To take DS to A&E today

[VoldemortsNipple]

A bit of background. DS (16) has been having dizzy spells for a while now and they seem to be getting worse. He will become dizzy, his breathing becomes laboured and he gets chest pains. If I'm honest, it looks like a panic attack. However DS is naturally not a worrier and they don't seem to be brought on by anxiety. We have been going to the GP to get to the bottom of it since the beginning of the year. I cant fault the GP as she's been brilliant.

DS went for an ecg back in March, which showed a slight problem? We were told it was probably nothing and just down to DSs build. As a precaution the GP asked for a second opinion from the cardiologist. Next thing we know, DS had to have an echocardiogram. I really wasn't worried at this point, I just thought they wanted to rule things out.

When we went back for the results GP said the echo identified that DS's heart muscles were weak. She had spoken to a cardiologist who recommended an MRI scan. She also told DS to take it easy and don't take part in vigorous exercise.

So when we turned up for our appointment which we thought was for an MRI, we find out we were just there to see a Cardiologist. He asked us for a brief history and decided that he wanted to start again from the beginning as from what results he could see, he didn't think DS had a heart condition but did think it needed investigating. He told DS he could exercise and to carry on like normal. He sent him home with a portable heart machine on to record any symptoms. That was 4 weeks ago and we haven't heard anything back.

So for the past week DS has been at a cadet camp. The camp was for higher level cadets and was physically tough. DS took a letter with him from myself explaining that he was undergoing tests but was okay to carry on as normal. During the week, DS has had at least ten attacks, which is way more than normal. Twice the instructions took his to hospital because he was taking a long time to recover. The hospital were happy to let him return to camp as DS was determined to carry on and finish the course. On the way home yesterday, DS had another attack on the minibus and he momentarily blacked out.

He is supposed to be going on another cadet trip in a weeks time for ten days. I can't get an appointment with his GP next week and we still haven't heard from the last hospital appointment. So do you think it would be unreasonable to take him to A&E and see if we can get some answers? I'm not convinced that he doesn't have a heart condition. The Echo results obviously showed there was something going on and the NHS website says panic attack type symptoms can manifest in some heart conditions. I really need some peace of mind before sending him off to another camp.

Sorry for the long post, I didn't want to drip feed.

Glad you've had some reassurance.
Not sure I'd be brave about sending him off to camp again (but then again he's probably quite determined so I can understand letting him go).

Hope it all comes out okay soon.

I can't fault the GP tbh. She as been really good throughout. I feel that she doesn't want to dispute what the cardiologist has said though until she sees some evidence. I've said myself that the attacks look like panic attacks,they just don't fit with ds's demeanour.

The cardiologist is on holiday so no chance of anyone looking at his results until he is back next week. It might be worth speaking to CRY though even for advice on what questions we should be asking.

Even if his heart is slightly... different.. there could be other reasons for the dizzy spells. Which may or may not need treating.

(sorry, I mean reasons physiological not just panic attacks as only alternative)

I would think panic attacks are unlikely unless there has been an incident like a death at the school or close family member dying or witnessing something similar.

I think panic attack is a label attached to young people sometimes when no one knows what is actually going on. People tend to assume young people will not have a serious illness.
Take it with a pinch of salt.

Also I don't really see that panic attack fits with loss of consciousness .

So I'm a cardiologist, name changed for security. Forget looking at scary websites, his symptoms could be a number of things. If he was my patient I'd do an echo (which he's had) and put a monitor on him until we caught an episode. Either he's having an intermittent arrhythmia or it's something else. You won't know until you see it. He should have repeated monitors until an episode is 'caught'. It might even show that his heart is completely normal during the episodes, you never know

It's bollocks that nothing can be done with the result that's sitting on the consultant's desk. The secretary can take it to the on call consultant or one of the registrars and ask them to look at it. If you're concerned I'd ask her to do this and get one of them to ring you if there was an issue. Or get the GP to do this

Other possible tests to look for cardiomyopathy would include an MRI. Anyone in you or your son's father's family had symptoms that are similar?

Taking him to A&E without symptoms is pointless as has been suggested above, they will do nothing new. He will have an ECG that may be normal for a 16 year boy (they have some 'abnormalities' that can be normal for them), an unnecessary chest x Ray and blood tests

If he has an episode while you're there with him take his pulse - could be useful

SVT is common and can be annoying, but is usually treatable. Hypertrophic cardiomyopathy will need follow up and probably a special pacemaker. Lots of other possible genetic arrhythmias it could be. Simple stuff like caffeine, exhaustion, smoking, drugs (not meaning your son necessarily OP, but 16 year olds in general with these symptoms). POTS is a diagnosis of exclusion, doesn't sound like he has this to me

For what it's worth I wouldn't let him go on the trip

Good message Bunny

Wouldnt a tilt table test be used if POTS were suspected?

Yes it would, but his symptoms don't sound like POTS therefore it's not on the list of tests I'd think were important at this stage. His symptoms don't sound like they are provoked by standing up. An exercise test might help (getting him to walk fast on a treadmill whilst hooked up to an ECG) but is not as sensitive in young fit people

POTS is a syndrome really, rather than a pathological problem. People drop their BP and their heart rate goes up when they stand up from sitting, which leads to fainting. Common in young women generally

ChopinLiszt thanks

If he blacks out again, or has difficulty breathing please take him to A&E, because he çoukd we'll need treating straight away, çoukd be hart attack or whatever. I would not be sending him to camp, whilst he is still experiencing symptoms, it will probably put more strain on his heart and it's a lot of responsibility for the leaders, who have others to look after.

I know a good deal about POTs which is why I asked about the the tilt table test as you said it was a diagnosis of exclusion.

Thank you bunnykins

In layman's terms, the first ecg he had done indicated something abnormal with the T wave although they said it was probably normal for ds's build.

I thought that would be the end of it until we received a letter to go for an Echo. The Echo results must have shown some weakness to the muscles, I'm think it's unfair to say they were interpreted wrong. I do remember thinking that the radiographer was spending much longer looking at the side, but this is possibly me reading more into it.

When she received the results, the GP said she had phoned a cardiologist for advice as what to do next and they recommended an MRI. (He never had the MRI but seen a cardiologist instead) So I don't know, maybe the results were at the higher end of normal? He had a few episodes while wearing the cardio monitor so hopefully they will indicate something or nothing.

The cardiologist said he wanted to do his own echo. He said he could read the report but didn't have access to the actual echo. So I think it's worth pushing for this even if the results from the cardio monitor are normal.

Badkitten yes it is, once you've excluded a primary/pathological tachycardia (eg an SVT) causing the symptoms. It's more of an exaggerated 'normal' reaction to standing up. Lots of people have a bit of a drop in BP and an increase in heart rate on standing and feel dizzy, if this is more exaggerated it becomes a problem. It's hard to treat successfully. I assume you have been diagnosed with it.....? Autonomic dysfunction is another name for it I suppose. It will be apparent on a tilt table test, which can confirm the syndrome and exclude other pathologies. It is a diagnosis of exclusion because you cannot diagnose POTS without ruling out a primary tachycardia as the cause for the drop in BP and subsequent symptoms. It's a bit of a medical term, sorry if I'm just causing more confusion. It doesn't mean it's less of a diagnosis, just one that you can't come to until ruling out other things first. I hope that makes sense

Voldemort hopefully the monitor will be helpful then, I hope you get some answers. If he wants to repeat the echo he must want to see the bit that was described as weak for himself to be sure there was something there, or whether perhaps the previous person was over cautious with their assessment

I hope so Bunnykins

I suppose I'm typical in that I obviously want everything to come back clear, but at the same time I want ds's symptoms to mean something. Otherwise you feel like a bit of a fraud and a time waster. I'm sure nobody actually thinks this but it's just how I feel.

There's definitely room for interpretation and user variability with echos so I'd push for the cardiologist to repeat the echo himself. He can decide based on that the merit of an MRI. I'm glad that he had episodes when on the monitor, as that should be very helpful (even if just ruling some things out).
Don't worry about feeling like you're wasting people's time. HCPs usually like ruling out serious pathology - it's never nice diagnosing nasties.

Listen to Bunnykins she has given good advice.

Understood Bunnykins, thank you for your patience :)