People use the term “palpitations” for a variety of symptoms. Palpitations refer to the sensation of an abnormal heart rhythm, commonly, the heart “racing,” “fluttering” or “skipping a beat, and in some cases are produced by abnormal rhythm of the heart.
How can the pediatric cardiologist rule out arrhythmias in case of ocassional palpitations?
A good history and physical examination are helpful in finding the cause of the palpitations. If the child has fainting along with the racing of the heart, this may indicate a more dangerous heart rhythm problem and should be evaluated by a physician right away.
To diagnose the problem, documentation of the heart rhythm while the patient is having the palpitations will be required. An electrocardiogram done during an office visit may not show the rhythm disturbance but will help to rule out any structural reason for the problem.
Portable monitors that record the heart rhythm outside of the hospital (Holter monitor) are usually the most helpful to diagnose the rhythm. A Holter monitor is a 24-hour recording of the electrical activity of the heart, if the event is very rare you need monitoring for days or weeks, in this case a implantable device could be used (LINQ: small insertable cardiac monitor ideal for patients experiencing infrequent symptoms that require long-term monitoring or ongoing management.)
If the symptoms occur during exercise, an exercise test may be helpful in making the diagnoses.
Currently some devices are developing for recording arrhythmias telematically and the so-called wearables (wireless technology incorporated, devices that allows remote monitoring of the patient’s heart), as examples:
- Alivecor (smartphone wereable), learn more at link
- Nuubo (t-shirt with nanotechnology), learn more at link
All the wearables still are pending updated for clinical use in pediatrics.
How do you treat the palpitations in case of arrhythmias?
Premature atrial and ventricular contractions do not typically need any therapy except staying away from things that make it worse, like caffeine. If they happen so often that they disturb normal daily living, there are some medications or procedures that can be used to try to control them.
There are several medicine and non-medicine treatments for the other causes of palpitations. The key is to make the diagnosis, or at least to rule out any life-threatening rhythms.
Once the type of arrhythmia is diagnosed, it can be treated with medications, but if they are produced by cells that cause an abnormal conduction pathway, they require specific studies called Electrophysiological Studies (EFF), where they can be “ablated” to “break” the electricity through that conduction path.
Electrophysiological Study is a specific type of cardiac catheterization that is performed by arrhythmologists (or EP, cardiologists specialized in arrhythmias) and requires general anesthesia in children.
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