On the dilated pupils, Low O2 sat can cause pupils to fix and dilate. Your sons 02 sat dropped into the 80% range. Yes something isn't right there. Anytime it drops below the 90s it's bad, and it's exponentially bad. It could cause all those other symptoms you are seeing such as fixed and dilated pupils and the bluing issues. There are a few things I can think of that would lead to a low 02 sat. Poor heart output, pulmonary issues. These issues can then be further broken down.
So low O2 sat seems to be the main issue. But what is causing it?!?!
On the echo, they would have measured his heart's output called ejection fraction and stroke volume. If this wasn't brought up then it's probably normal at rest. I say at rest because it might change under load (exercise).
It seems to me like his heart is beating well, is structurally normal, and he doesn't have any sort of arrhythmia.
I would take the next steps.
Buy an O2 sat monitor for him. These are cheap. I recommend the Nonin Go2 Achieve. Then start monitoring it when he exercises and tell him that if it drops below 92% he needs to stop. Start keeping a log of when it happens and notes.
One of my suspicions is pulmonary hypertension (transient perhaps?). Or possible embolism, blocked artery heading into or out of the lungs.
The other suspicion is the anomalous finding of the extra vein on top of his heart. You didn't say exactly what this is, but some of these can cause circulatory problems. Some of these extra structures can sometimes divert blood flow away from where it should be going. If it's a vein on top of his heart then it's probably a pulmonary vein (vein comeing back from lungs to heart).
Perhaps a pulmonary consult would be a next step?
The only other thing I can think of is some sort of viral infection.
Lisa, I just read this post. Get him to Neuro. He needs MRI to rule out Neuro problems. It can't hurt and you can rule it out. Believe me I know it is so hard to put your foot down. I learned a lot and I am not so nice anymore. Lots of damage to my son. After MRI, you ask the Neuro to read it NOT just radiologist! Demand from your primary care an MRI. Please keep us posted.
Okay, Lisa, then one thing you may want to consider is seeing a nuerologist. Dilated pupils are usually a sign of something going on in the brain. Has he ever had an MRI done or a CAT Scan? I hope you did not take my post the wrong way; I too am a mother so I can ubnderstand your worry and concerns as to what is going on. I have a daughter who has gone through everything from a stroke when she was 10 to a heart transplant when she was 22. The oxygen levels of 86% are not normal, but those levels can be low if the person is a shallow breather. Myself included, when I went in for a proceedure recently my O2 sats were in the high 80s, low 90s. They gave me oxygen and it jumped up to 99-100%. I have HCM so I have a problem with being short of breath at times. Most of the time my O2 sats are around 94-96%. I also have Raynaurds so that thought automatically came to mind. Next time his fingers/nails are blue, check the INSIDES of his mouth. That would be an important clue for a doctor that there could be a heart related issue going on. Paleness around the lips basically no one will think anything about that, they also don't consider blueness around the lips as really being that significant in youngsters. You said his regular doctor stopped him for all of his activities? Did I read that right? If he has hit that level of concern, what else is he doing for your son right now? I can tell you that even with heart disease present there are only a very few conditions where a pediatric cardiologist will restrict a child from sports activities. Have you taken him to the ER when he is feeling like this so that an EKG could be run at that precise time? Hang in there. Also, just to let you know, there is a Pediatric Cardiology Forum here on MedHelp for supporting parents with questions and concerns. You may post over on that site as well.
I can understand why my post is confusing,There is so much more thats going on with this issue of my son.My son is the kid who never ever wants any one to think some thing is wrong with him.He never misses school and takes very good care of his body or he tryes to.The thought of some body thinking he is sick or different from any one else would kill him.See Jacob is not the average teen who wants sympathy trust me I'm the mom of a 23 year old who loves sympathy any way he can get it.I also have a 17year old son he's like Jacob doesn't want any one to know any thing and nothing would ever be wrong with him or sick in any way and I have a 10year old who like my 23 year old he loves that special attention and sympathy when he has the flue.So this is not a sympathy getter thats for sure.May be my post would make people think it was only in march and Dec {we only have so much we can type 8000max}lol The dialated pupils only happen when he has the other symptoms and these only happen when he is exerting exercising.Yes I understand where your coming from {him sneaking in his room and working out}but if you knew him, working out,football any thing physical is what he loves more then any thing.The dialated pupils isn't because its dec.The Raynaurds Phenomenon I am aware of that as well.Raynaurds phenomenon has nothing to do with low oxygen.Raynaurds phen can also becaused by migrain medication and other things but not low oxygen.I appreciate you taking the time to read my post and comment on it.I am not a first time mom who always thinks some thing is wrong with their child.I sure know alot of parents like that.lol.I will keep searching for answers.but again thank you very much.May your day be blessed
There are a couple of things that come to mind for me after reading your post. The dialated pupils; in December, it's dark most places, even in the home where lights have to be turned on; dialated pupils would most likely be normal. That is an automatic response to the dark. People do not understand that a person can drink until he is blue in the face and yet still be dehydrated; the reason for that happening is because along with the drinking, the person must eat plenty of protein, it's the protein that helps to keep the body hydrated, not necessarily the drinking. The test results surprised me; usually if a person is dehydrated, his creatinine and BUN are elevated yet you say his liver enzymes and calcium were. Has he been evaluated by a gastrointestinal specialist for the elvated liver enzymes? Are Have those tests been repeated to see if they are still elevated? Ironically, the darkened eyes are amost assuredly from a lack of sleep. With the amount of sleep your son is getting, he may actually be getting too much sleep and therefore, not sleeping well. The blue fingers could be a result of something called Raynaurds Phenomenon which is where the blood vessels constrict; patients having this problem can't put there hands in cold water or in the freezer, they have to wear mittens all the time because this disorder can be very painful. The problem here is that you never mentioned pain. If you think this could be an issue, you may consider seeing a Rhuematologist. Some children have the blue fingers/nailbeds due to a lack of oxygen, the problem is that they would have found the causing factors for that in the echo, without any difficulty. Children who have chest pain due to heart related issues would have to have a VERY SEVERE form of heart disease in ordser to actually have that pain. That disease would be so self limiting that they would never be able to do 90 push-ups let alone 200. They would be lucky just be able to walk across the room. Pain for most children and teens are a usually caused by the heart beating hard and hitting up against the chest wall; in other words they are having palpitations. That feeling is uncomfortable so they describe it as pain. From what I can tell, it appears your son got sick in March and them again in December, this could just be two unrelated viruses that you are dealing with and not connected at all. Most children who are sick, look sick, they throw up and feel horrible, but that does not mean that every time they get sick, it is related. The fact that he is doing things behind your back (push-ups and sit-ups in his room) makes one question if he is not playing on your sympathies. I am not saying this is what is happening, but I have seen this more than once with teens playing their parents. You have to be honest with yourself and ask yourself if this could be a possibility I think if Jacob was my son, I would consider seeing another cardiologist, if nothing else, just to ease your mind. The idea that he is going to drop dead from a heart issues is pretty close to nil. The main cause of athletes dropping dead during practice/game is usually due to Hypertrophic Cardiomyopathy which would have shown up on the echo. Even in that disease, the death rate is only about 2% . Take him for a second option.
Thank you for your comment,I don't even know where to begine.I guess I will start from scratch because there is deff a problem.Even his primary Doc said{once he had to stop all exercise because of sever symptoms}
"I'm afraid if he continues to exert he is going to drop dead"Thats scary words for a mom to hear.That being said ,why are we not being refered some where?Any way thanks again for reading my long post and commenting. I will keep you posted on what we are going to do next.
I can't say for sure what is going on though it seems obvious your son is having trouble oxygenating when he exercises. I am not an expert on the heart. I know what I know from doing research myself about my svt so I wouldn't begin to know what could be causing your sons problem. It is possible he has afib but I would think that the doctors would have caught that on one of the stress tests. So the two things I would do if I were you would be take him to the ER the next time it happens and/or go for a second opinion. Inform the doctor about the symptoms you found on his computer if he is not speaking up himself. And finally, make sure he hydrates himself before, during and after he exercises, not just after. If you already become dehydrated then you will be sick after even if you start to drink the water. That said, I don't know that I have heard of dehydration causing purple fingers so keep on top of this. Something clearly isn't right. Do your best to have a frank and open conversation with your son as well. Maybe there are some things he isn't telling you. Take care, I hope you get to the bottom of this soon. Keep us posted on how he is doing.