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What is the cause for palpitations in a child?

Q: My daughter aged 13 years had chest pain and palpitation and on examination cardiologist found her to be a patient of MVP. He performed 2D echo and findings are: Normal LV function 0.73%. The Mitral valve were bulky redundant and exhibited grade II late systolic prolapse pattern. Doppler interrogation revealed Trivial Mitral Regurgitation. Normally functioning aortic, pulmonary and tricuspid valves. Interventicular and interatrial septum were intact. No I/C clot. Her Hb is 12%. Thyroid function within normal limits. Her heart size is normal. Cardiologist has suggested IE prophylaxis, Inderal 40mg 1/2 tablet thrice daily; and no restriction of physical activity. Weight is 55 kg. Lungs clear. S1 present A2 + Kindly guide me as whether there is any major problem to my daughter and whether any precautions to be observed? what is the significance of IE prophylaxis. Does it suggest any future treatment. Her class room is on 3rd floor with 40 steps. She goes to class by cycling. Please explain to me as to any future complications or surgical intervention at a later date or is there is any life threatening condition in future?

A:This is a well recognised entity and looking at the echo report I don't think that any sort of activity restriction is required, I would personally not give Inderal unless we can show that the palpitation is due to a Paroxysmal atrial tachycardia which can be associated with this condition. I would get a 24 hour Holter test for this. Many of the palpitation are also psychosomatic. IE prophylaxis is to prevent the valve getting infected (Infective endocarditis). This occurs only if there is mitral regurgitation. I am not sure from this report whether this mitral regurgitation is pathological or physiological. Most of these infection spread from bad dental hygiene so adequate care has to taken. A regular visit to a dentist is worth the trouble as PREVENTION IS ALWAYS BETTER THAN CURE. Also when any procedures is performed on the patient, the concerned doctor (cardiologist) needs to be informed.


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