AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Question QUESTION: Hi,
My question is can you explain a junctional rhythm with premature/extra beats. Symptoms are dizziness,blackouts,chest pain and fatigue. She is only 10 so I know that a little young for your interest. I am just trying to understand what it is and how they may treat it. So that I can ask the correct questions of our doctor when I hear from him. I will be more than happy to give a little back history if needed/wanted but I've tried asking it before and they responded to detailed.
Thank you in advance and any advice on how to educate myself would be so helpful.
Tammy
ANSWER: Dear Tammy,
Ask if it's a junctional escape rhythm or an accelerated junctional rhythm, unless you already know. Junctional escape has heart rate 40-60 beats/minute. Accelerated junctional has heart rate 60-100. Though in either case, with all her symptoms, she probably needs a pacemaker, with the lead in her atrium (the upper chambers of the heart) unless she's taking digoxin. Has she any other heart disease? If so, it might explain the junctional rhythm.
Junctional rhythm occurs if the normal pacemaker, located in the right atrium, doesn't function well. Then the heart is driven by a lower pacemaker. located in the junction between the atria and ventricles, hence the name junctional rhythm.
Better send me the background history. It's midnight here so I won't answer till tomorrow. Please keep me informed about what you discover when you see the cardiologist.
David Richardson
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for the information and your time already. The cardiologist/electropysologist did not tell us what type of junctional rhythm it was but mentioned premature/extra beats and stated that he had not seen a rhythm put together quite like hers is? He put her in a 24 hour holter and wanted to study the two results together and we are waiting for the results. She has been exceptionally healthy with the exception of having a very loud heart murmur that was evaluated when she as 18 mos old and deemed begign although it was so loud and b/c of location we were told by the doctor before the echo she would definetly need surgery but the echo was neg. so we have never thought of it again (don't know if it has anything to do with this).
Hx: she has had 6 months of dizziness and blackouts dizzy 5-6 times a day and black out 4-5 times a week but she has also felt terrible for these months fatigue, nauseau, headaches and then the chest pain about 3 months ago began with exercise. They tried her on Florinef and Attenlol both with no help. She has had a negative echo and EKG. She recently had a tilt table test that was positive very quickly which they were expecting but he had her on the monitor for almost 3 hours and said that she was in the junctional rhythm for over 90 percent of the time even before and after the testing period. Now she is taking Midodrine (sp?) The dizzy episodes are one thing but the days of overall not feeling well are the hardest to deal with for her. Any other suggestions to ask him about would be greatly appreciated. He had mentioned doing an EP study based on the holter results. Do you feel this would be helpful?
Again thank you for your time.
Tammy
Answer DearTammy,
Disorders of heart valves are among the causes of junctional rhythm. But the positive tilt test shows her blackouts are from low blood pressure when she stands. Midodrine is a good treatment for low blood pressure when standing. Has it helped her overall not feeling well? The suggested dose for an adult is 10 mg. three times a day. That obviously is too much for a 10-year-old girl. Divide her weight by 10 to get her dose. That's her weight divided by 1oo pounds (adult weight) and multiplied by 10 mg, the adult dose.
My only suggestion is to be sure the cardiologist understands that she has days of overall not feeling well, and ask how an EP study will help and why not just put in atrial pacemaker. Maybe a temporary pacemaker to see if that helps her overall feeling bad. Please oh please let me know what you find out and how she gets along.
