fast heart beat- 4 year old

[Lori484]

My 4 year old (5 in a few days) complained two days ago about her heart beating fast.  She also said her belly "hurt" and was pretty lethargic -  she then vomited in the afternoon, she blamed it on her morning snack.  She said she ate too much cheese- school gave her cheese and crackers.  Anyway, the rest of the day she rested, and ate next to nothing.  She was a little better yesterday, and today was fine.  Until tonight-  she all of a sudden thought she was going to throw up again.  She didn't...  But then she said her heart was beating really fast. I felt her chest this time, and I did feel her heart beating "hard" and fast...  

I am not sure these issues are connected or not.  She has never vomited just one time-  She has only vomited when she had the flu last winter.

Should I be concerned?

[Marie M Gleason, M.D.]

It is a normal physiologic response for the heart rate to speed up at times of stress, fever, or illness and feeling sick and vomiting is one of them.  If a person was going to be sick because of a pathologic fast heart rate, that would be an arrhythmia called supraventricular tachycardia (SVT) or ventricular tachycardia (VT).  So if your child mentions a fast heart rate again, the best thing to do is to obtain an accurate pulse rate by using the radial pulse (wrist) or the carotid pulse (neck): count for 30 seconds and then double it.  That gives you the heart rate in a minute. Do not just feel the chest wall--that is an inaccurate way to get the heart rate. Most children in this age group have a resting heart rate between 80 and 110 beats per minute, so anything much above that feels fast to them.  Likely any number under 130 is just sinus tachycardia (the normal heart rate speeded up due to stress).  In the absence of fever, anything over 160 at rest could be a true arrhythmia and you should talk to your primary doctor about getting an ECG and perhaps seeing a cardiologist.  In your child's case, most likely there is nothing amiss.

[Lori484]

Thank you for your quick response.  I took my daughter to her ped today.  She gave me a script for an EKG and said I could take her right away, or watch her and if it continues to take her.  She listened to her heart for 1 minute and said it sounded great and was perfect for her age, etc.  She also felt her belly and said it was soft and felt good.  I will use your guide to measure her HR if it happens again.  Thanks for the information it will help me understand her next episode better-  I hope there is not a "next" episode.