LVH

[spudsmum]

HI - My son, who has Aspergers, has had to attend A&E for the past 2 evenings due to sudden and severe chest pain (the first day he had had 3 smaller, less painful attacks during the day also). Unfortunately the casualty doctors did not see any attack as this had passed by the time we got there.  The first evening I was told he had a slightly abnormal ECG showing up stress to his Left Ventricle in his heart, but as the chest x-ray was clear and blood pressure ok  he was sent home being asked to return if symptoms re-occurred.  The symptoms did re-occur the next night.  Again sudden/severe chest pain (this was following an argument).  He had the ECG repeated, this time they explained more clearly it was Left Ventricular Hypertrophy showing up with a slightly raised ?wave.  He then had a blood test to check for cardiac arrest and angina - this came back clear.  We have now been told bring him back if the symptoms last more than 15 minutes (currrently they've lasted 10ish minutes), if he goes pale or short of breath.  They say they feel this is his stress reaction and nothing to worry about.  He does get stressed a fair amount with 'bullying' at school and mis-understandings in general to do with his Aspergers (which is mild).  I would like to ask, should we be asking for any further investigations?  Is there anymore we should/can do?  We did also tell them that this has happened (to a lesser degree) when he has been completely unstressed - relevant or not?  His diet is fairly restricted, again due to Aspergers and does contain a high proportion of fat, but he is also good at eating fruit - a lot of this too.  He is extremely thin, noted by A&E also.  As he is still not yet a teenager (almost though) is this a problem that will only get worse with age, or does it remain constant?  Hopefully you can help, with the questions above.  With thanks. SC.

[Jeffrey R Boris, M.D.]

Dear Spudsmum,

I’m not sure what A&E is, but by your description, it sounds like your local version of the urgent care clinic or emergency department.  It sounds like his chest pain is most likely non-cardiac in nature, especially since he had the blood testing as well as the ECG that demonstrated normal findings.  The majority of chest pain in pediatric and adolescent patients is non-cardiac, as well; it typically is what we refer to as “chest wall pain.”  We frequently see this, especially in adolescent patients.  Usually it is sharp and hurts worse with taking in a breath.  It can last seconds, although it can last minutes.  Occasionally, people can be pale with this from a combination of fear, discomfort, and hyperventilation.  It is not associated with stress, and typically resolves with adulthood.

I can not tell whether the finding of left ventricular hypertrophy (LVH) on his ECG is strongly demonstrated or only suggestive, as I don’t have the study (or your son) in front of me to evaluate.  Therefore, I don’t know if more testing is necessary.  If he has strong evidence of LVH or other concerning examination findings, then further evaluation by a pediatric cardiologist would be indicated, including consideration of an echocardiogram (cardiac ultrasound).

[spudsmum]

Many thanks for your quick reply.
We live in the UK and yes, A&E is Accident & Emergency - like your Emergency Dept. I guess!  
I'm afraid I cannot clarify wether the LVH was 'strongly demonstrated or only suggestive' as this was not made very clear.  The only comment is that he had an ECG on both visits which showed this LVH. Following the second one they explained it meant he had thickening to the muscle wall of the Left Ventricle (as a non-medic that's as best as I understand it!).  I forgot to mention alongside the blood tests, he did also have a blood pressure test, one to the arm, followed by one to the leg to see if there were any differences.  There was a minor difference, but they felt not enough to be concerned.
Anyhow, you have put my mind more at rest as I feel they did probably do everything necessary.
I will ask my family doctor, (who always receives results when a visit to A&E is made) when we next visit whether the findings were strong or suggestive and take from there.
Once again, many thanks for your time and peace of mind!
Spudsmum