Heart Arrhythmia: Abnormal Heart Beat in Children
Guest: Dr. Anthony Hlavacek – Pediatric Cardiology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Tony Hlavacek who is a pediatric cardiologist here at MUSC’s Children’s Hospital. Let’s talk in this podcast, if we can, Tony, about arrhythmias in children. Just what is an arrhythmia?
Dr. Tony Hlavacek: An arrhythmia is an abnormal heart rhythm. Most children have, if you feel their heart beat, between 80, in an infant, up to 160 to 180 times a minute. An arrhythmia is an abnormal heart rhythm, either too fast or too slow, or irregular.
Dr. Linda Austin: And are these usually abnormalities that children are born with, or do arrhythmias develop as the child matures?
Dr. Tony Hlavacek: Well, your heart is an electrical organ. Children are often born with an abnormal pathway in their heart that will cause an arrhythmia. Now, some of these abnormal pathways won’t manifest until they’re older, in their teenage years, and some of them will manifest when they’re babies. It just depends. So, it’s an abnormality that they’re probably born with but it may or may not show up until they get older.
Dr. Linda Austin: How do you go about evaluating an arrhythmia?
Dr. Tony Hlavacek: The first thing we do is just, as with any other disease, get a good history and physical and we ask about the symptoms. Do they tend to start and stop suddenly? What’s usually going on with these heart rhythms? What is the patient doing when they get them? How do they make them feel? And that will give us some ideas on what type of heart rhythm it is.
We can often do just an electrocardiogram. That’s just a one-time test that we can do in the office. It takes just a minute or so. And we can look at the heart rhythm and see if there’s any evidence of abnormal pathways inside the heart. We can send patients home with a 24-hour EKG in which we can trace their heart rhythm over 24 hours to see if there’s something abnormal going on during that time period.
Then, in some patients, if they get arrhythmias that occur, let’s say, you know, once a week, two times a week, we can send them home with a monitoring device that they can put on their chest and record a heart rhythm whenever it occurs. So if they notice that they’re having an abnormal heart rhythm, they can take this little device out of their purse, or pocket, and put it on their chest and record it and we can look at it over the phone.
Dr. Linda Austin: And how do you go about treating these arrhythmias?
Dr. Tony Hlavacek: Some of these arrhythmias are treatable with medicines, so we can start with some medicines. They can suppress these arrhythmias. Now, we don’t like to put children on medicine for their entire life, so if a patient needs a medicine to treat their arrhythmia, we’ll talk to the family about going in and doing something more definitive.
That usually involves going into the catheterization lab and doing something we call an ablation. With that, we’re able to put tubes inside the heart and track exactly where these abnormal pathways are, or abnormal areas of the heart that are causing this arrhythmia, and get rid of it. We can use freezing or radiofrequency ablation to get rid of these abnormal pathways. That way the patient can be better without medicine.
Dr. Linda Austin: Just as one does in an adult patient with arrhythmia?
Dr. Tony Hlavacek: Correct, exactly.
Dr. Linda Austin: Since children have rapid heart rates anyway, I would imagine that it’s not unusual for a parent to become concerned just watching their child.
Dr. Tony Hlavacek: Right. It’s not uncommon that we see patients in clinic and the parents are concerned that the heart is beating too fast or beating abnormally. Children’s hearts do beat faster than adults. Babies’ heart beats can be up to a 180 beats a minute. And as you get older, your heart rate slows down a little bit. So parents often will feel their child’s chest and notice that the heart’s beating fast and get concerned about it.
We can do tests and figure out whether these fast heart beats are abnormal or not. They’re often normal. It’s also not uncommon for children, or even teenagers or adults, to notice heart beats or skipped beats. Some people might call them palpitations. These are actually quite common and they’re benign; they’re not worrisome. We can do tests to document these and show that these extra or skipped heart beats are often nothing to worry about.
Dr. Linda Austin: Dr. Hlavacek, thank you so much for talking with us today.
Dr. Tony Hlavacek: No problem.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.