Re: Dylan/ Still problems

[Guest guest]

How scary that must be. I know that feeling of almost losing a child. Our

youngest almost died last Oct. It was everything I could do to keep from losing

it. But my friends and family and mostly my faith got me threw it. There is

still the chance that he may not reach adulthood, but I know at least he will be

in a better place and not be in pain anymore. My prayers will continue for

Dylan. Also prayers for comfort, peace and strength for you and the rest of the

family. God Bless

HUGGLES,

Grace

EDS, It's a Life Thing

http://www.ehlersdanlos.ca/whateds.htm

Dylan/ Still problems

Hi all, Obviously I have emails to catch up on but here is what's up. Yes we

are home form NIH. But all is not so good yet. He is stable for now. The first

day of the study they found he was in Bradycardia ( low heart rate). The echo

found some problems with some of the arteries, I can't remember exactly what

right now. They said things didn't look good and thought maybe the leads were

bad and they would run the test again later. On day 2 they transferred us to

another hospital to have an MRI of the spine and an MRA of the Aorta, We were

waiting for another girl to come out of the MRI that was there with Marfans and

the plan was to take us all back when she was done. But, then Dylan collapsed

holding his chest and crying in pain. They rushed him over to ER and put him on

the monitors and he was in bradycardia again and rarely got out of it. His HR

stayed between 38 an 60, mostly staying between 40 and 52. They called up to the

MRA and had it read immediately and it was fine. They found a 1st degree AV

block. I still have to look that up to see what that means. They are undecided

as to why he had the chest pain, but I thought I was losing him right there

before my eyes. God I was so scared, and I still am. Something else kept

blinking on the nurses station that I still don't know the meaning of, I kept

saying: ST INF HI. I know it was for him because of the room and bed #. Any way

they said he was stable to travel home. Thank you all for prays and thoughts

when Lana sent out the email that he was in trouble.

I'll write a separate email about what they found so far about him in the NIH

study. And another about how to get in the study.

Thank you all, I was so scared, but knew I wasn't alone.

Cindylouwho/Cindy C.

[Guest guest]

Thank you Grace. The drs have no explanation as to why he had the chest pain.

Sorry your child is so sick. It is scary indeed.

Cindylouwho

Dylan/ Still problems

Hi all, Obviously I have emails to catch up on but here is what's up. Yes we

are home form NIH. But all is not so good yet. He is stable for now. The first

day of the study they found he was in Bradycardia ( low heart rate). The echo

found some problems with some of the arteries, I can't remember exactly what

right now. They said things didn't look good and thought maybe the leads were

bad and they would run the test again later. On day 2 they transferred us to

another hospital to have an MRI of the spine and an MRA of the Aorta, We were

waiting for another girl to come out of the MRI that was there with Marfans and

the plan was to take us all back when she was done. But, then Dylan collapsed

holding his chest and crying in pain. They rushed him over to ER and put him on

the monitors and he was in bradycardia again and rarely got out of it. His HR

stayed between 38 an 60, mostly staying between 40 and 52. They called up to the

MRA and had it read immediately and it was fine. They found a 1st degree AV

block. I still have to look that up to see what that means. They are undecided

as to why he had the chest pain, but I thought I was losing him right there

before my eyes. God I was so scared, and I still am. Something else kept

blinking on the nurses station that I still don't know the meaning of, I kept

saying: ST INF HI. I know it was for him because of the room and bed #. Any way

they said he was stable to travel home. Thank you all for prays and thoughts

when Lana sent out the email that he was in trouble.

I'll write a separate email about what they found so far about him in the

NIH study. And another about how to get in the study.

Thank you all, I was so scared, but knew I wasn't alone.

Cindylouwho/Cindy C.

[Guest guest]

Hi Cindy:

Please don't be concerned about returning emails. We are all here for you &

your family & the last thing you need to be concerned about is us.

THANKS TO EVERYONE, FROM CINDY

There, I said it for you... Feel better?

Please just concentrate on getting through all of this. And perhaps instead

of " one day at a time " , go for an hour or a minute, at a time... One foot in

front of the other!

And, please know that you have the collective love, prayers, thoughts &

support of us all. I'm sure this must be very difficult for you & no one knows

how

anyone else feels, even if they've been through something similar, everyone

has their own set of challanges, but I'm sure others can empathize with you.

I hope this helps too, as you mentioned 2 things & I thought I could save you

some time.

~~~~~~~~~~~~~~~~~~

You said, " Something else kept blinking on the nurses station that I still

don't know the meaning of, I kept saying: ST INF HI. I know it was for him

because of the room and bed #. "

~~~~~~~~~~~~~~~~~~

This surely isn't medical advice, but there are different parts to all of the

little " bleeps " /the little lines, that go up & down & accross. etc. There

are things/sections, called, for instance,

1) QRS Complex

2) T wave

3) P wave

4) U wave

And an S-T segment. It could be that they were referring to that. I'm not

really sure what you saw means, but it could be something related to that, like

a description of that part of his EKG. But if they said he was OK to travel,

then I wouldn't be too upset, at least not about that issue, but you can

surely ask the Dr. Remember, that's what they are there for & why you pay

them!!! So, maybe to get it off of your head, just give them a call & ask what

that

meant.

Also,you wanted to look up 1st Degree heart block. This is an extact copy

of an article that I found on eMedicine & I thought it explaind things pretty

simply & in an organized fashion.

Heart Block, First Degree

Last Updated: September 27, 2002 Rate this Article

Email to a Colleague

Synonyms and related keywords: atrioventricular block, first-degree

atrioventricular block, AV block, first-degree AV block

AUTHOR INFORMATION Section 1 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Author: FM Brown, MD, Instructor, Department of Medicine, Division of

Emergency Medicine, Harvard Medical School; Associate Chief, Department of

Emergency Medicine, Massachusetts General Hospital

FM Brown, MD, is a member of the following medical societies: Society

for Academic Emergency Medicine

Editor(s): Theodore Gaeta, DO, MPH, Residency Director, Clinical Associate

Professor of Emergency Medicine in Medicine, Department of Emergency Medicine,

New York Methodist Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy

Editor, Pharmacy, eMedicine; Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant

Professor, Department of Family Medicine, McGill University; Consulting Staff,

Department of Emergency Medicine, The Sir Mortimer B -Jewish General

Hospital;

Halamka, MD, Chief Information Officer, CareGroup Healthcare System,

Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel

Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical

School; and H Plantz, MD, FAAEM, Research Director, Assistant Professor,

Department of Emergency Medicine, Mount Sinai School of Medicine

INTRODUCTION Section 2 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Background: First-degree heart block, or first-degree atrioventricular (AV)

block, is a condition that results in prolongation of the PR interval on

electrocardiogram (ECG) to >0.20 seconds. The PR interval is defined as the time

from the initial deflection of the P wave from the baseline to the beginning of

the QRS complex. A normal PR interval is from 0.12-0.20 seconds.

Pathophysiology: Electrophysiological studies have shown that first-degree

heart block may be due to conduction delay in the AV node, in the His-Purkinje

system, or a combination of the two. AV nodal dysfunction accounts for the

majority of cases. However, in the subset of patients with first-degree heart

block and bundle-branch block, conduction delay in the His-Purkinje system is

the

more likely cause.

Frequency:

In the US: Prevalence in the young adult population ranges from 0.65-1.1%.

Higher prevalences are reported in studies of trained athletes (8.7%) and

medical students (8%). The incidence is 1.13 per 1000 persons.

Mortality/Morbidity: Morbidity and mortality rates from heart disease appear

to be unaffected by the presence of first-degree block. CLINICAL Section 3 of

8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

History:

Patients may have a past history of heart disease, including myocardial

infarction (MI) or myocarditis.

Patients may be highly conditioned athletes with a high degree of vagal tone

or they may be on medications that slow conduction through the AV node.

Physical: First-degree heart block is generally an incidental finding noted

on ECG without any particular associated signs.

Causes:

The following are the most common causes of first-degree heart block:

Intrinsic AV nodal disease

Enhanced vagal tone

Acute MI, particularly acute inferior MI

Myocarditis

Electrolyte disturbances

Drugs

The drugs that most commonly cause first-degree heart block are those that

increase the refractory time of the AV node, thereby slowing AV conduction.

These drugs include the following:

Calcium channel blockers

Beta-blockers

Digitalis glycosides

DIFFERENTIALS Section 4 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Heart Block, Second Degree

Heart Block, Third Degree

Quick Find

Author Information

Introduction

Clinical

Differentials

Workup

Treatment

Follow-up

Bibliography

Click for related images.

Related Articles

Heart Block, Second Degree

Heart Block, Third Degree

WORKUP Section 5 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Lab Studies:

Routine laboratory testing usually is not indicated in the evaluation of

first-degree heart block.

Electrolyte and drug screens can be ordered if the physician has a suspicion

of metabolic derangement or drug toxicity.

Imaging Studies:

Routine imaging studies are not indicated.

Other Tests:

Follow-up ECGs may be indicated in patients who are treated with AV nodal

agents while in the ED and for patients with concomitant MI. First-degree heart

block can be evaluated further on an outpatient basis.

TREATMENT Section 6 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Emergency Department Care: No specific therapy is required. However, patients

with concomitant MI should receive appropriate therapy.

Consultations: Follow-up with a cardiologist is advised. FOLLOW-UP Section 7

of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Further Inpatient Care:

First-degree heart block does not require hospital admission unless the

patient has an associated MI.

Identify and correct electrolyte abnormalities.

Withhold any offending medications.

Further Outpatient Care:

In the absence of a disease process that requires admission, patients with

first-degree AV block may be observed as outpatients.

Patients will need follow-up ECGs over time to check for progression to

higher grade AV block.

Physicians should closely observe patients with first-degree heart block and

coexistent bundle-branch block.

Consider alternative medications to those that slow AV nodal conduction.

Complications:

Patients with first-degree heart block occasionally may progress to a higher

grade block, often with accompanying hemodynamic instability. This occurs

primarily in patients with acute MI or myocarditis; however, it may also be drug

related, especially in the setting of an acute overdose.

Drugs that slow AV nodal conduction, even in appropriate doses, increase the

risk of progression to higher degrees of heart block and should be given with

great caution.

Prognosis:

Prognosis for first-degree heart block is very good.

BIBLIOGRAPHY Section 8 of 8

Author Information Introduction Clinical Differentials Workup Treatment

Follow-up Bibliography

Bexton RS, Camm AJ: First degree atrioventricular block. Eur Heart J 1984

Mar; DA - 19840717: 107-9[Medline].

Gomes JA, El-Sheriff N: Atrioventricular block. Mechanism, clinical

presentation, and therapy. Med Clin North Am 1984; 68: 955-67[Medline].

Mymin D, Mathewson FA, Tate RB, et al.: The natural history of primary

first-degree atrioventricular heart block. N Engl J Med 1986 Nov 6; 315(19):

1183-7[Medline].

Rowland E, Morgado F: Sino-atrial node dysfunction, atrioventricular block

and intraventricular conduction disturbances. Eur Heart J 1992 Dec; 13 Suppl H:

130-5[Medline].

In a message dated 8/19/2004 1:46:44 PM Eastern Daylight Time,

c-clark05@... writes:

From: cindy clark

To: ceda

Sent: Thursday, August 19, 2004 1:01 AM

Subject: Dylan/ Still problems

Hi all, Obviously I have emails to catch up on but here is what's up. Yes

we are home form NIH. But all is not so good yet. He is stable for now. The

first day of the study they found he was in Bradycardia ( low heart rate). The

echo found some problems with some of the arteries, I can't remember exactly

what right now. They said things didn't look good and thought maybe the leads

were bad and they would run the test again later. On day 2 they transferred us

to another hospital to have an MRI of the spine and an MRA of the Aorta, We

were waiting for another girl to come out of the MRI that was there with Marfans

and the plan was to take us all back when she was done. But, then Dylan

collapsed holding his chest and crying in pain. They rushed him over to ER and

put

him on the monitors and he was in bradycardia again and rarely got out of it.

His HR stayed between 38 an 60, mostly staying between 40 and 52. They called

up to the MRA and had it read immediately and it was fine. They found a 1st

degree AV block. I still have to look that up to see what that means. They are

undecided as to why he had the chest pain, but I thought I was losing him right

there before my eyes. God I was so scared, and I still am. Something else

kept blinking on the nurses station that I still don't know the meaning of, I

kept saying: ST INF HI. I know it was for him because of the room and bed #. Any

way they said he was stable to travel home. Thank you all for prays and

thoughts when Lana sent out the email that he was in trouble.

I'll write a separate email about what they found so far about him in the

NIH study. And another about how to get in the study.

Thank you all, I was so scared, but knew I wasn't alone.

Cindylouwho/Cindy C.

I hope this helps. In the meantime, I'm sending all good thought, lot's of

good, healing energy & as always, I love you lots.

Luv 'Ya,