Pediatric Heart Expert Forum
What should i do
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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What should i do

My son is 7 years old and these episodes began 3 months ago.  They first started when he was playin in the jungle gym.  He was suddenly very faint, pale, sweaty, said he was short of his breath and his heart hurt.  I took him to the hopsital and they performed an ecg which was normal (he had fully recovered bythe time we got there).  
It happened agin a few weeks later, again during exercise and again he was recovered by the time we reached casualty, again ecg was normal.  At this point a referal was sent to a paediatric cardiologist and we was told not to let him have any exercise until then.  
His appointment is in a month and we have had almost 6 weeks where he has been fine - until recently!
4 days ago his school called an ambulance.  He was very short of breath, dizzy, clammy, grey with bluish lips complaining of chest pain, he had been playing with his friends on the yard.  He had almost recovered bythe time the amb arrived although he needed o2 therapy on route, ecg was normal.  
Then same again the folowing day and the day after that, he has had a chest xray and a 24 hr ecg which were both normal.  He says he feels dizzy most of the time and is always short of breath, he describes this as a feeling that he cant really get enough in and needs to take a big breath.  He is very pale all the time and really doesnt lok himself.  
Im wondering if i should stop taking him to casualty when this happens as its having a massive effect on his day to day life, and he always recovers himself, perhaps we should just wait and see, and keep a diary to show the cardiologist.  Any advice would be greatly appreciated as every time he goes to hsop we see another doc who has a different oppinion and now we just feel very confused and frustrated. thanks xx
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Dear Maxli,

The thing that you need to keep in mind about an emergency department is that their job is to make sure that patients are not dying of something acutely (like a heart attack).  Once that is established, they do whatever stabilization is required and let the patient go with plans to follow-up with the patient’s primary care provider (PCP).  Therefore, they are not going to be able to give you a consistent management plan, which is certainly going to be confusing.  

I can’t say exactly what is happening with your son at this point.  He may have typical neurocardiogenic syncope (fainting) or he may have an arrhythmia (abnormal heart rhythm).  At minimum, I would make sure that he is drinking 32 ounces of fluid a day, having a salty snack, not skipping meals, and not having any caffeine intake.  If this is syncope, there are medications that can be helpful for this, as well, if this initial intervention is not working.  That said, if this is, in fact, due to an arrhythmia, it would be appropriate to not have him exercise until he undergoes his cardiology evaluation.  Either way, it will be important for him to be seen and have more of a complete evaluation.
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