Cardiac arrhythmias are very common in children. Even more common are frightened parents who notice that their child's heart is beating a little faster than they think it should. Pediatrician Marija Lakićević has encountered both of these cases many times. He says that the practice is to refer every child whose parents complain about this problem to the Health Center to a pediatric cardiologist, just in case.
"When they come to the doctor's office with this problem, the parents are, of course, scared. What I can do at that moment is to listen to the child's heartbeat, measure the pulse, evaluate the general condition of the child. However, I usually give a referral to a cardiologist, because I think that in such cases it is necessary to perform an ECG, regardless of whether the child complained of irregular heartbeat or the parent noticed. Of course, most of the time everything is fine with the child's heart, but in such cases caution is necessary," says our interlocutor.
Rarely the disease in question
Normal (physiological) heart rate variations are very common in children. And in such cases, it is by no means a disease. However, there are pathological tachycardias (rapid heartbeat) that can be very dangerous, although they occur very rarely.
"In children, it is somewhat difficult to determine the normal values of the heart rate, because they depend on the age, but also on the body weight and height of the child. Also, some conditions change the heart rate. For example, an elevated body temperature always goes with an acceleration of the heart rate and it's completely normal. However, for most parents, this symptom causes fear and running to the pediatrician. Also, there is a rule - the smaller the child, the faster the heart works. Thus, at birth, the upper limit is about 220 beats per minute, while during the first the heart should not work faster than 160-180 beats per minute. For preschoolers, the upper limit is about 120/min, and school children and adolescents are considered adults, so any frequency over 100 beats per minute is tachycardia that should be check with a pediatrician," warns Dr. Lakićević.
What can tachycardia indicate?
"In cardiology, there are two groups of children who suffer from tachycardia. The first group consists of children who have a congenital or acquired heart disease and are regularly monitored by a cardiologist. During this monitoring, the appearance of tachycardia can be expected, which the doctors explain to the parents. And the pediatricians who monitor such patients are quickly referred to a pediatric cardiologist when they suspect tachycardia. These patients require special attention and should be seen by a pediatric cardiologist as soon as possible because prolonged heart palpitations can exhaust an already damaged heart. Another group of children are those who do not have overt heart disease but still have tachycardia. Namely, when these children are examined in detail, no congenital heart defect or any acquired heart disease that is the cause of tachycardia can be found. The causes of tachycardia in these children are hidden in fine changes in the structure of the heart that cannot be seen on an ultrasound examination, which is the main diagnostic procedure in assessing the structure and function of the heart. That's why children like this are examined by pediatric cardiologists who deal with arrhythmias (arrhythmologists) who use special diagnostic methods to establish the diagnosis," explains our interlocutor.
Diagnosis
In addition to a detailed examination, which includes a heart examination, the first step towards diagnosis is an EKG.
"The electrocardiogram provides information about the type of possible rhythm disturbance, but it lasts a short time (usually no longer than 30 to 40 seconds), so it is not always possible to catch tachycardia. When a child has frequent heart palpitations, a 24-hour ECG recording is also planned, which is called holter. This diagnostic method is decided by a cardiologist who also interprets the findings," says Dr. Lakićević.
How are tachycardias treated?
Our interlocutor says that most children's tachycardias are not treated.
"Tachycardias in themselves are not a disease, they are possibly a symptom of some disease. Therefore, first of all, the cause that led to the acceleration of the heart's work should be eliminated. For example, when we lower the body temperature, the tachycardia also passes. The treatment of the vast majority of tachycardias (which require therapy) is is carried out with drugs called antiarrhythmics. The therapy is prescribed by specially trained pediatric cardiologists, and the treatment requires a lot of patience on the part of the child, the parents, and the doctor. When the drugs do not work, or when it is clear that it is a permanent rhythm disorder (which will not go away with growth and the definitive formation of the child's heart) resort to catheterization of the heart and the performance of a special examination called an electrophysiological study. The doctor examines the heart and looks for the place that is the cause of the rapid heartbeat. Once that place is found, further steps are determined that are really only in the domain of children cardiologist", says doctor Lakićević.
See a doctor urgently when:
- If a child with palpitations has dizziness, lightheadedness or loss of consciousness
- If the child complains that his heart is working unusually fast and hard during physical activity, and then he also has dizziness and weakness
- Examination is also mandatory for children who feel a sudden and very fast heartbeat out of pure calm. This palpitation also stops suddenly and it is very important to catch it on the EKG
"Short-term and harmless tachycardias (without dizziness, weakness, sweating, lightheadedness) are usually the result of children's growth and development, but also of their emotional status, and are not a reason to go to the doctor. When they last a long time, when children complain that they are difficult to bear, or if occur too often, you should contact the pediatrician who follows the child and who will decide whether there is a need to refer the child to a pediatric cardiologist for examination," concludes Dr. Lakićević.
Situations in which the heart should work faster
These are so-called physiological tachycardias that should be distinguished from pathological ones that require monitoring or treatment. The common characteristic of these harmless tachycardias is that they stop when their cause ceases.
Physical activity
During physical exertion, the body needs more oxygen and nutrients, so the heart simply has to work faster to meet the needs of a child playing or playing sports. That's why it's normal for the heart to pump faster during physical effort, so preschoolers are considered to have a normal heart rate of up to 200 per minute (with greater efforts, even more). Older children and adolescents rarely measure more than 190 beats per minute during normal physical activities. What is key to a good assessment is that with the cessation of physical exertion, there is a gradual normalization of the heart's work within a few minutes.
Emotional stress
Similar to physical activity, emotional stress normally accelerates heart rate. Then, in addition to heart palpitations, the child sometimes complains of tightness and stabbing in the chest, and often of inability to breathe and tingling in the hands. This usually happens with emotional children who, again, do not show their emotions. Adolescents complain of these complaints much more often than younger children. When such children calm down, when they are given support and comfort, their heart palpitations also stop. This group of throbbing also includes normal reactions to pain and other unpleasant sensations.
Increased body temperature
A high body temperature leads to a normal acceleration of the heart's work. We can safely say that the characteristic of a healthy heart is that it works rapidly during a high temperature. That's why it shouldn't worry you. When the temperature normalizes, the heart slowly calms down.
Low blood pressure
It is similar in children who suffer from lower arterial pressure, who, as a rule, have a slightly faster heart rate than children who have normal values of arterial tension.
Dehydration
When a child loses fluid (for example, with vomiting and diarrhea), the heart tries to compensate for the lack of fluid, so it works faster.
Inhalation therapy
Children who inhale drugs for bronchitis or asthma often report that their heart beats faster. This is an expected phenomenon - tachycardia is a regular companion of inhalations, but it is also a normal reaction to these drugs that widen the narrowed airways, but also accelerate the heartbeat. There are also diseases that directly accelerate the heart's work. Such is hyperthyroidism, where the thyroid gland produces too many hormones that lead to an accelerated heart rate. And some neurological diseases (for example, epileptic seizures) cause an acceleration of the heart, which is completely expected.
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