
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