13 yr old male with PVC's and large arm/neck veins

[1211kmeier]

Hi, I'm hoping you can shed some light here.  Last July my then 12 yr old son started having some odd symptoms all at once.  He began having "big beats" as he calls them.  Really hard heart beats then back to normal rythm.  He also started to get light-headed and stated his ears would get all quiet when this was happening.  I noticed his veins in his arms and neck started bulging at that time and had never done that before.  His pediatrician ran lab tests all normal, he was seen by a Cardiologist, they did 3 EKG's, 2 Holter monitors and a 30 day heart monitor.  They said he occassionally had PVC's (premature ventricular contractions) but said it was nothing to worry about.  They weren't convinced that he was pushing the button at the time of the PVC's so reassured us he was fine.  He was also seen by a counselor and neurologist.  They said they didn't think he was having seizures, and we saw a counselor because he pediatrician told us these were probably just panic attacks.  He put him on Buspar and we took him off after just a short while because the "big beats" were becoming more frequent.  Since then, the "big beats" have reamained constant, but other syptoms subsided until this past weekend.  Yesterday he said that when he yawned and stretched he became lightheaded and dizzy again.  Like in the beginning.  Could this just be hormone related?  I know he's changing and growing by leaps and bounds, but he's scared and I don't feel like we've gotten to the bottom of this.  Is it normal for a 13 year old to have swollen veins on his arms and some on his neck?  I asked on of his dr's and he laughed and said he would probably have some too if he were skinny.  I don't feel like anyone is taking us seriously.  I don't think he is fabricating all of this.  I know he tends to worry, his brother passed away three years ago from SIDS, which is why his dr said he is just panicing.  Any suggestions on where we should go from here.  Thank you for your time.

[Jeffrey R Boris, M.D.]

Dear K,

It is normal that it just comes on out of the blue, as kids' systems are quite good at hiding things until they get to a certain point that they can't do so anymore.  And, the rapid growth and hormonal changes of adolescence bring it out much more so.  Best of luck with this.

[Jeffrey R Boris, M.D.]

Dear K,

This definitely sounds like both you and he are concerned; these symptoms do sound scary.  And, unfortunately, I don’t have all the history that I would typically ask someone his age.  It certainly does not sound to me as if he is making this up—he has better things to do, such as try to be a normal adolescent and blend in with his peers, not stand out and be different.  However, as your cardiologist suggests, it sounds as if the premature ventricular contractions (PVCs) and the rest of his symptoms are not related.  The set of symptoms that you are describing sounds to me possibly like he is having what is called neurocardiogenic near-syncope; allow me to explain.  Syncope is the fancy Greek term that we use for passing out; near-syncope is almost passing out.  Syncope occurs when you don’t get enough blood pressure to the brain.  Neurocardiogenic means that the control of this has to do with the nervous system and the cardiovascular system.  The symptoms can include dizziness or lightheadedness, fast or strong heart beats, hearing buzzing/ringing/muffled sounds, seeing spots or tunnel/dark vision, having nausea, and feeling really hot or really cold.  They are brought out by standing up abruptly, stretching, seeing a disturbing sight (like the sight of blood), being in a very warm or crowded location, etc.  It is made worse by something a lot of adolescents do:  they typically don’t drink enough fluid, skip meals, have a fair bit of caffeine intake, or combinations thereof.  And, we see this a lot in adolescents, probably due to growth and hormonal changes, meaning that it usually goes away by adulthood.

So, how do we fix this?  I recommend that he have four 8-12 ounce glasses of fluid (water, juice, milk) per day as well as a salty snack (pretzels, saltines, pickles) in addition to everything he is eating and drinking.  Notice that I didn’t include chips—don’t want to give too much fat!  I also recommend that he not skip meals and that he eliminate caffeine intake (coffee, tea, soda, energy drinks), if he is doing either of these things. This helps about 85% of the patients whom I see who have these symptoms.  There are medications that can help with this, as well, but I like to make sure that these patients are doing these other things first for at least a month before even considering medicine.  Anyway, this is how I would approach what you are describing to me, especially since it sounds like he has had a fairly reasonable evaluation.  Since this does not substitute as a true pediatric cardiology evaluation, I would definitely discuss these thoughts with your cardiologist and see if it sounds like a plausible etiology, since the cardiologist said that the PVCs were “nothing to worry about.”

[1211kmeier]

Thank you for your reply.  I will discuss this with my son's cardiologist.  The symptom's you've described are almost all identical to things he has mentioned since this whole thing started.  I will definiately have him add more fluids and salty snacks.  Is it normal that this would just start suddenly?  He had never experienced anything like this before.  He's otherwise healthy.  He's about 5'7" or 5'8" and growing fast, he's tall and skinny about 130.  The first handful of times this happened he first would grab his head saying he felt funny, he would become instantly flushed, his heart would start racing and he would hear funny things or nothing at all, as the weeks passed he mentioned also seeing spots and sometimes looked like everything was going black. We've had many calls from the nurses office stating he was "dizzy again".   Keeping my fingers crossed this will help things.  Again, thank you for your time in getting back to us.