Abnormal ECG for complex needs child - anyone know how to interpret these?

[worriedaboutecg]

My 15 year old has complex needs. ASD, APD, ADD, dyspraxia, dyslexia, possible EDS and definite hypermobility, supernumerary teeth, total flat-footedness and need for orthotics, severe myopia, just a range of complex issues. On the waiting list for a CT scan related to possible issues nobody has really explained. Very vague mention of some rare syndromes that need eliminating.

He had an ECG ordered and it is clearly not right. The technician was lovely, really lovely, but said I would need to speak to the consultant, so I asked to take a photo (allowed) and then asked a friend who is a senior consultant in a specialist paediatric field, and is always incredibly helpful. He looked at it, was silent, and then said he couldn't offer a view as he's not interpreted ECG in years now and didn't want to get this wrong. We have known one another for 30 years and he usually caveats that he's not sure, will ask someone, etc etc but is really helpful in explaining what things might mean. He did say that you can't trust the readouts at the top as they are machine done and ECGs are more complex than that.

If anyone here knows what the hell any of this might mean, I'd be so grateful.

I'm worried now.

Did you mean to add an attachment?

How did the technician leave things, are you waiting to speak to the hospital consultant or your gp.

To be fair, the technicians are not trained to interpret ECGs so I wouldn't read too much into that. Their job entails ensuring correct placement of the ECG stickers and ensuring that it is the best recording they can obtain. (That is no mean feat when you have half naked and worried people in front of you!) but interpretation is not part of their job role.
Similarly it may well be many years since your friend has even looked at an ECG, so it wouldn't be appropriate for him to attempt interpretation. He is right in that the readings at the top are not necessarily reliable, so the ECG needs to be interpreted in the context of the clinical situation.
Finally the ECG is going to give answers about the electrical conduction system of the heart, but won't answer questions about structural abnormalities. Is your DC particularly tall?

Hope you get some answers soon.

Sorry! yes I did.

That's exactly what he said - that while he's in a paeds discipline it's been years since ECG interpretation is in the frame for this. And that's also what the lovely tech said.

I know I am probably being neurotic, but frankly I have not had my child not have something found on almost every assessment or test he's ever had so it's hard not to worry.

And yes he is tall. Was taller than me at 11 and I am 5ft 6" myself.

Waiting to speak to the consultant who ordered them, but he's a psychiatrist so not sure this is his field, either! And worried that it will get bounced from CAMHS back to hospital and who knows where from that point. Our Trust has some amazing people within it, but it's very troubled. Stuff gets stuck in the system all the time.

All I can tell from the ECG is that the rhythm of the heart is normal.
I can appreciate that when you have a child with complex health needs, the natural instinct is to worry that something else has cropped up. I would advise you to wait until it has been reviewed by the consultant. I am not using it as a get out, but if you think about how nuanced paediatric cardiology is (i.e the difference in interpreting the ECG of a tiny preemie newborn, and a hulking great 6 foot 15year old!) then it's not surprising that neither your doctor friend or I am willing to speculate on the ECG, as it needs to be read in the context of your DC and why the test has been requested, and the expertise of their consultant in interpreting it.

Thank you, that's really reassuring.

Where was the ECG done? A GP surgery, hospital etc? And why?

Looks like very normal sinus rhythm to me. I’m not a consultant but I look at ECGs every single day. I may miss minor subtleties but I can pick out a normal rhythm from abnormal and that is normal

In my experience, when a camhs psychiatrist isn't sure about an ECG, they ask a paediatric cardiologist for advice. So I wouldn't worry too much about getting it interpreted as I think the person who requested it will be able to ask someone who knows how to do so.

Is he on stimulant medication for the ADD? This in itself can warrant an EEG, just to see the stimulant isn't effecting the heart at all. Really just to keep an eye on it. I'm sorry you've nothing been through so much medically. It's really tough. I hope you get some answers soon and they say it's all good.

I don't actually know. We were told he needed bloods and an ECG as they're considering medication for him for anxiety, depression and the ADD - but they're not considering methylphenidate due to the anxiety (his sister and I are both on it already, so we get blood pressure checks etc regularly and have had ECG).

It's just that with him, there are a lot of indications that physically things aren't right, so that makes me panic a bit when I read stuff on the top (even though told not to pay it attention!) because he has lots of indications that his body isn't correctly put together, for want of a better term. It's not just neurodevelopmental with him - there are physical issues as well. We've more than once had a GP or dentist ask if he's ever been seen by clinical genetics, but the advice I had is that he doesn't fit criteria for any obvious genetic syndrome (fails "the eye test" and is also cognitively able, and with most genetic syndromes that mimic autism the young person usually isn't) and that if they do a genetic assay they will almost always find some sort of gene oddity, because that's how humans are, and in almost all difference or mutation there are question marks about a theoretical potential risk of some or other dire problem, which are highly unlikely to actually be in the frame but all parents inevitably panic about and as there's no way to rule that in or out the anxiety stays. So the advice we had was not to go that way as it wouldn't gain him anything, and would be highly likely to cause worry for no reason.

It's an odd one. I have just always had a sense there is some physical problem we've missed here, just as we missed so many of the other issues till he was secondary-aged - because literally everything is attributed to autism once they have that diagnosis. I do feel really reassured by those of you saying it's a normal rhythm. I know literally nothing about medicine unless it affects one of the kids or me, and I accept my limitations and that I have to trust what the medics tell me, which is where my info comes from. And all of us have so many appointments (two complex needs kids, and I've had breast cancer in the past and am on a trial) that I tend to work on a need-to-know basis and only ask questions if being informed is useful. I just do as told and attend all appointments, and ask questions around it when and if a problem is found. But this is likely to mean a wait of some weeks, being CAMHS and their waiting lists, and I was scared because of the "abnormal ECG" heading.

I do feel really comforted by the posts here, so thank you all. I promise I'm not generally neurotic around the kids. I vaccinate, feed well, give affection, attend appointments and trust in the doctors when you do actually finally get to the top of all the lists. It's just heart is, you know. Fairly important! But from the sounds nobody here sees anything amiss, so I can stand down with the worry and wait for the appointment.

@BrainFullOfSpiders sorry, obviously I know where - just not why! It was at the cardiology department at the local hospital. Had bloods in paediatrics, then upstairs for the ECG. He was so lovely, the tech, but took it 3 times "to get a clear reading". Then again, it might just have been pad movement, mightn't it.

The main reason to do an ECG in the circumstances described would be to check for a pre-existing rhythm disturbance, most commonly "long QT", which is often benign with no symptoms, but would be at risk of tripping into a dangerous heart rhythm if combined with certain medications.

The chance of an ECG detecting a serious rhythm disturbance (dangerous on its own) is very low, and a structural heart problem even lower. However every is quite aware of their own limitations when it comes to children's medicine so they'd want to have someone with confidence read it rather than going "yeah probably fine"..

@worriedaboutecg thank you. :) I ask as it can’t affect how much you look in to the ECG. It’s good to know if he already had a previous cardiac history as that should have shown.
I sent it to my friend (also have one in the know!) and she said it does look a normal ECG.

Very hard to interpret one from a photo. Can see that the rhythm looks normal. I can't do a manual QTc on a photo, but the machine calculated one is fine, which is usually the thing they're most interested in for ADHD medication. Some of the QRS complexes (big spiky bits) might be slightly taller than the average, but that's pretty common in teenage lads, especially skinny ones, so probably nothing to worry about. So at first glance reassuring, but I'm sure that when someone's had a chance to have a proper look at it they'll get back to you.

I can’t interpret the ecg but when DS was poorly as a baby his ecg was apparently abnormal with two paediatricians very concerned. They scanned it over to a hospital specialising in cardiac paediatrics who said it was fine. The hospital he was in decided to order an echocardiogram (I think possibly to reassure us as they’d caused so much stress telling us there were serious issues and wanting to blue light him off to cardiac specialists) and it was totally normal on echo.
I hadn’t realised how tricky ecgs are to interpret so I wouldn’t be too worried. As it happened the cardiologists at the specialist hospital explained why it was acceptable/normal under the circs (fast heart rate due to meningitis “hiding” one of the waves) and it resolved as he recovered. I know how incredibly stressful it all is though so sending solidarity.