Pediatric Chronic Tachycardaia

[EdHill]

Are these normal ranges the appropriate normal ranges to use for pediatric subjects or are there more appropriate normal ranges?

Would the following data from my son, while on methylphenidate for ADHD, indicate any problem in regard to chronic tachycardia that would require follow up by a cardiologist or are the incidences of tachycardia too sporadic and mild to be of any real concern?

Age 5-7 Normal Range = 65-133 bpm  -  Subjects'  mean bpm @ age 5-7 = 129
    Subject @ 7y 6m = 129

Age 8-11 Normal Range = 62-130 bpm  -  Subject's mean bpm @ age 8-11 = 111
    Subject @ 8y 5m = 133H
    Subject @ 8y 8m = 133H
    Subject @ 9y 0m = 125
    Subject @ 9y 4m = 37L
    Subject @ 9y 7m = 129
    Subject @ 9y 10m = 119
    Subject @ 11y 1m = no pulse obtained
    Subject @ 11y 6m = 91
    Subject @ 11y 10m = 135H

Age 12-15 Normal Range = 60-119 bpm  -  Subject'  mean bpm @ age 12-15 = 117
    Subject @ 12y 7m = 108
    Subject @ 12y 11m = 126H

[EdHill]

Thanks for your reply.  We have never observed and he has never complained of any symptoms such as shortness of breath or chest pain. All of these mesurements where taken during visits to his doctor's office (not his favorite place to be) by the medical staff, while sitting. They usually measured the vital signs shortly after he entered the room and before the doctor saw him. None of his doctors or nurses ever mentioned anything concerning possible dehydration or arrhythmias.  His doctors are of course aware of these measurments and have never suggested any further consultations.  I just wanted to  determine whether these incidences of tachycardia would be of any real concern to a cardiologist or if they appear to be mild enough not to worry about them at this point.

[Jeffrey R Boris, M.D.]

Dear Ed,

In comparing your son’s heart rates to another source of standards published in 1979, your son has normal to borderline high heart rates.  We do know that stimulants can raise kids’ heart rates modestly, so it would be important to know whether he was symptomatic with this, or not.  As well, it would be helpful to know if he were drinking adequate fluid on a daily basis, because this can also contribute to higher resting heart rates.  How you measured these heart rates would be important, too; was he standing, sitting, etc., and was the measurement taken directly after walking into the room or after sitting for a few minutes.  Finally, it would be important to know if his heart rhythm was normal or if he was having an arrhythmia at the time.  Since I am not able to evaluate your son directly, my recommendation would be to discuss these findings with your primary care provider, who should be able to take a more complete history and determine whether further cardiology evaluation would actually be necessary.