Diagnosing and Treating Pediatric Heart Palpitations

As with adults, heart palpitations in children can range from a harmless annoyance to something indicative of a more serious heart condition. According to pediatric cardiologist Vince Thomas, MD, of Children’s Specialty Physicians in Omaha, the key to knowing where to start with treatment is to determine whether the palpitations are truly an arrhythmia.

When a child has heart palpitations, Thomas recommends that the investigative process begin with the child’s history, including how the palpitations start and stop, how long they last, how often they occur and what the patient is typically doing when they occur.

After discussing the patient’s history, the investigation should move to family history. “There are many different types of genetic arrhythmia syndromes that run in families and most pass on from generation to generation,” says Thomas.

Additionally, asking about stressors in the family can yield valuable insights. Providers can ask if anyone in the family is suffering from heart disease, such as a grandparent who may have recently had a heart attack, or parents that have separated or divorced. Some children who experience either of these events complain about their heart.

The focus then shifts to the physical exam. If the patient is having palpitations but their rhythm is normal, their palpitations are likely caused by stress, anxiety or misinterpretation of a fast but normal heartbeat.

However, if a patient has a heart murmur, or if an arrhythmia can be heard during the examination, further evaluation is needed.

If an arrhythmia is suspected, the patient should be referred for an ECG to check for potential genetic syndromes such as Wolff-Parkinson White Syndrome, Long QT Syndrome and hypertrophic cardiomyopathy.

If it is determined that the patient has an arrhythmia, treatment can include observation, medication, or an electrophysiology study and ablation, which eliminates heart tissue that sets up the arrhythmia. At Children’s, 3D mapping may be used to perform ablations with minimal radiation.

“We want to make sure providers are empowered to order the tests they think are necessary and feel confident in their decisions,” says Thomas. “If there is anything that they are concerned about or don’t understand, or if they feel it’s better for it to be taken care of by a specialist, they can always refer to us.”