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Forum Name: Miscellaneous Cardiology Topics

Question: 5 year old with postural orthostatic tachycardia


 concerned/parent - Tue Apr 28, 2009 11:30 pm

How high does a child's exercise heart rate have to be before it poses a health risk? my child's resting heart rate is 80-89 and will rise to 200-215 within 2-3 minutes of cardio exercise- such as dancing or running. She usually doesn't last long with these activities and will just sit down. I'm afraid of what could happen if she pushes herself to try to keep up with her friends. Do I have a reason to be concerned?
I am seeking an eval for her with a POTS specialist and have educated her and her school has made her comfortable with self limiting activites. In the meantime, she dances and I am the one with chest pain due to fear of what could happen to her.
Thank you.
 John Kenyon, CNA - Mon May 04, 2009 10:51 pm

User avatar Hello --

While looking through your daughter's history I note bicuspid aortic valve and patent foramen ovale. POTS is a likely culprit in this case, or perhaps the very similar neurocardiogenic syncope syndrome, both of which are often seen in patients with this combination of relatively trivial defects. In general these patients tend to do very well, although they do have to be evaluated periodically (annually in adulthood, sometimes semi-annually, but sometimes more often in childhood, just to track the evolution, if any, of the defects. Usually nothing new shows up). Children your daughter's age tend to "run hot" anyway, and will have faster heart rates at most any level of activity, but of course your daughter's is a level above normal, which can cause fatigue. If she's been worked up for cardiac arrhythmias (not more common in these patients than in the general population), and found free of these, then she probably can do as much as she's able to do and feels good doing, and should let her body be her guide. If she's tired she should rest. Some people with this combination of defects wind up being quite accomplished athletes, while others wind up slightly aesthenic and tire easily. There's no particular rhyme or reason to this. I've seen one of each in a pair of siblings, even. Both are otherwise quite healthy adults now.

I hope this is helpful to you, and I hope you can find some middle ground for your concern, which is really difficult -- I understand this. I don't think extreme concern is warranted, but of course you should keep an eye out for any changes is the regular pattern. This makes it difficult to feel calm while watchful, but both you and your daughter will benefit because she will pick up on your anxiety, and that will just creat a cycle where both of you become unduly anxious. Best to just be watchful like the good parent you are, but there's no special reason to expect anything crucial to happen so long as she allows her energy level to dictate what she does.

I hope this helps. It's really difficult to be the parent in these situations and I admire your having educated yourself so well to what's going on. Hopefully you will know more soon and when you do, please follow up with us here. In the meantime, if there are any changes, or if you have any additonal questions, please let us know. Good luck to you both.
 concerned/parent - Wed May 06, 2009 8:19 am

Thank you. I appreciate your time and consideration to address my question.
Concerned/parent

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