dear teacher

(because if you say "heart condition" the school kind of freaks out, but if you say "don't treat her with kid gloves," they might not administer hugs at the appropriate time)

Thank you for your concern about Emma. As you know between Thanksgiving and winter break Emma developed some strange and disconcerting symptoms. Fortunately, we’ve been able to sort through them and they are completely benign at this point. I’m taking this opportunity to more clearly communicate the doctor’s findings and what he recommended. I apologize for not doing this sooner.

The doctor diagnosed Emma with SVT (supraventricular tachycardia). This is a mostly benign condition in which the heart’s normal electrical system behaves erratically. While the condition is usually benign, the symptoms are severe and include: shortness of breath, dizziness, pounding, fluttering or racing heart, chest pain or pressure, fainting or near fainting. In essence, it feels like you are having a heart attack even though you are not. So, it can be quite upsetting to Emma when she experiences this. And because of this, she sometimes becomes upset even when her heart is racing for normal reasons, such as anxiety about Stay Day, enthusiasm about a new or exciting activity, or after exercise.

Here are the guidelines the doctor gave us for being able to track her symptoms, determine if they are benign or dangerous, and help Emma understand what is happening in her body.

• Give Emma a hug and reassure her, and then take the opportunity to listen to her heart rate by placing your ear against her chest.
• If she is crying or upset, we are usually able to calm her down with the hug and by telling her that we need her to be quiet so that we can listen to her heart. We also have her take a few deep in and out breaths to help calm her down more quickly.
• It will be obvious if she is having an episode; you will feel her heart pounding hard and fast or fluttering and shallow. It will feel and sound notice-ably and disconcertingly different than just the pounding heart of a child who has been running or laughing or crying.
• If she is NOT having an episode, simply upset or excited and the heart rate sounds fine (probably 120 beats per minute or less) reassure her that it sounds healthy and fine. Give her another hug and have her return to her previous activity.
• If she IS having an episode, keep your ear to her chest and count the heart beats. A safe range for a 4 year old is up to 200 heart beats per minute. According to the cardiologist, a good rule of thumb is that if you CAN count the beats, even by counting very rapidly, it is most likely under 200.
• In the case that she is having a benign episode, the doctor recommended she lay down and rest until it passes (which usually only takes about 5 minutes). If you have happened to count the beats/per minute please write down the number. Also – please ask Emma if she notices that she feels better right away – like a switch flipped – or slowly and gradually. This will help the doctor to narrow the diagnosis. You can also have Emma give a 2 or 3 long, hard exhales or grunts as if she were constipated in an attempt to slow the heart rate down. As soon as you listen to her heart rate and hear that is normal she may return to what ever she was doing previously. At home we immediately return to our normal behavioral expectations for her once the episode is past – meaning she does not receive a treat, cannot escape doing chores she doesn’t like or extort us into lots of extra naptime stories. We continue with our day as normal. And truly, at this point, it hasn’t seemed that she has ever tried to use her symptoms to her advantage, or as a manipulation tool. It more seems that she is afraid of them and wants to avoid having them again.
• If you CANNOT count the beats because they are too quick or too irregular, then this is NOT a benign episode. 200 beats per minute or more is dangerous. Please call me immediately, and continue to track her heart rate until I get there or until you feel that she needs immediate medical attention.

At this time the doctor does not wish to prescribe Emma any medication, which is usually reserved for patients whose episodes occur frequently enough to negatively affect their quality of life and prevents them from their daily activities. He has just asked that we track the symptoms and report back to him. It seems like the episodes comes in waves, so we see a bunch for a few weeks and none at all for a few weeks. Indeed, she may never have one at school, but I wanted to equip you with what to do in case she does. I am also including a WebMD article that includes a basic description of SVT if you are interested.

We have been working with Emma to help her understand the difference between normal increased heart rate, and the SVT episodes. Usually the hug, listen, and reassure routine is enough to satisfy and calm her down.

Thank you again for your concern and interest. Please know that this situation does not cause us any anxiety. First and foremost, we trust the Lord with Emma. And we have found the doctor’s guidelines very reassuring for knowing how to handle the situation and help Emma in a calm, direct way.

Thank you so much,

Carol Claflin

Scott Claflin