questionable pelpatations in 4 yr. old

[momtofourboys]

Okay I have posted once before and I will very qucikly review Christopher's history since it is a long one.
he has had a Large VSD, ASD and something else repaired at 3 month. he currently has asthma. pectus ex, right bundle branch block, right vent. outflow tract obstruction, pulmonary
stenosis, PFO, can get tachycardic, and rapid breathing. shortness of breath when walking or running turns blue when talking 3-4 words at a time. occasionally has left sided chest pain
which goes away after 20-30 minutes of resting. now the past couple of says when he does any type of excercise, he says MOMMY I CAN FEEL MY HEART
he points to the left of his surgical scar
he is 4 years old. I don't know but I have a feeling it is some sort of palpitationsHeart palpitations. could this be right? should I worry. at rest his HR was 126. VERY RARELY does it go below 110.
I did call his Primary care doctor, but he was off today and will be in tomorrow, yes they do have hours over the weekend. I don't know if I am just over reacting. I would love to have a  ct scan and a stress test done on him. but I don't believe this is possible
sorry for all of the misspelled words  What is a normal heart beat in a 4 year old male at rest, same as respirations and BP
thanks in advance
Michelle

[LukeL]

I see you live in Vermont. There are some excellent Children's hospitals in Boston and Philldelphia. I am also sure New York has some top notch hospitals. While it is somewhat far away Johns Hopkins in Baltimore would also be an excellent choice.

[momtofourboys]

i must add in the last part of the post I said his murmur was a grade 3/6-4/6 prior to running and after her ran it went back down to 1/6-2/6
he also doesn't turn blue EVERY time he runs. his heart rate will pick up and then drop (180 then go to mid 50-low 60's)
michelle

[momtofourboys]

I do understand that it can not be done over the internet. He does see a pedi. cardiologist. all he says is that it is his asthma doing it to him. Chris does have bidirectional flow at times I guess it is not all of the time. I just wished I could get some  one near by that will listen. the cardiologist never even documented that he has chest pain. Chris did have a holter for 24 hours, but his shirt loved to wear those little sticky pads instead. I am now obtaining a BP cuff, not an automatic one the old fashion one. and just keep pushing the cardiologist. his PCP has seen him run and just stop after running 2 cirlces around inside of the offices and saying I can go I am too tired. PRIOR to hiim running his PCP said him murmur wasa grade 3-4 when it usually it a 1-2. (prior to his surgery it  was a 6/6) the cardioligist doesn't believe his PCP
maybe I will have to buy 3 plane tickets out to Cleveland
Thank you for your support in knowing that I am not going CRAZY.
Michelle

[Cleveland Clinic]

I am sorry, but I am not a pediatric cardiologist. But I can tell you that he does not have a 'normal' 4 year old heart, by your description he has at least RVOT obstruction, pulmonic stenosis  and a PFO. Given this you need to have a pediatric cardiologist following him on a regular basis, and not simply a PCP, as this is something that he is certainly not used to dealing with.
By your description of his sympotms, he turns blue after mild exertion, and this suggest cyanosis and reversal of flow across the PFO from left to right to right to left. THis shunt, caused by the pulmonary hypertension and/or RVOT obstruction, causes the blood to bypass the lungs and cause sstemic desaturation. In adults, cyanosis with this mild exertion, tachycardia and chest pains are all reasons for repeat non invasive imaging, including an echocardiogramn and Holter monitor, as these patients can frequently have VT from prior scar site.
But, once again, I want to reinforce to you that he needs a Local Pediatric Cardiologist to evaluate him for the development of any of these complications and close follow up. This a complex congenital case that can not be correctly diagnosed or treated over the internet.