Question to Docs about my 4 y/o son + heart
 

My four year old was diagnosed with Asthma a couple of years ago. He was prescribed typical nebulizer (sp?) treatment with albuterol and pulmicort in addition to singulair orally.

http://www.singulair.com/montelukast_sodium/singulair/consumer/asthma/for_adults/request_information/index.jsp?WT.srch=1&WT.mc_id=S248L


Recently he been coughing a lot and a visit to the doctor after 3 weeks of this resulted in diagnosis of the onset of a chest cold, and the singulair and amoxicillin were prescribed.

My sis-in-law lent us her stethoscope to listen to his breathing and Monday and to her horror his heartbeat was all over the place. That afternoon he was on a EKG (I can take a pic of the printout) and monitored. Doc told my wife to stop the singulair and that a cardiologist would review the EKG.

He has not taken a pill since Monday and today my wife listened again and its still very irregular. Possible additional side affects, he is sleeping a lot as of the last couple of weeks, 12 hours a night and on top of that VERY moody and grouchy.

We are supposed to hear on Friday from the cardiologist but we cannot help but be sick worrying.

Singulair's website says a possible side affect is irregular heart rate, will this go away with time once its out of his system.

EKG - the part in the middle where its flat would be where he was freaking out because he thought the EKG was going to hurt him.

http://i6.photobucket.com/albums/y21...3/DSC_0331.jpg

Looks pretty normal except the last couple of beats which appears to be artifact. The irregularity you are hearing may just be the normal "sinus arrhythmia" present in younger individuals. However, I can't tell from this tracing if the last beat is a PVC (iso-electric), dropped beat (unlikely in a 4y/o), or artifact.

Agree with above. It looks like sinus tachycardia which could just be the nebulizer treatment. The Albuterol is a beta agonist which increases the heart rate as a side effect. He should be fine.

I was just playing with him and I am worried sick right now, thanks for your input it has helped a lot to calm me down.

BTW - he is not using the nebulizer and is not receiving any treatments, and has not for a while the only medication was the Singulair and amoxicillin. The nebulizer has not been used in a while we only use it as a last resort because we do not like to use it.

You guys are GREAT for helping Jim rest a little easier about this...

Pelican guys ROCK!

angela

Hmmm. If this is referring to the fifth complex in the v4-6 portion of the tracing, unlikely to be a PVC as the rate is about 120 (the base rate). Another possibility is the T wave of the fourth complex may contain a PAC which would be blocked. OTOH the whole precordium has a wide range of voltages (one guesses probably due) to respiratory variation which clouds this possibility. Finally, if anything the last complex might be a PAC (absent or altered morphology p).

In other words, we need a rhythm strip or another tracing.

I scanned the package insert and didn't see anything about cardiovascular side effects, although there was an admonition to report any cardiovascular symptom to the company.

Jim,

Sorry to hear about your son. For some reason I can not open the pic with the EKG. It is however very unusual for a four year old to develop a serious heart condition, but it is very common to have both a very fast rhythm and irregular beats during infectious diseases.

Montelucast (Singulair) is generally a very safe asthma medication. I have hundreds of kids using it daily and to my knowledge I have not heard of one single case with heart side effects of any significance. It is most likely perfectly safe to stay with singulair, but on the other hand it is not that effective at least not short term.

If he has been coughing for three weeks I would give him the budesonid (pulmicort) 200ug twice daily until he is well. Actually, I would probably start out with 200ug four times a day for a couple of days to get a head start on putting a lid on the inflammation in his air ways. Furthermore, at his age there are some bacteria types that are pretty common resulting in or aggravating air way symptoms like this (any fever, BTW?) - but the amoxicillin may not cover their resistance pattern. I would probably go with Erythromycin instead.