Toddler with WPW

[cvv02]

Hello there,
I have a couple questions concerning my daughter is 2 years old.  At a checkup during my pregnancy her fetal heart rate was found to be tachycardic. She seemed to not "settle" into a normal resting HR. at points her heart was beating so fast the NST would chart the beats at 20 even though you could audibly hear that her heart was beating very fast.  After birth I noticed that when she cried her lips would turn blue and her legs were very mottled and purple-y in colour.  I took her to ER right away.  Her blood pressure in her legs was found to be low and they were worried about a problem with her aorta. Her echo showed a small vsd that they were confident would close on its own and her EKGs were all abnormal showing WPW. She has since gone on to gain weight and meet all of her milestones.  At four months of birth she was diagnosed with ashtma, but luckily we haven't really had any troubles with SVT until recently. Last week she was playing and laughing and literally out of nowhere she starts shaking uncontrollably and turns very mottled over her entire body even her finger nails dusky. She was completely panicked and pounding on her chest. I grabbed her and took her to ER.  While at the ER she was on the moniters and her heart rate was constantly jumping around from 150 to 189 to 170 to 165 to 190 and oxygen sat of 92 .  Never staying the same even though she just lied on the bed for 4 hours (which right there is not normal for her) She also presented at the ER with no fever but within two hours had a fever. Chest xray was clear, ears were clear no signs of infection to explain fever, and ashtma well controlled.  The dr sent us home and is setting up a cardiologist appt and she woke up the next morning seeming fatigued but otherwise ok. I am just wondering if there could be any connection between a problem with a heart causing the body to respond with a fever? and how much fluctuation is normal while resting. It cant be normal to constantly be jumping around all over the place?

[cvv02]

they did do an electrocardiogram at the er. (and it must be added that its a small hospital w/o the necessary pediatric equipment but i was done) dr said she was very tachycardia but wasn't necessarily showing the usual "wpw wave".  she has had fever many times with bouts of pneumonia and her rate gets fast.. maybe 140s 150s never that high. it was really the shaking that frightened me. I have seen her have difficulties breathing before with her ashtma where she is indrawing and not well but nothing like this before.  I hope we get an appt into see the cardiologist soon.  is it possible to not have svt caused from wpw but something else with her heart? she is generally healthy but lately she has been sleeping for 5 hours every afternoon and still able to go down at her usual bed time.  does arrythmias cause fatigue even if they aren't over 200 bpm or just more of  a nuiscence not worth worrying over? hope this makes sense. I really don't mean to babble.
Thank you for your response!

[Marie M Gleason, M.D.]

Wolff-Parkinson-White syndrome (WPW) is an electrical abnormality of the heart. There is an extra electrical pathway in the heart that can allow electricity to go down the normal pathway and up the extra pathway.  When this happens, it creates a circular electrical pattern causing a rapid heart rate called supraventricular tachycardia (SVT).  In young children, typically SVT rates are over 200 bpm, although they can come down slightly as the patient gets older. SVT would not cause a fever.  The small VSD would be independent of the heart rate, and would not be a cause for blueness or mottling.  Fever, however, can cause a person's normal heart rate to increase (sinus tachycardia) and in young children it can approach 200 beats per minute. Fever can cause mottling and blueness in children. Curiously, some children will have an increase in their heart rate before the actual fever is demonstrated. Regardless, if your child's heart rate was fast, and a fever was also present, one cannot say if it was sinus tachycardia or SVT without looking at a 12 lead electrocardiogram.  I am not sure if that was done while in the Emergency Dept.  If so, and they thought it was sinus tachycardia, then they did the right thing to address the issues of the fever, and make sure that you follow up with your cardiologist.  If there is a high suspicion for SVT, your cardiologist may order a transtelephonic event monitor or a holter monitor to try to capture an event and see if it is true SVT.  Only then could a recommendation for medication be made.