13 year old boy in hospital with chest pain possible SVT

[Havoc]

I was going to reply on this earlier, but I was extremely busy. Regarding the possibility of SVT, it's not all that uncommon for young people to develop re-entrant pathways like WPW. I have never seen any evidence that it's CF related. As Miss T mentioned, the treatment (if it is WPW or something like it) is usually an ablation where they destroy part of the heart tissue ( a pacemaker node called the bundle of Kent that allows the action potential to divert from the AV node back up through the atria, rather than down through the ventricles).
<br />
<br />Albuterol is a beta agonist (actually beta 2 specific), unfortunately it does have some alpha agonist properties and can increase heart rate, but due to it's relatively short half life there is no chance of something like that building up in your body to create a lasting effect. Xopenex is supposed to be even more beta2 specific, however I still notice some tachycardia with it.
<br />
<br />It's good that he's doing the Holter monitor, hopefully they can catch some of his SVT's and make a diagnosis.
<br />
<br />I threw out a lot of medical stuff for time's sake. Let me know if you need anything explained.

 

[Murgie]

13 year old boy with SVT

Jonathan,
You are well informed in so many areas, I have read your posts and I am impressed at your knowledge and delivery of it!
What is WPW?
Are you saying xopenex inhaled is worse than albuterol?
Ablation? Destroy part of the heart tissue, thats horrible sounding. How do they do this?
His monitor is catching at least 4 episodes a day. but mostly automatic less of my son pressing the record button.
Do you know anything about Acid Fast Baccillus? do tell!
thanks!

 

[Murgie]

13 year old boy with SVT

Jonathan,
You are well informed in so many areas, I have read your posts and I am impressed at your knowledge and delivery of it!
What is WPW?
Are you saying xopenex inhaled is worse than albuterol?
Ablation? Destroy part of the heart tissue, thats horrible sounding. How do they do this?
His monitor is catching at least 4 episodes a day. but mostly automatic less of my son pressing the record button.
Do you know anything about Acid Fast Baccillus? do tell!
thanks!

 

[Murgie]

13 year old boy with SVT

Jonathan,
<br /> You are well informed in so many areas, I have read your posts and I am impressed at your knowledge and delivery of it!
<br />What is WPW?
<br />Are you saying xopenex inhaled is worse than albuterol?
<br />Ablation? Destroy part of the heart tissue, thats horrible sounding. How do they do this?
<br />His monitor is catching at least 4 episodes a day. but mostly automatic less of my son pressing the record button.
<br />Do you know anything about Acid Fast Baccillus? do tell!
<br />thanks!

 

[Havoc]

Murgie, thank you for your kind words.

WPW is Wolff Parkinson White Syndrome. I'm not sure if i can adequately explain it with out drawing stuff. Here goes:

In the heart there are pacemaker sites that control heartbeat. The main one is the sino-atrial node (SA node) and it is located in the left atrium (top left chamber of the heart). An electrical impulse is generated in the SA node and travels through the atria causing them to contract and squeeze blood into the ventricles (the lower chambers of the heart). Most of the filling of the ventricles happens by gravity (70%), the other 30% comes from the contraction of the atria. Between the atria and ventricles is a structure called the AV junction. It's job is to slow the electrical impulse enough to allow the ventricles to completely fill. It's at this point where problems happen. Sometimes, especially in the older population, the electrical impulse is slowed too much causing a AV block. The other thing that can happen is that the impulse goes back up into the right atrium where the bundle of Kent is located. It's called a re-entrant pathway because the impulse gets stuck in this vicious circle and creates a rapid heartbeat.

The heart is obviously an important organ and so there are many fail safes in place. In fact, every cell in the heart is capable of becoming a pacemaker (a function called automaticity). It's because of this that there are all these other (potential) pacemaker sites.

There are medications (beta blockers) that reduce heart rate, but they don't work with re-entry tachycardias because they take advantage of the blocking at the AV node, so these medications will actually worsen things like WPW.

There are several procedures for ablation. Some are open, some can be minimally invasive (similar to laproscopic surgery of the abdomen) and the 3rd (modified Maze procedure) is a procedure similar to a heart catheterization. An energy source is directed at the offending pathway, effectively cutting it off and the SVT goes away. It's very safe and nearly painless. Only a very small amount of heart tissue is destroyed, just enough to cut off the re-entry pathway.

Xopenex is supposed to be better than albuterol, in that it's supposed to have less side effects (like tachycardias). In my experience, both taking and giving the medication, it's not that much better. It does seem to vary from person to person, though.

Regarding the AFB, I would need more information. Essentially AFB (and the genus mycobacterium) are a group of bacilli which resist gram staining because of mycolic acid in their cell walls. To give you more information, I would need to know which specific bacteria he is culturing. One of the common AFB's that affects the lungs is N. asteroides. Usually these infections are treated with sulfonamides like bactrim, they also usually respond well to linezolids (like Zyvox). In some cases when those fail they bring out the big guns like Imipenem.

I hope this helps some.

Regards,

Jonathan

 

[Havoc]

Murgie, thank you for your kind words.

WPW is Wolff Parkinson White Syndrome. I'm not sure if i can adequately explain it with out drawing stuff. Here goes:

In the heart there are pacemaker sites that control heartbeat. The main one is the sino-atrial node (SA node) and it is located in the left atrium (top left chamber of the heart). An electrical impulse is generated in the SA node and travels through the atria causing them to contract and squeeze blood into the ventricles (the lower chambers of the heart). Most of the filling of the ventricles happens by gravity (70%), the other 30% comes from the contraction of the atria. Between the atria and ventricles is a structure called the AV junction. It's job is to slow the electrical impulse enough to allow the ventricles to completely fill. It's at this point where problems happen. Sometimes, especially in the older population, the electrical impulse is slowed too much causing a AV block. The other thing that can happen is that the impulse goes back up into the right atrium where the bundle of Kent is located. It's called a re-entrant pathway because the impulse gets stuck in this vicious circle and creates a rapid heartbeat.

The heart is obviously an important organ and so there are many fail safes in place. In fact, every cell in the heart is capable of becoming a pacemaker (a function called automaticity). It's because of this that there are all these other (potential) pacemaker sites.

There are medications (beta blockers) that reduce heart rate, but they don't work with re-entry tachycardias because they take advantage of the blocking at the AV node, so these medications will actually worsen things like WPW.

There are several procedures for ablation. Some are open, some can be minimally invasive (similar to laproscopic surgery of the abdomen) and the 3rd (modified Maze procedure) is a procedure similar to a heart catheterization. An energy source is directed at the offending pathway, effectively cutting it off and the SVT goes away. It's very safe and nearly painless. Only a very small amount of heart tissue is destroyed, just enough to cut off the re-entry pathway.

Xopenex is supposed to be better than albuterol, in that it's supposed to have less side effects (like tachycardias). In my experience, both taking and giving the medication, it's not that much better. It does seem to vary from person to person, though.

Regarding the AFB, I would need more information. Essentially AFB (and the genus mycobacterium) are a group of bacilli which resist gram staining because of mycolic acid in their cell walls. To give you more information, I would need to know which specific bacteria he is culturing. One of the common AFB's that affects the lungs is N. asteroides. Usually these infections are treated with sulfonamides like bactrim, they also usually respond well to linezolids (like Zyvox). In some cases when those fail they bring out the big guns like Imipenem.

I hope this helps some.

Regards,

Jonathan

 

[Havoc]

Murgie, thank you for your kind words.
<br />
<br />WPW is Wolff Parkinson White Syndrome. I'm not sure if i can adequately explain it with out drawing stuff. Here goes:
<br />
<br />In the heart there are pacemaker sites that control heartbeat. The main one is the sino-atrial node (SA node) and it is located in the left atrium (top left chamber of the heart). An electrical impulse is generated in the SA node and travels through the atria causing them to contract and squeeze blood into the ventricles (the lower chambers of the heart). Most of the filling of the ventricles happens by gravity (70%), the other 30% comes from the contraction of the atria. Between the atria and ventricles is a structure called the AV junction. It's job is to slow the electrical impulse enough to allow the ventricles to completely fill. It's at this point where problems happen. Sometimes, especially in the older population, the electrical impulse is slowed too much causing a AV block. The other thing that can happen is that the impulse goes back up into the right atrium where the bundle of Kent is located. It's called a re-entrant pathway because the impulse gets stuck in this vicious circle and creates a rapid heartbeat.
<br />
<br />The heart is obviously an important organ and so there are many fail safes in place. In fact, every cell in the heart is capable of becoming a pacemaker (a function called automaticity). It's because of this that there are all these other (potential) pacemaker sites.
<br />
<br />There are medications (beta blockers) that reduce heart rate, but they don't work with re-entry tachycardias because they take advantage of the blocking at the AV node, so these medications will actually worsen things like WPW.
<br />
<br />There are several procedures for ablation. Some are open, some can be minimally invasive (similar to laproscopic surgery of the abdomen) and the 3rd (modified Maze procedure) is a procedure similar to a heart catheterization. An energy source is directed at the offending pathway, effectively cutting it off and the SVT goes away. It's very safe and nearly painless. Only a very small amount of heart tissue is destroyed, just enough to cut off the re-entry pathway.
<br />
<br />Xopenex is supposed to be better than albuterol, in that it's supposed to have less side effects (like tachycardias). In my experience, both taking and giving the medication, it's not that much better. It does seem to vary from person to person, though.
<br />
<br />Regarding the AFB, I would need more information. Essentially AFB (and the genus mycobacterium) are a group of bacilli which resist gram staining because of mycolic acid in their cell walls. To give you more information, I would need to know which specific bacteria he is culturing. One of the common AFB's that affects the lungs is N. asteroides. Usually these infections are treated with sulfonamides like bactrim, they also usually respond well to linezolids (like Zyvox). In some cases when those fail they bring out the big guns like Imipenem.
<br />
<br />I hope this helps some.
<br />
<br />Regards,
<br />
<br />Jonathan

 

[Murgie]

Hi Jonathan,

Thanks again for this info. There was an intern doctor who mentioned Wolff parkinson, but then it was omitted. So much happening I cant recall all the reasons but I write all that I can as they speak and keep a notebook to refer to. We dont see the cardiologist until 4/26, he will read the heart monitor 30 days recordings and make his assesment at that time. I feel a bit relieved at the outcome.
Now to the AFB, it may take 4 more weeks for the lab to identify exact mycobacterium and treatment, tuberculosis has been ruled out(skin test negative). Doctors have not suggested putting Sam on anything until they know what it is they are treating. His CF team did say this strain causes an increase in lung DISfunction.
Do you have to personally deal with so many health issues? If so what motivates you to research and comfort others? I suspect this is good therapy for you and it certainly is helpful for me.
thanks
Murgie

 

[Murgie]

Hi Jonathan,

Thanks again for this info. There was an intern doctor who mentioned Wolff parkinson, but then it was omitted. So much happening I cant recall all the reasons but I write all that I can as they speak and keep a notebook to refer to. We dont see the cardiologist until 4/26, he will read the heart monitor 30 days recordings and make his assesment at that time. I feel a bit relieved at the outcome.
Now to the AFB, it may take 4 more weeks for the lab to identify exact mycobacterium and treatment, tuberculosis has been ruled out(skin test negative). Doctors have not suggested putting Sam on anything until they know what it is they are treating. His CF team did say this strain causes an increase in lung DISfunction.
Do you have to personally deal with so many health issues? If so what motivates you to research and comfort others? I suspect this is good therapy for you and it certainly is helpful for me.
thanks
Murgie

 

[Murgie]

Hi Jonathan,
<br />
<br />Thanks again for this info. There was an intern doctor who mentioned Wolff parkinson, but then it was omitted. So much happening I cant recall all the reasons but I write all that I can as they speak and keep a notebook to refer to. We dont see the cardiologist until 4/26, he will read the heart monitor 30 days recordings and make his assesment at that time. I feel a bit relieved at the outcome.
<br />Now to the AFB, it may take 4 more weeks for the lab to identify exact mycobacterium and treatment, tuberculosis has been ruled out(skin test negative). Doctors have not suggested putting Sam on anything until they know what it is they are treating. His CF team did say this strain causes an increase in lung DISfunction.
<br />Do you have to personally deal with so many health issues? If so what motivates you to research and comfort others? I suspect this is good therapy for you and it certainly is helpful for me.
<br />thanks
<br />Murgie

 

[missT]

Hi, Jonathan has really said it all. I can tell you in my own experience that my SVT did not register on the Holt Monitor. I wore it for 24 hours. The SVT was always kicked off by something. I stopped drinking caffeine and alcohol because that can kick it off. It was a very scary time in my life until i went ahead with the Alblation. The reason I chose to have the alblation is because I really did not want to be on any more medication. The operation basicaly cured the problem and they went in through the groin. I can tell you that I thought it would be a piece of cake but there are two things...first, I had to be sedated so I was awake through the whole procedure. They did not want to knock me out because of my bad lungs. Second, I was extremely fatigued for at least a week after the operation. Besides that the outcome was good. Again, I am not a medical person but I do know that years of medications cause side effects and that is why I believe the albuterol may have caused this...who knows? I can tell you that no other person in my family has ever had this problem. I know that CF in one way or another caused it.

 

[missT]

Hi, Jonathan has really said it all. I can tell you in my own experience that my SVT did not register on the Holt Monitor. I wore it for 24 hours. The SVT was always kicked off by something. I stopped drinking caffeine and alcohol because that can kick it off. It was a very scary time in my life until i went ahead with the Alblation. The reason I chose to have the alblation is because I really did not want to be on any more medication. The operation basicaly cured the problem and they went in through the groin. I can tell you that I thought it would be a piece of cake but there are two things...first, I had to be sedated so I was awake through the whole procedure. They did not want to knock me out because of my bad lungs. Second, I was extremely fatigued for at least a week after the operation. Besides that the outcome was good. Again, I am not a medical person but I do know that years of medications cause side effects and that is why I believe the albuterol may have caused this...who knows? I can tell you that no other person in my family has ever had this problem. I know that CF in one way or another caused it.

 

[missT]

Hi, Jonathan has really said it all. I can tell you in my own experience that my SVT did not register on the Holt Monitor. I wore it for 24 hours. The SVT was always kicked off by something. I stopped drinking caffeine and alcohol because that can kick it off. It was a very scary time in my life until i went ahead with the Alblation. The reason I chose to have the alblation is because I really did not want to be on any more medication. The operation basicaly cured the problem and they went in through the groin. I can tell you that I thought it would be a piece of cake but there are two things...first, I had to be sedated so I was awake through the whole procedure. They did not want to knock me out because of my bad lungs. Second, I was extremely fatigued for at least a week after the operation. Besides that the outcome was good. Again, I am not a medical person but I do know that years of medications cause side effects and that is why I believe the albuterol may have caused this...who knows? I can tell you that no other person in my family has ever had this problem. I know that CF in one way or another caused it.

 

[Havoc]

Murgie,

Personally, I am actually very healthy for a CFer. I spent 10 years in pre-hospital emergency medicine and have a BS in pre-hospital emergency med. So, I've seen and treated a bunch of SVTs and have a decent understanding of a wide variety of conditions. One of the perks of emergency medicine is that you see a lot. Everything from childbirth to traumatic injuries to cardiology and almost anything else you can imagine.

I have been inactive as of late, mostly because of the risk of picking a nasty bacteria up from the hospital or one of my patients.

There are other causes of SVT besides WPW, but the definitive treatment is usually ablation of a re-entry pathway or a rogue pacemaker node.

It's interesting that they are capturing a full 30 days when he is having multiple events a day. Is the cardiologist aware of the frequency of the events? My concern would be with rates approaching 200BPM, you obviously compromise blood pressure. Furthermore, it's like running a marathon, your body gets tired, your immune system takes a hit. So, he's trying to fight off PA, Staph and a mycobacterium and his body is under stress from an SVT.

Who is being reluctant to start him on antibiotics until they get the culture and sensitivity study, his CF team or ID? I can appreciate them wanting to treat with he right drug, but part of me thinks that it would not be harmful to start him on Bactrim or Zyvox until they get the sensitivity studies back. They may have a very good reason, but don't be afraid to ask what that reason is. I would also probably phone the cardiologist and advise them that he is having as many as 6 events a day and see if you can't bump up his appointment.

Best of luck,

Jonathan

 

[Havoc]

Murgie,

Personally, I am actually very healthy for a CFer. I spent 10 years in pre-hospital emergency medicine and have a BS in pre-hospital emergency med. So, I've seen and treated a bunch of SVTs and have a decent understanding of a wide variety of conditions. One of the perks of emergency medicine is that you see a lot. Everything from childbirth to traumatic injuries to cardiology and almost anything else you can imagine.

I have been inactive as of late, mostly because of the risk of picking a nasty bacteria up from the hospital or one of my patients.

There are other causes of SVT besides WPW, but the definitive treatment is usually ablation of a re-entry pathway or a rogue pacemaker node.

It's interesting that they are capturing a full 30 days when he is having multiple events a day. Is the cardiologist aware of the frequency of the events? My concern would be with rates approaching 200BPM, you obviously compromise blood pressure. Furthermore, it's like running a marathon, your body gets tired, your immune system takes a hit. So, he's trying to fight off PA, Staph and a mycobacterium and his body is under stress from an SVT.

Who is being reluctant to start him on antibiotics until they get the culture and sensitivity study, his CF team or ID? I can appreciate them wanting to treat with he right drug, but part of me thinks that it would not be harmful to start him on Bactrim or Zyvox until they get the sensitivity studies back. They may have a very good reason, but don't be afraid to ask what that reason is. I would also probably phone the cardiologist and advise them that he is having as many as 6 events a day and see if you can't bump up his appointment.

Best of luck,

Jonathan

 

[Havoc]

Murgie,
<br />
<br />Personally, I am actually very healthy for a CFer. I spent 10 years in pre-hospital emergency medicine and have a BS in pre-hospital emergency med. So, I've seen and treated a bunch of SVTs and have a decent understanding of a wide variety of conditions. One of the perks of emergency medicine is that you see a lot. Everything from childbirth to traumatic injuries to cardiology and almost anything else you can imagine.
<br />
<br />I have been inactive as of late, mostly because of the risk of picking a nasty bacteria up from the hospital or one of my patients.
<br />
<br />There are other causes of SVT besides WPW, but the definitive treatment is usually ablation of a re-entry pathway or a rogue pacemaker node.
<br />
<br />It's interesting that they are capturing a full 30 days when he is having multiple events a day. Is the cardiologist aware of the frequency of the events? My concern would be with rates approaching 200BPM, you obviously compromise blood pressure. Furthermore, it's like running a marathon, your body gets tired, your immune system takes a hit. So, he's trying to fight off PA, Staph and a mycobacterium and his body is under stress from an SVT.
<br />
<br />Who is being reluctant to start him on antibiotics until they get the culture and sensitivity study, his CF team or ID? I can appreciate them wanting to treat with he right drug, but part of me thinks that it would not be harmful to start him on Bactrim or Zyvox until they get the sensitivity studies back. They may have a very good reason, but don't be afraid to ask what that reason is. I would also probably phone the cardiologist and advise them that he is having as many as 6 events a day and see if you can't bump up his appointment.
<br />
<br />Best of luck,
<br />
<br />Jonathan

 

[Murgie]

Since my last post, we found toxic mold in our home and have been busy with proper removal and repair to an area that sam spend a great deal of time. No doubt this is a contributoe to his many ailments. i plan to call the Cf team this am and request the meds Jonathon, tks!

 

[Murgie]

Since my last post, we found toxic mold in our home and have been busy with proper removal and repair to an area that sam spend a great deal of time. No doubt this is a contributoe to his many ailments. i plan to call the Cf team this am and request the meds Jonathon, tks!

 

[Murgie]

Since my last post, we found toxic mold in our home and have been busy with proper removal and repair to an area that sam spend a great deal of time. No doubt this is a contributoe to his many ailments. i plan to call the Cf team this am and request the meds Jonathon, tks!
<br />

 

[Havoc]

Have you guys found anything out regarding his SVT?