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pediatric tachycardia

I hope you can shed some light on this. For about a year now, my niece has been experiencing random odd bouts of tachycardia, no known trigger. Goes away on its own, although sometimes she feels that when she drinks water it helps to calm her heart. Other than feeling her heart beating like crazy, no other symptoms when this happens. Initially she had one elevated TSH test, but since then thyroid has checked out normal -- we don't know what to make of that. She was positive for Lyme's disease a few years back, but then an expert in Philadelphia said this was most definitely a false positive, so he said this is not Lyme's related. Cardiologist said these things can happen in puberty and she will likely outgrow it since they can't find anything else wrong. Everyone is uneasy with this explanation, are there any avenues that have not been tried yet? She is otherwise very healthy and active, height and weight proportionate. One doctor said maybe she had POTS, but that does not seem quite right, either. There is no orthostatic intolerance. She's a pretty easy going girl, even with all of this going on, don't think it is anxiety. Any ideas for my $15 fee?
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351246 tn?1379685732
I can understand your concerns about your niece. Apart from the tests you mentioned, I am not sure what other tests were done and hence I am giving you a detailed outline of what all conditions could be responsible and tests which can be done to diagnose this.

Palpitations and tachycardia can occur due to various causes. If your niece can feel her heart beating fast (palpitations) then it could be a normal finding if she is a thin built person. Becoming aware of ones heart beat can further increase its rate due to anxiety. Other than this tachycardia could be due drinking coffee or tea or any drink with caffeine in it. It may not be true in your niece’s case, but as a medical professional I feel obliged to add that certain street drugs also cause tachycardia.

Other common causes of tachycardia are anemia, low or high blood pressure, diabetes, thyroid disorders (especially hyperthyroidism which is probably ruled out in her case), tumors of adrenal gland, electrolyte imbalance (serum electrolytes should be done) or due to arrhythmia (most common being supraventricular tachycardia). If all other causes mentioned are ruled out, then arrhythmias will need to be ruled out.

The best way to diagnose the cause of tachycardia is through wearing a holter. Even children in teens can wear this as they go about their daily activity. This will record her heart beat and blood pressure and give an idea about the heart rate and its pattern.

Having said all this, her doctors may be right. Teens usually have sinus tachycardia, where the point which is responsible for generating the heart rhythm does so at a higher rate than considered normal. This is physiologically seen in fever or after exercise. In children and teenagers this is seen during fast growth spurts. This can be evident if a holter test is performed. This will settle down as she grows older.

Also, often children do not appear anxious but are so. Hence, if her parents or someone close could maintain a diary without her knowledge regarding her episodes of tachycardia and the sequence of events that preceded it, then maybe a correlation can be made (children may have a rapid pulse before an exam or an activity class due to the excitement of going for it etc.)

Please discuss all these possibilities with her treating doctors and ask regarding holter. Hope this helps resolve her tachycardia issue! Good Luck and take care!
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