My teenage daughter has been diagnosed with pac's and pvc's, we don't know which one she gets more often, about 4 years ago. She has had multiple ekg's done, 2 echo cardiograms done, and 2 CT scans of the chest done with contrast, as well as a few chest x-rays, a holter monitor and an event monitor, although one of the chest CT scans was for a different issue. All the tests have come back completely normal with the exception of finding the occasional pac/pvc no ectopy . Anyways, she's usually had these palipations very infrequently and they seemed to cluster closer to her period, where she may get two or three a day for 2 days prior to her period and then she wouldn't get them again for another month.
The last few days though she has gotten them much more frequently, she gets them at least 20 or 30 times a day and it's been that way for about a week. Her period isn't due for quite some time, she's not taking any medications, she's stayed away from caffeine including chocolate. She has been getting an average of, according to her, 7-8 hours of sleep a night. We just can't figure out why the sudden increase in the palpitations.
My question is, does this sudden increase warrant yet another trip to the doctor's office or is it really not anything to worry about? They don't seem to be causing any other symptoms except they are starting to make her a bit nervous and she claims that she's been having a fast heart rate although that seems to go part and parcel with the nerves. Should we be doing more about these things or are they harmless despite the fact that they seemed to increase out of nowhere?
Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) can be benign or they can also be a sign of another problem. Without seeing your daughter’s heart rhythm strips, it is difficult to tell what these are. There are a few things that I can say, though. First, both PACs and PVCs are seen in children and adolescents. As you mentioned, they can be worsened with caffeine, although she is already avoiding those. The concerns come under several circumstances, though: if she has sustained palpitations (3 or more in a row), if she has more than one morphology (waveform appearance) of the PVCs, if the PVCs get worse with exercise stress testing (not better), or if there are more than about 1400 PVCs/day. If these suppress with exercise and she’s having just a few of them, these are likely benign. Unfortunately, medication therapy for these is not without side effects, including the likelihood of increasing other arrhythmias. As well, since this has been a chronic problem over the last 4 years, the likelihood that this is benign is higher, though not guaranteed.
Finally, from a general cardiac health standpoint, adolescents typically need 10-14 hours of sleep per night, so you may want to help her sleep more, or get help for her with this.
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