IT’S NOT THE HEART!

I had funny feelings in my chest.  Because both my brothers had cardiac issues in their 50s, and I was about to go on a hiking vacation, I was a little concerned. So while at work, I asked one of the nurses to check my EKG.  Her eyes bugged out, and I could see her thinking “Dr. Hamilton’s having a heart attack??”  Her hands shook as she stuck the leads on, apparently more worried about me than I was. Fortunately the EKG was normal and vacation went fine.  And I lamely apologized to the nurse for scaring her with my apparent muscle pain.

We older adults are continually warned to take chest pain seriously. With bad pain, we’re to call 911.  Paramedics carry medicines for heart attacks, and can send EKGs to  the ER to warn that a cardiac patient is imminent.  Also, sometimes adults pass out from heart attacks while driving themselves to the hospital, endangering others as well as themselves- let the medics drive!

You may be surprised, but kids get chest pain too, and when they do, sometimes parents panic.  Is my child having a heart attack like Uncle Frim did? The good news: rarely is chest pain something bad in kids.  The majority of their chest pain is in the chest wall: muscles, ligaments, and ribs.  The rib cage is not rigid like a bird cage; it has joints, expanding to suck air into the lungs, and contracting to squeeze air back out.  Like any joints, whether in the chest wall, knees, or knuckles, they can hurt.  Furthermore, the rib cage often hurts in kids for no apparent reason.  Sometimes the joints are strained by coughing, or lifting weights, sometimes they just hurt randomly.

The treatment for “costochondritis” (latin for rib and cartilage inflammation) is the same as for any sore joint.  Medicines like ibuprofen (brand names Motrin, Advil) decrease pain and inflammation- kids can take them three time daily for four days to settle things down.  Rest is important too- no PE, running, or other exercise that will get kids breathing hard and stress those sore rib joints.

Red flags for pediatric heart conditions below.

A teenager was in the chair at the hair salon, getting her hair done.  As the stylist worked, the girl started to feel weak, her vision closed in, and she slumped in the chair, unconscious.  Everyone began shouting, someone called 911, and they lowered her to the floor.  When the paramedics arrived, she was awake and feeling normal.

“Hair-Grooming Syncope” is the medical term for this phenomenon, where hair braiding, drying, or brushing leads to fainting spells.  It can happen in boys as well as girls, and isn’t from seizures or heart conditions.  It’s another case where teenagers can have an exaggerated tendency to faint.

Teens faint more easily than adults.  About 15% of kids have “syncope” before adulthood.  Kids have more pliant blood vessels in their extremities, and blood can pool there when they stand, sit, or lie down for long periods.  Then when they get up, it takes some seconds for the leg muscles to pump that blood back up into the central circulation to feed the brain.  When the brain lacks blood, kids faint. They fall down flat, blood gets back to the brain, and they wake up.

Other things besides hair grooming and sudden standing can make kids faint, like stress or anxiety. The site of blood itself can bring on syncope- we always have parents sit down when we stitch their kids’ lacerations, because sometimes the sight of blood gets them woozy and they collapse before we can catch them.  Illnesses like stomach or flu viruses, or certain smells can also cause syncope.

Like with chest pain, fainting is rarely due to heart conditions in kids.  However, there’s some red flags for the heart when kids faint or have chest pain.  If the child or teen has pain or faint-feeling while exercising, that needs checking. Kids who have chest pain or palpitations with fainting are concerning.  We also worry if there’s family members who suddenly died at an early age.  Rare-but-lethal heart rhythm conditions can run in families: these are the kids at risk for collapsing on the basketball court.  But if your kid feels woozy in the salon chair, don’t panic- it’s the hair, not the heart.

Fainted? Stay flat!

     I have had several personal fainting episodes in my life, some quite silly.  For example, there was the time in high school biology class:  I was to get a drop of blood from my fingertip to look at blood cells under the microscope.  I guess I was nervous, because when I poked myself with the lancet, no blood came (being nervous will cause a reflex wherein blood is kept out of your extremities).  I thought that was weird, so I poked myself again.  Still no blood.  I poked a third time.  Now I began to get woozy, my vision got spotty, and I got clammy and had to put my head down.  Stabbing yourself again and again is not a natural thing to do to yourself, and my brain gave up and put me down. 

    Even sillier was the time in medical school after I had been up all night in the hospital.  The next morning they had a blood drive in the cafeteria.  I did my part, gave up a pint, and then leapt up and headed for the free cookies and juice.  Funny, I thought as I reached for an oreo, I can’t see.  My vision had blacked out so fast that I did not realize what was happening until people were helping me into a chair like I was a sack of potatoes.  The combination of fatigue, blood loss, and jumping up made it extra hard for my body to pump blood into my head, and down I went.

     Teenagers, like I was then, faint easily.  First, they have healthy, squishy blood vessels in their legs, unlike we older folks whose vessels have stiffened with age.  This helps blood pool in the legs, away from the head.  Then when a teenager stands up quickly, or stands still for a long time, enough blood stays below that it can’t get up to the brain fast, and the teen passes out.  Teenagers get this even more easily when they don’t drink enough fluids or eat regularly, adding slight dehydration and low blood sugar to the mix.  Finally, being ill with a virus or other infection slows your body’s response time to stresses like being on your feet, and out you go.

     Fainting is not an emergency.  Fainting is not a seizure. Unlike a seizing patient, the fainter will typically wake up quickly if allowed to lie flat, or at least in a chair with the head below the knees.  Having the head down helps the body get blood back to the brain and wake it up quickly.  Then keep the person down for five minutes, and then sit up and stand up slowly, in stages.  The body needs time to compensate and recover.  I have had kids come in with fainting episodes lasting on and off for fifteen minutes because bystanders stood them up too fast and tried to get them walking around.

     When do we worry about fainting episodes?  When the patient does not wake up within five minutes.  That may indicate a seizure.  Also, if the patient faints while exercising, when the legs muscles are squeezing blood out as fast as it comes in, that is a sign that the problem may be with the heart’s ability to pump.  Finally, multiple fainting episodes in a week may be because of a more serious problem.

     But for one fainting episode, don’t panic!  Lay the patient flat, and leave them there.  If they wake up in half a minute, no problem.  Keep them down, sit them up later, give them something to drink, and give them plenty of chance to rest.  Then they may have their own silly story to tell.