PVC's after Grand Mal Seizure

[Ihatemednonsense]

Hi, my 17 yro son was found last week, on the ground, across the street from his HS. Apparently he was having a severe Grand Mal Seizure. EMS reported he had been seizing for at least 15 minutes. Verset was administered to stop his seizing. However, he has a history of neg reaction to Versed as well as many other medications. This is due to a medobolic disorder, which causes various reactions and poor metabolizing of all drug's. He also has a rare genetic blood disorder "Porphyria", a history of Atypical seizures, he was infected with Lyme Disease and several Co-infections for many years before being diagnosed and now the diagnosis of CIRS. Unfortunately, he has a genetic defect with the gene which helps to eliminate environmental toxins.

While enroute to the ER His BP started to fall in the ambulance. The Paramedic ran two bag's of IV fluids in an effort to get his Systolic pressure at or above 90. He was also placed on O2 and hooked up to a 12 lead EKG. Once at the ER he received an additional 2 bag's of IV fluid. He was repeatedly asking the same question several hrs after the event had occurred. He was also still lethargic and somewhat altered approximately 4 hrs post arrived to the ER. Since, He continued to question whether he had a GM Seizure or not and was still in a "Daze." He was sent for a catscan to rule out head injury and/or a possible brain tumor.

Strangely, after so many hours had passed since arriving at the ER, he started throwing PVC clusters. They were occuring approximately every 15 minutes or so and he was oblivious to the alarm. He finally asked "what that noise was?" as He had been lying still just starring at the TV.  I simply told him, "Oh, it's nothing, sometimes those little alligator clips aren't clamped on all the way so the alarm goes off." I continued to watch the monitor every time the alarm went off. The monitor stated something to the following, "PVC's alert, bradycardic activity, image being captured." Then, I watched it "screen printing" images of these events which lasted for several minutes. Yet, no one came in his room or said a word about the monitor alarming many, many times? So, I asked the nurse about it and he said "I'll ask the Dr. and get back to you"

When I went outside to call my other children, the nurse told my husband "The Dr. said not to worry about the monitor. The reason the alarm has been going off periodically, is because your son was moving around alot."
WTH? I'm sorry but I was standing rt next to him during several of the alarms, he was completely still and on another planet! He wasn't moving a muscle and I've never heard of PVC showing up because the was moving! I'm confused bc i.e. My FD annual physical which includes a stress test, consists of being hooked up to a 12 lead and riding a stationary bike. Cardiologists use treadmills to conduct stress tests. So, how is it possible my son (who was not moving!) end up with all those PVC alerts while lying in a bed?

Does anyone know if all the alerts from my sons EKG, could truly have been false positive PVC cardiac events? Because, honestly "the explanation we were given for the EKG monitor alerts, makes absolutely no sense to me!"... Thank You in advance for any feedback.

[itdood]

coupla thoughts.

no feelings on my part with caregiver222.  I just wanted to put some info in the post for anyone reading that.  There are a lot of people who get PVCs and when they read that it's going to upset them. So no biggie, I just added some info.

In running down a diagnosis for PVCs, there is a benign bucket and established guidelines to get into that bucket, and established clinical pathways.  It's very complex.   We can even predict the future with that diagnosis.  People who have classified benign PVCs are at no greater risk for sudden cardiac arrest than the general population.  it's well studied.

I'm positive I inherited my propensity to have (and feel) my PVCs from my maternal grandmother.  She had benign PVCs too.  She was always going to the ER, they made her so upset.  She died.  When she was 96.  It wasn't her heart that got her (it was dementia).  The last few years we hoped her heart would give out to spare her more suffering, dang thing wouldn't quit.

One of the things I read in your post about the short EKG run, which won't catch any of the PVCs, is that they can't tell anything from that.  But there is useful info in a short EKG.  They can look for signs of problems with the heart muscle such as conduction problems, signs there might be some blood flow restrictions, or previous damage.  So that's a good thing!   He doesn't have prolong QT, no conduction delays, no wave abnormalities that would indicate muscle issues.

Think about it that way.  A young heart in *good condition* is a force to be reckoned with, there isn't any stopping them.  

But, given your son's other issues, a holter might be a good idea.  I would do a 14 day event monitor.  The 24 hour heart monitors seem to get more complaints on this board.  The 24 hour heart monitors are usually owned and maintained by the cardiology office, and sometimes they really suck at it.

The 14-30 day event monitors are usually owned and operated by the company that makes them.  I used a cardionet monitor when I needed it and it worked great.  Cardionet makes a good monitor and they maintain them well.  They feed the data back usually via cell (mobile).  Mine had great data.  I remember a few months prior they had me on one of their cruddy 24 hour holters and told me it didn't catch anything, which was wrong, but no arguing with these people, they know it all.

Have you made an appointment with a cardiologist yet?  I would do the following to rule it out

Stress test, or perhaps a stress-echo, and echo, and 14 day event.  If that all checks out, then you can move on.

best of luck, you are a great mom!

[jemma116]

Regarding your question re paranoia - You are very concerned parent with regard to the health of your son and this is natural.

Don't take the blood pressure too often in the one day.  You probably already know how to do blood pressure readings (especially as you do it yourself manually), make sure that he is rested and has not been rushing about and has not had a hot drink before taking the reading and tell him not to talk while the reading is being done - this will influence the reading.

Have restrictions on the amount of time he spends playing video games and being on the computer - this is not very good if he suffers from seizures.  Even people who do not get seizures can still get bad migraines and see zigzag bright lights (even with the eyes shut) when they spend too much time at the computer screen.

The chest pains may be to do with the congestion or part of the same virus/bacteria that has caused the ear infection.  This will also explain why he was hearing more noises and not tolerating the noise.  

To help him with regard his congestion and the ear problem that may also be congestion putting pressure on the ear drum, get him to do steam inhalations.  This helps to loosen up any catarrhal congestion and also help to clear the congestion in the Eustachian tube.

To do a steam inhalation, boil up a kettleful of water pour this into a bowl taking care not to get scalded.  Put some Vick or olbas oil or a few drops of any menthol oil into the water.  Bend the head over the bowl and cover the head and the bowl with a towel.  Breathe in the steam through the nose and out through the mouth.  Do this for approximately 10 minutes and try and do this 4 times a day.  This can be done for as long as required without any side effects that you can sometimes get with taking medications for congestion and nasal sprays.

As he has an ear infection and is feeling unwell, keep him at home for a few days, keep him warm and let him rest and give him plenty of warm diluted juices to drink.  Honey and freshly squeezed lemon juice with hot water is very nice if he likes this.  Don't worry too much if he is off his food as long as he is drinking and getting his fluids.  If he likes jello (English jelly) make that and also soups that he likes.

[Ihatemednonsense]

Hi, Tk you all for replying and providing helpful and informative information. I am extremely grateful! Jemma 116, your 100% correct about the nurse in the ER! I feel it was Extremely unprofessional to allow, a cardiac monitor to alarm "countless times" and never even come into the room! Your also correct about notifying the ER Dr. Eventually, they just came in the room and shut the dang monitor off! I admit I'm not your average parent when it comes to medical emergencies. I tend to stay calm and go into EMT mode.

Yet, all things considered we were at the children's ER because... "Our son was found lying in the street by a passing car! (The Drv happened to be one of his teachers!) He was having a severe GM Seizure for at least 15-20 minutes before ES arrived! His BP was dropping in the ambulance and he was completely unconscious the entire ride to the ER! So, I believe this nurses laziness boarders on cruelty! By allowing a young patient and his parents to sit in a room with the EKG alarm going off every 10-15 minutes, after the frightening event (I just described) which brought him to the ER in the first place!

Anywho...I had to pick my son up from school today. BC he started to experience a strange and "unnerving" medical event. During lunch he suddenly started feeling disoriented. He explained the sound of every one talking became very loud and distorted, his vision was blurring in and out, then he started to feel what he described as "sensory overload". He said he had to cover his ears and started feeling somewhat "dazed." His friend told him he didn't look well and should go home. FYI, he suffers from tinnitus, So, I can only assume the experience would feel quite "maddening!"

When I picked him up I called the Dr. and he was seen. I filled the Dr. in on last Weds GM Seizure. As, the Hospital has yet to send him the ER notes, EKG reading and test results. Our Dr. agreed the PVC alarm explanation was "completely asinine!" The Dr. did an EKG today but they only monitor for about a minute. Which, I've never understood because it's seems way too short to catch anything. IDK? My son still has the sinus & ear infection he started antibiotics for 10 days prior to last weeks seizure. Therefore, a new antibiotic was given, we discussed ET tubes and what to do going forward.

My son's ER EKG "PVC's alerts with Bradycardia activity warnings" could have been from so many things! As, mentioned by "itdood" that crossed my mind as well, is the LG amount of IV fluids he received, the residual misfiring of brain activity from such a severe seizure. I believe it could have been from the Versed? It's just simply impossible to tell based on all the factors when you put them together. But I know it had nothing to do with him "moving around!" Not only bc this makes no sense but also due to the fact he wasn't moving at all...

My only concern still is, "I've taken his BP after seizures in the past and the BP monitor has detected "IHB's" on several occasions (BTW the GM Seizures are new!) Typically, I take BP manually. As, I believe "I'm" more accurate than a monitor. But, I decided to double check with the monitor one day, bc I got a very low BP. Well, the BP was the same but I saw the IHB flashing. I took my own BP just to check the monitor and no IHB alert. I checked his BP (+ other vitals) every 15-20 minutes x's 3 as he was recovering and every one had the IHB alert?

IDK, perhaps it's normal to have PVC's post seizure activity? My main issue is, "No Dr. has yet to validated whether or this is "normal" and to be expected. Along, with the drop in his BP and how long it should take for him to recover?" We know his brain stays in the perpetual state of "Sympathetic" response mode, after having SPEC scans done. He complains of chest pain at times but it's not heart related. However, he does have episodes of "air hunger."

I believe the only way to rule out any hidden cardiac problem, is to place him on a portable monitor for several days. Let him go about his every day routine of school, Theatre tech class, playing VIDEO GAMES! (very curious about the computer) texting (which he does alot of) sleeping and during a seizure if he has one...

  Is this paranoia or just being thorough in case there is an underlying disorder?

[Ihatemednonsense]

Hi, first I'd like to Thank you very much for your input. I understand what you're saying about benign PVC's. A few years ago during my FD stress test apparently I threw a couple of PVC's. Subsequently, the Dr. hired for our FD physicals "took me out of service!"  I had to see a Cardiologist and be cleared to return to work. I went to the Cardiologist, he looked at my EKG reading and asked "Why are you here?"

I explained it was mandated and I wasn't very happy about the situation!  The Dr. went on to explain, in general "most people" throw PVC'S during any average day. He also told me, "Unless someone starts throwing hundreds of PVC's throughout the day and don't feel well, there's no reason to be concerned!" Therefore, I understand your point.

With that said, I believe "caregiver222" was making a specific point about "non benign" PVC'S when stating; "There is no such thing as a "benign" PVC (((*IF THEY OCCUR AT A SPECIFIC PLACE IN THE ELECTRICAL WAVE "CALLED R ON T PHENOMENA"))) Now, since I'm only an EMT-B in NC and we don't do EKG's the "R on T phenomena" is Greek to me. However, I would think caregiver222 point was "these types of PVC's are very different and therefore "Not Benign!" I could be wrong but I believe it's probably what caused the difference of opinion?

I simply just appreciate Ya'll taking time to provide me with your opinions! Thanks again and take care. :)

[jemma116]

As you are concerned (as any mother would be), make an appointment for your you and your son to speak with his doctor and ask about a referral to a cardiologist or specific heart tests to rule out any problems.

[itdood]

I disagree with your statement that:  "There is no such thing as a "benign" PVC"

Classifying PVCs as the benign is a common outcome.  It means they are occurring in an otherwise structurally normal heart and meet other certain criteria such as load, frequency, and origination.  These types of PVCs do not indicate heart disease or predict SCD.  It's proven with studies.

We use the term all the time on this board, and I feel a blanket statement like this will cause misinformation and undue alarm.

[caregiver222]

Versed is the flavor of the month. For decades, ordinary valium was the first responders choice for siezures, a drug with a long safety history.

Cutting to the chase, the nurse should have called a physician in, regardless of what happened. To report her will accomplish nothing, but she was wrong.

That being said, premature ventricular contractions are due to a ventricle that is sensitive to stimulation.  The drill in a hospital environment is often to administer a small dose of intravenous lidocaine.

The EKG machine is ocasionally capable of showing "false" look-alike PVC's, called arftifact, which usually shows up when the leads are improperly secured (to a hairy chest without shaving, for example). I

Sometimes there is a "run" of PVC's in the hospital after an accident, trauma, infection, electrolyte imbalance or loss of consciousness. Or even after a few cups of coffee. So if they did exist for a short time, and go away there should be no lasting danger.

There is no such thing as a "benign" PVC. If they occur at a specific place in the electrical wave (called R on T phenomena) the heart can develop ventricular fibrillation. Mother nature, however, seems to have a mechanism that insures this event cascade rarely takes place, especially in a youngster.

Unless they become chronic, there is no need to be concerned.

[itdood]

My experience is that movement wouldn't be detected as a PVC.  Movement usually looks very erratic on an EKG, just jagged nonsense.  A PVC wave is very distinctive and if the computer on the EKG says it detected a PVC I would think it's spot on.

Anyways, I'd need to see the strip to say for sure.

With all that going on, it's probably not a surprise he started throwing PVCs and should return to normal as he stabilized.  There's a more excitable area in the right ventricle, called the Right Ventricular Outflow Tract that can sometimes start to fire.   Think of it as a backup.  If the ventricles do not beat at a minimum every 5 seconds, you will hit the floor.  So if for some reason the single from the atrium doesn't reach the ventricle, cells in the RVOT or in the AV node will fire something called an escape beat.  If this backup fires while there is atrial signals, and both are firing at the same time, it's called a PVC.

I'm speculating, but perhaps after the GM seizure his autonomic nervous system was completely out of whack and not controlling heart rate correctly.  Perhaps it went so low (bradycardia) that escape beats started in the ventricle.  

Then, they loaded him up with so much fluid perhaps that caused somewhat of an electrolyte imbalance, or some other issue with a lot more fluid volume, who knows...  A lot could have been going on.  

So the bottom line is that it was probably a temporary situation given all the other stuff going on, and his heart muscle is fine.

I'm in a recent PVC flare and threw a bunch driving into work today.  The benign variety aren't an indication of bad things to come.

There's a study done on the general population, if you take healthy adults, no heart or blood count issues and monitor them for 3 days, 85% of the people will throw at least 1 PVC.  About 3% will throw more than 500 over those 3 days.