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Hi, my son went to the doctors for weird heart problems involving blacking out, extreme fatigue, and extremely rapid heart rates and a high blood pressure. He has always had those symptoms but only to a minor extent. Within the last few months the symptoms have increased in severity. I took him to our family doctor and she said that it was highly unusual and sent him to see a cardiologist (at one our areas best children's hospitals). We got an emergency appointment, but when we got there the dr seemed unimpressed. He said that most people have those symptoms to some extent if they are not always active (essentially calling him a whiner) and that when he feels fatigued it's because he is out of shape. He said that if it was directly related to his heart that his blood pressure would be low and not high. He shrugged off the high blood pressure as white coat syndrome. When I take it at home it is still high, like 135/68. His heart rate is still fast at home too. Resting, it's around 100-120, and when he was on his bike today (very light excercise, just up and down the flat street) we clocked it at 195! It makes him feel extremly fatigued and he blacks out on some occasions (the cardiologist said that unless he passes out, then it is nothing to worry about). He is 5 10' and 126lbs. He has always had a fast heartbeat, is 14, and is growing a lot! What I am wondering is if it is worth seeing another cardiologist or do you agree with the original cardiologist. Please explain!

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Hi Rytogo,

Find another doctor for a cardiac evaluation.  He should not be blacking out.  For the doctor to dismiss this is ridiculous.

His blood pressure is high and his resting rate is also fast.  I'm very concerned with the 195 with light exercise.

Does he take any medications?  Have asthma?  Has he had an EKG or chest x-ray for starters? 






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He does not take medications, he has mild asthma, he had and EKG (normal) but no chest x-ray
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No inhaler? They can raise blood pressure and heart rate.

I'm glad the EKG was normal. Electrically the heart is normal. Usually a chest x-ray is done to see if the heart is enlarged.

Do you notice any difference, checking the blood pressure in the left arm versus the right?
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He doesn't use the inhaler (at least not in the last year). I don't know if it's just me but I can never find an artery in his left arm, and when I can it always seems unreliable. He also had a holter on, it was mostly normal (although he didnt do much that day but sleep, do his adverse heart rate was 82) and that's the thing, it can be very low but it jumps very rapidly. The way he describes it is that it "does not transition" That it just jumps up. I am almost positive that it is not white coat syndrome, when he had his appendix removed (in the same hospital) they said he was the calmest person they ever saw. But when the recovery nurses would come take his vitals after he surgery they all said that he had a very rapid heart rate. (his blood tests were normal then, but that was 2 years ago)
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Now that I remember, he didn't have an x-ray, but he did have a ultrasound and that was normal. That's why I think the doctor shrugged this off, all the tests (except heart rate and blood pressure) came back normal.
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It's very promising that the EKG and ultrasound both came back as negative. This minimises the chance of it being something particularly sinister.
The blood pressure is a touchy subject. The systolic bp is high but the diastolic which has a greater effect on long term outcome is ok. The systolic BP can jump as a result of stress or indeed white coat syndrome but a good method of checking this properly is to use an ambulatory blood pressure monitor for 24 hours. It's like the holter monitor but measures blood pressure, not EKG.
The heart rate is a problem though assuming as you say that the resting heart rate is 100+ This is too fast, 190+ with minimal exercise is also problematic.
I really don't want to cause offense though when I say that if the holter monitor states a relatively normal resting rate, then I am more inclined to use that as the evidence to go on.
He shouldn't be blacking out, this does need investigation.
I will say though that cardiologists are sent case after case of normal by GPs/Family Practice Docs who are not completely certain if something is normal or not. The cardiologist is the best one to say if he is at risk. Having said that, he should afford you the proper respect to work through your fears with you. If you do not have a rapport with him, then find another cardiologist that can give you a second opinion but also whom you might have greater trust in.
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