Slow Heart Rate with fast heart rate bursts

[Mila_G]

A disseminated infection considerably effected my son Neurologically. He is now 13. Strong multi-antibiotics have improved him from a Neuro perspective but his heart rate continues to decline. To Date he has had minimal heart testing. A recent 24-holter monitor had Bradycardia events calculated at 50bpm and below, not 60bpm and below, and spontaneous Tachycardia events.

At 50bmp and below he had 770 events of totaling 5.25 hours.
If changed to 60bmp and below these numbers would quadruple, he would have likely close to 2500 brady events for a total estimated 18 hours.
The Tachy events were fewer 123, for 69 minutes total time.
While sitting, standing he runs in the high 40's
while sleeping it reduced to 42bpm
However he has sudden onsets of tachycardia even during sleep and resting that last just seconds or minutes and then fall immediately down to around 50 or below. He does have symptoms, complaints of shortness of breath.

This doesn't seem to br normal to me. Plus during these episodes of brady to tachy to brady, there are these scribble lines, like fibrillation or fluttering would look. Except that when this occurs the ecg waves become very drifty or wandering. I can only find info that says drifting and wandering tracings indicate artifact. But these wavy lines occurs with the onset of a onset of a tachy event during brady, and with VE? and PAC? events.

His report had the Afib on "off" and there was no calculations provided for the QT or QRS ?? durations.

Is anyone familar with Bradycardia and sudden short bursts of Tachycardia?

Additional he had an echo that revealed an ejection fraction of 54%, and mild regurgitation of the Mitral, Atrial, and Pulmonic valves



if anyone knows how to read or interested in seeing the ecg I have it on my public storage box with my son's personal info removed;
http://www.box.net/shared/static/c9kyodbu85.pdf

http://www.box.net/shared/static/c9kyodbu85.pdf

[Mila_G]

No it wasn't interpreted by a electrophysiologist.  I'll look for one.  The problem has been that we don't really have any interpretation, and there is a disconnect between linking the various specialty medicines to have one cohesive evaluation.

The official diagnosis is that he is being treated for suspected Central Nervous System Tuberculosis.  His immune system was suppressed when he was 10 and an infection disseminated to the brain.  It took 2 years for someone to think to test for TB.  Since then, we have not had many answers other than a 12 month multi-drug antibiotic treatment plan.  His heart rate has been decreasing since the onset of the illness so we are concerned that it may have spread into the heart or vascular system and did damage.  We aren't getting much help to find answers.

I'll check out the other forum.
thanks

[Momto3]

Hi Mila_G,

Sorry to hear your son is dealing with these brady-tachy issues.  It can be quite frustrating when our hearts are jumping between racing and beating slowly.  Are these results from a Holter monitor?  If so, were they interpreted by an electrophysiologist?  If they were, then I think you can feel confident in the doctor's interpretation.  If not, you may want to take the records for another opinion.

Has he been given an official diagnosis?  There is a dysautomonia forum here on MedHelp that may be even more helpful.  Patients with this disorder deal with the ups and downs of heart rates.  

I can't say much about the tachy-brady, but I do know an normal EF is considered to be 55-70% with a 5% variation in interpretation.  Mild regurg is generally not too medically significant.  However, the physician may want to monitor the valves to be certain they do not worsen. Some doctors will suggest repeat echocardiograms at specific intervals.