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What can be done for low heart rate?

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My seven year old son s heart rate dropped to 44 while in the ER. Nothing was done to raise it. They would open the door to make sure someone was in there and close it. I know this is not right. What should be done for my son in the ER? He has had several seizures in the last month and has been admitted twice for them. They keep him overnight in the PICU to monitor him, but do nothing for the low heart rate. They don't even have a cardiologist come check him out.
Posted Sat, 21 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Santosh Kondekar 8 hours later
Thanks for the query,

1.My seven year old son s heart rate dropped to 44 while in the ER. Nothing was done to raise it. They would open the door to make sure someone was in there and close it. I know this is not right. What should be done for my son in the ER? He has had several seizures in the last month and has been admitted twice for them. They keep him overnight in the PICU to monitor him, but do nothing for the low heart rate. They don't even have a cardiologist come check him out

=== Such situations arise out of poor doctor patient communication. At times even momentary heart rate drops to 44 may be normal or a machine error.. or may be related to reduced fluids/temperature etc.

Is your child in ICU right now? why don't you attempt to stop a doctor and discuss your situation? After all its your child. What you are trying to say may be true, like say dropping heart rate and the perception that nothing was done for the child .This can really be serious and legally punishable if it is true and done without your consent.

Treatment for low heart rate may not always be "seen" ( as in CPR) especially when you were more than 5 feet or in another room. Low heart rate if the same was on clinical examination, may need specific drugs which might have been injected and you may not know unless it is put on paper.Its doctor's duty to mention either heart rate was not low on examination or if it is low, the drugs given for it. Often it may take few minutes to get the rates up with medicines if they were seriously low.

Cardiologist is not always required for management in ER, as most ER have trained physicians for managing emergencies including low heart rate. They do have a protocol.

You seem to have a feeling that the "doctors" just don't want to treat this child due to his seizure issues, this needs to be discussed with XXXXXXX doctor in the treating team.

Hope my answer is adequate, i will be available for follow up should you have any more concern.
Above answer was peer-reviewed by
Follow-up: What can be done for low heart rate? 1 hour later
Thank you for your response. He was discharged yesterday. It's definitely not poor communication. I was very animate about a cardiologist seeing my son. His heart rate didn't just drop for a moment or even a few minutes. It stayed in the low 40's to low 50's for hours and they did nothing about it. I am a NICU mom of 3 micro preemies and spent 6 1/2 months at the NICU. I know as infants - they were given caffeine to stimulate them to get their heart rates back up. The doctor did not believe me my child was so out of it because of a seizure. They wanted to give him a pill just in case he accidentally took a pill. After about an hour of discussing my thoughts - he finally agreed he had a seizure. And his brother was in another room also recovering from a seizure. They did a urine and blood test that showed all was normal but still wanted to give him that pill "just in case." My son's neuro surgeon came to his room around 10 pm that night. He thoroughly checked him out and looked at his chart, EEG and EKG that was taken earlier. When he was there three weeks ago all the same test were run. He looked at the test results of the EEG and saw that he had a partial seizure. So what would be different about this visit? I spoke with his neurologist today and told her the situation that happened at the hospital (she has been out of town and just back today) When I told her about his heart rate - the first thing she asked was if a cardiologist was called. I told her no and I even asked for one to check him out. I was told one would be there in the morning. The next morning the PICU doctor told me he would be discharged. I asked about the cardiologist and was told his heart rate was normal now that the cardiologist wouldn't be able to tell me anything. I don't think it's because they don't want to treat him for his seizure issues. I really don't know what happened this weekend. All I know is when a child's heart rate or anyone for that matter is that low - a cardiologist should be called in to check the patient. He has been admitted several times for his seizures. Both of my boys seizures aren't your typical few seconds to a minute or two. If I do not have their diasipan - it will not stop until it is administered. My son that I am asking about today - when he had his first seizure was transported to the hospital in an ambulance. When we got to the hospital he started seizing again. It last almost 30 minutes and took four doses of ativan to stop the seizure. I know nothing was administered to him for his low heart rate. Even though I had to go room to room for my two sons. Someone from my family was always with them. I would not let them do anything to either of them unless I was in the room. I have to be with my child when any procedure is done. I am very protective of my boys and I will hold them while they are being stuck with a needle or anything else. I want to be there to comfort them. I know something is really wrong with the situation we went through this weekend and know that something should have been done for his low heart rate and a cardiologist called in for a consult. I even requested one and did not get one. I am not asking because of legal issues. I work for an attorney and could go that avenue on my own. My concern is - what should have been done? I know we will be there again and I want to know what needs to be done for his low heart rate. Because I know it's not just keep him on a monitor. 44 is a very low heart rate. I have lost two babies before and I will do my best to never lose another one. We do see a cardiologist on Monday and their neurologist on Thursday. I am sorry for my long response but I just wanted to let you know all the details so you can give me a very accurate answer. Thank you!
Answered by Dr. Santosh Kondekar 2 hours later
I understand your concern.

May be you are over protective, but do not loose faith in your doctor, and no interaction can survive with lost faith. Also, this attitude will interfere with treatment, decision making and psychology of doctors.

Again, I repeat
1. There should be documented proof of low heart rate, not just the monitor.

2. A cardiologist is not always available in ER as a cardiologist is not required for treating low heart rate in ER. ER people need to be trained in confirming and managing recent onset low heart rate as a life saving measure as it can be life threatening.
There are standard bradycardia (rate below 60) managing protocols which all ER doctors need to be aware of.
Neurologist and cardiologist do not have enough expertise in managing children as their training doesnt always involve enough pediatric exposure.

3. The CONFIRMED low heart rate situations may require any or all of the following measures including CPR, adrenaline, aminophylline, confirming heart block an arrhythmias.

4. Heart block and arrhythmia cases do have low heart rate and they may be stable with it. often one has nothing to act on emergency as it may not always create any further issues. Such cases may require a long term evaluation for cause of arrhythmia. Here cardiologist has important role to play.

5.Drugs like phenytoin or calcium IV given for seizure may cause low heart rate. Here a neurologist has some role to comment on.

Since you will be seeing your Cardiolgist and Neurologist on monday you will be able to discuss the issue with them.

I hope i could address your concerns, please reply if any further issues need to be cleared.
Above answer was peer-reviewed by
Follow-up: What can be done for low heart rate? 17 hours later
I am sorry but you misunderstood me. I am NOT an over protective mom. I protect them when needed be and will not let them hurt themselves. My boys have come this far because I let them find out what their limits are. I never let anyone limit them. If you limit someone, how will they every know how far they can go? Again, what I said was that when my boys are getting anything done I am always with them so I can comfort them. Especially after getting an iv or a catheter. You are right about a neurologist and cardiologist not knowing how to treat a child. That is why they see a pediatric neurologist and a pediatric cardiologist. As far as the heart rate goes - I am not only going by the monitor alone. As you said, it could have been an error. His heart rate was 44-50 for hours and was proven to be correct because he had an EKG done. They had proof his heart rate was that low and did nothing. They did not give him any medication for the seizure or low heart rate. So let's get back to my original question that wasn't answered - was this normal? I want to know what should have been done, so the next time we end up in the ER I can make sure my child (ren) are completely taken care of and not have a deadly low heart rate in the 40's for hours and it was about 10 hours. This is not right!!!!
Answered by Dr. Santosh Kondekar 5 hours later
Thanks for the query,

I appreciate your understanding and patience in the situation. There are some rare causes where doctors may need to just sit hands on waiting for time, even if the child is having some kind of focal twitching seizures or even if the heart rate is low as in some kind of arrhythmias, as at times further therapy may not be benefiting but harming the child at least for that time being.

But often, if it is noted for the first time, As i had told you before, there are protocols for managing bradycardia and seizures for each ER. Routine ER seizure control has a stepwise approach using 1-2 -3 -4 drugs one after another. Pediatric cardiologist is not required in ER unless ER pediatric doctors are not trained in managing the same.

Bradycardia, as i told you before, can be life threatening on routine cases and may need cardiopumonary resuscitation or drugs like adrenaline, atropine and dopamine or aminophylline.

Thanks for letting me know about the ECG heart rate, please get reconfirmed that the heart rate is same on repeat ECG and also it has no other arrhythmia that just needs to wait for further investigations and may be a pediatric cardiologist.

Hope my answer is adequate.
Above answer was peer-reviewed by
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