5 Year Old Enlarged Right Heart

[KC42]

My 5 year old was having difficulty breathing during a nap recently (new behavior) and I called the pediatrician.  They checked his oxygen levels and they appeared fine.  His father had WPW with 2 surgeries.  They did an EKG on my son to check for WPW.  No sign of WPW - however, they found possible right side heart enlargement but wanted to re-do the test to see if the leads were just improperly placed.  Upon a repeat test - moving the leads - my son was very still and did good breathing during the test - they called and said they found the same result and referred us to a pediatric cardiologist for follow up ultrasound to check for valve or flow problems.  My son has also been experiencing recurring fevers with no other real symptoms except a cough and complaining of his belly hurting.  No intestinal issues - no vomiting or diarrhea.  He has been referred to an immunologist a few years ago after recurring high fevers and that dr said it was lingering effects of fifths disease.  Since then he has been sick often - but just a fever and cough.  His lymph nodes in his neck are frequently swollen adn stick out prominently.  Whenever he spikes a fever the lymph nodes are very visibile and sore to the touch.  We are just finishing up the third round of 102 fevers lasting 2-3 days each nearly exactly 2 weeks apart.  Do you have any ideas?  I have looked into carditis, myopathy, and right ventricular wall motion abnormality.  He has complained that he feels tired or out of breath a few times in the past 2 months - also his heart rate has been 120-140 on a regular basis.  He complains that sometimes it feels jumpy (his heart rate).  Any ideas would be great.  We see the ped cardiologist next week.  I am hoping for some answers.  Oh - and I have always thought my son looked puffy - his face, hands etc.  Not overly swollen - just puffy and lacking defintion.

[Jeffrey R Boris, M.D.]

Dear KC,

It is difficult to give answers here, since I have no real information from a cardiac standpoint.  It will be more important to see the pediatric cardiologist for evaluation.  However, the diagnosis that comes to mind with the ECG suggesting right ventricular enlargement is atrial septal defect (ASD), a hold between the upper two chambers of the heart.  If that is what he has, it should be repaired, but is easily done.  I think the other cardiac diseases that you list after your internet search are only going to be confusing and much less likely to be the cause of your son’s problems.  I wish you good luck with your cardiology evaluation.  I also would recommend that you make sure that you get all of your questions answered to your satisfaction; if you feel that this is not happening, you can certainly seek a second opinion.

[KC42]

Thank you for your comments.  My son met with his new pediatrician yesterday.  She also felt that ASD was a likely culprit.  She noticed that all the bloodwork he had ever had done showed a high hemoglobin count which she said was consistent with cardiac issues.  She also said that if the heart issues didn't answer the lowered immunity issues that she wanted to investigate some immunoglobulin deficiencies.  I am anxious for our consult tomorrow with the pediatric cardiologist to hopefully get some answers.