hr 44 in a 17 y/o boy

[pkause]

recently a boy was brought to office for a hr 44 b/p 80/60 peripheral cyanosis, fatigue and nocturnal chest pain..........question is , why at 17 and what are some of the causes if blood work is neg and echo is neg?
are there any other tests and may he need a pacemaker for the rest of his life?

[dolfnlvr]

I had an EXTREMELY low HR when I was 17.  I was anorexic and had a HR of 35 BPM.  They put me on a holter monitor and did various tests to see if the structure of my heart was sound.  Thing is...it scared me enough to make me start eating more and Voila...increased HR.  

I wasn't to the point of no return, but I had lowered my caloric intake to <700 cal/day and it made my metabolism so low it slowed the HR.  I'm not at all saying that this is the CAUSE of this boy's issues.  But what I am saying is that a doctor will run various and assorted cardiac tests to see whether the heart is in trouble or if it is a problem somewhere else that is affecting his HR.  

There are MANY things that can cause this, as Artaud said.  Seek medical advice and follow through with the testing.  You'll know more soon.

Good luck

[Artaud]

Hi,

Just a guess, but perhaps the SA Node is damaged or diseased. The SA Node, really a grouping of cells in the Atrial Area of the Heart, are responsible for controlling the Heart Rate. If the SA Node fails to function, the AV Node, between the Atria and Ventricles, will discharge and maintain the heart rate, although much slower then the SA Node Rate. A viruses have been known to attack the heart, I have a friend so afflicted. He spent a few days in the hospital and they almost Cardioconverted him to try and restore the rhythm, but they were successful enough with medications. To this day he has no discernable Heart Rhythm, just feels like a lot of random stuff.

Blood work and Echo is negative, but I guess an EKG has been done as well? This should show the Electrical Activity of the Heart, and whether or not the SA Node is functioning. In the absence of a normal SA Node, or at least a normally functioning one, an External Pacemaker may be needed to maintain the rate sufficiently.

Also, the Vagal Nerve acts on the SA Node, causing the heart to slow after the Fight or Flight reflex, and can, at times, be too profound in its effect on the SA Node. Perhaps a problem lies with the Vagal Nervous System rather than the SA Node itself. Do some research on [ vagal nerve attack ] without the brackets of course.

Hypothyroidism?

Illicit drug or substance use should be considered. Although the Blood Work purportedly was normal, this likely was for the usual blood counts, electrolytes, etc., and not for abused substances. Even in the absence of these substances in the blood, could there be a possibility that illicit use of substances could be a cause?

Is the patient chronic or is this an acute episode.

Just a few thoughts. I hope he is aggresively following up on this problem with a Doctor, an Internist may be a good choice due to the possibility that the problem may not be heart related.

I wish him well.