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PAC's in 5 year old with ADHD
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PAC's in 5 year old with ADHD

My son's EKG showed he has premature atrial contractions. We are currently scheduled to see a pediatric cardiologist, but not until July. I was wondering, with his hyper activity, is there anything I should be very concerned with or keep an eye out for?

*He is also on Concerta for his ADHD, if that makes any difference.
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Dear Natemomma,

Isolated premature atrial contractions (PAC’s) are early beats that originate somewhere in the upper chambers of the heart, the atria.  PAC’s are likely not a large risk for your son, especially if there are few of them.  I don’t have all of the information on how frequently these are occurring, though; my guess is that your cardiology evaluation may include what is called a 24-hour Holter monitor.  This is a monitor that records all of the heart beats over a 24 hour period for evaluation.  Your cardiologist will be able to assess how many of these PAC’s are occurring, and if they are occurring more frequently than as just isolated beats, such as in a sustained tachydysrhythmia (abnormal fast heart beat).  

I also don’t know from the history you’ve provided if your son is aware of these beats or not.  The things to look out for would be if he were to tell you that his heart is beating very fast at rest for no good reason.  If this was occurring, that could be a sign that he is having a tachydysrhythmia, and would mean that he should be taken in to the local emergency department if it were to persist for at least 20 minutes or sooner if he has other symptoms like chest pain, dizziness, or passing out.

Finally, a note on Concerta and other stimulant medications:  The stimulants can lower the heart’s threshold for tachydysrhythmias, and may be a risk factor for them, if he is found to have them.  That said, if all he has is isolated PAC’s, make sure to weigh the risks and benefits of stimulant therapy with your doctor, as this will be important in optimizing his ADHD therapy.  PAC’s by themselves, especially when they do not cause symptoms, are not a reason to stop his ADHD therapy.
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