fainiting spell at school, mildly abnormal ekg

[momoftwo74]

Hi. I have a 9 year old son.He is active and healthy.He does have heartburn sometimes for which a pediatric GI doc prescribed  Zantac He only has to take Zantac on occasion. He is small for his age (idiopathic constitutional growth delay).A few days ago,he began to complain of feeling achy& tired.Snce there have been some viruses circulating at school,I assumed he just picked up a cold virus.Yesterday he went to school,shortly after getting off of the bus,he fainted in the hallway.EMTs were called & when I got there he was awake, but still feeling shaky and weak.Vitals were ok,so I opted to take him to the ER.ER doc did EKG & bloodwork, lu test,strep test (all neg). ER doc read EKG as normal.Later,the hospital called and said that my son's EKG was read by Cardiologist from the SIbley Heart Center in Atlanta (I live in metro area). I was told that EKG was mildly abnormal and to followup next week after Labor day at Sibley Center. Today my son still doesnt feel great. He will be up and fine & then complains of headache and queasiness which passes if he lies down for a minute. In retrospect, I do recall that he complained of mild chest pain  Thurs. night, which we both thought was related to his heartburn. The only other time his heart has been mentioned at all was his last two wellchild appointments (two docs at the Ped. Office), they have listened and then rechecked his heart. Both have said that they hear a slight murmur, and both said they though it was benign and/or what they heard is normal since my son has a thin chest wall (?). Its hard to be told to wait until Tuesday to talk to cardiologist. I would like to at least speak on the phone to him and talk to him about my son's current symptoms (headache and quesiness) and the results, but Wellstar hospital wouldnt tell me who the doc is so that the Sibley center could page him. If you have any advice for me about what might be going on with my son, it would be greatly appreciated.

[Jeffrey R Boris, M.D.]

Dear Mom

Although I’m not able to fully evaluate your son, I can say that it is quite common to have syncope (passing out) in the context of a viral syndrome.  It can lower the threshold for the autonomic nervous system to be somewhat more unstable and allow for this.  I agree with the initial intervention of increasing fluid and salt; I usually recommend four 8 ounce glasses of fluid a day plus a salty snack for someone his age.  As well, he should not skip meals and should have no caffeine.  I would let him get through this viral syndrome, which can sometimes take up to 2 weeks to resolve, and finding out whether this is truly chronic before a diagnosis of dysautonomia is given.  Common things being common, the most likely diagnosis here is not autonomic nervous system dysfunction, unless there is more of a chronic problem.

[mamiJ]

it sounds like it could be dysautonomia...my daughter had the same symptoms.

they had her on meds, but now she is just on a high salt diet with increased fluid intake.

I wish you the best.

Thanks!

[EchoTech]

I am not a doctor.

The pediatric cardiologist will be able to help you more and give you a more definitive answer at the office visit where they can examine your son and do any appropriate testing that might be needed.  The doctor could talk to you over the phone, but  it would be speculation to some degree without doing the physical exam and tests.  It would appear that your son is generally stable, so it is probably okay to wait for Tuesday, though I know that's one of the last things you want to do.

good luck.

[momoftwo74]

mamij, You were absolutely right. The cardiologist diagnosed him with Autonomic Dysfunction/Neurocardiogenic Syncope. We are going to try to control his symptoms without meds...push fluids and add more salt to his diet. If he faints again the doc will try meds. In the last few days he has been able to recognize presyncope signs and sit or lie down etc so that he doesn't faint. He has the pre syncope symptoms about once every couple hours. Did your daughter ever have them this often, and did she feel fatigued throughout the day? (My son is tiring more easily). Thanks for the comment. Its comforting somewhat to learn that this is generally a benign condition, its more disruptive than dangerous.

MM