Telehealth Visits and Advanced Technology Help Teen Diagnosed With Heart Condition during Pandemic

Photo credit: Cris Gebhardt
Sarina Behera, MD, and patient Lena O’Grady

COVID-19 has changed many things about everyday life, and health care is no exception. But even in the middle of a crisis, access to quality medical care is still very important. Fortunately, telehealth visits and at-home monitoring made it possible for 19-year-old Lena O’Grady to be diagnosed and treated for a heart condition with minimal personal contact.

During her sophomore year at the University of California, Los Angeles, one day Lena suddenly felt her chest tighten and her heart race. She had experienced similar episodes before, but this was worse, and she knew that she needed to seek medical treatment.

“These episodes, they come out of nowhere. My heart rate increased really quickly over a really short period of time. And I normally get some chills with that or shakiness or feel lightheaded or have to sit down. I’d feel really wiped out and exhausted afterwards,” she described. “And then in February of this year, I had a really bad episode where I had chest tightness, and the effects lasted a little bit longer afterwards.”

Over spring break, Lena spoke with her primary care doctor, Yasuko Fukuda, MD, who referred her to Sarina Behera, MD, a cardiologist at Stanford Medicine Children’s Health’s Specialty Services location in San Francisco. Dr. Behera was able to coordinate Lena’s care with a combination of in-person and telehealth visits.

“I just got to sit in my kitchen, and my mom could join in,” Lena said about her virtual visit. “We scheduled the procedure, and [Dr. Behera] gave us a rundown of how the procedure would go. And that was all virtual, which is pretty cool. I had some email contact with the nurses and electrophysiologist beforehand. I did not actually meet the electrophysiologist until right before my procedure. … So, that worked out really well.”

One important component for diagnosing Lena was a special heart monitor that she wore for a few weeks. Dr. Behera’s team sent it to Lena in the mail, to apply it herself and return it to the company when she was done wearing it, all without needing any personal contact.

The patch picked up on an abnormal heart rhythm, which told Dr. Behera that Lena had a condition called supraventricular tachycardia. Being able to have a telehealth visit and monitoring at home meant that Lena was able to stay distant while she was getting her diagnosis.

“With shelter in place, we were able to send a patch rhythm monitor to Lena’s home. It stays on for about 10 to 14 days,” Dr. Behera said. “She had an episode of supraventricular tachycardia that lasted for about two and a half minutes while wearing the patch. Therefore, we were able to diagnose her condition before physically seeing her in the office. She only required one office visit prior to her procedure.”

Supraventricular tachycardia, or SVT, causes an abnormally fast heartbeat. In Lena’s case, it was because of an extra electrical pathway in her heart that would go into overdrive sometimes. Without treatment, her condition could get worse.

As an active college student and runner, Lena decided to get a procedure called an ablation, which means the extra pathway was frozen so that it could not conduct an abnormal heartbeat anymore. The procedure was done by another Stanford Medicine Children’s Health cardiologist, Anne Dubin, MD.

Now that the procedure is behind her, Lena is ready to get back to enjoying her life free from the worry of abnormal heart episodes.

“I’m definitely relieved that it’s taken care of; the procedure went smoothly, and I had a really good experience at Lucile Packard Children’s Hospital,” Lena said. “I’m doing longer walks now. I plan to start running again soon. So yeah, feeling pretty good.”

According to Dr. Behera, SVT is a relatively common condition. People with SVT may have episodes of rapid heart rate that can happen during rest or activity, and they can start and stop suddenly. Due to the stress of the pandemic, some children may experience anxiety, which can produce similar symptoms. Dr. Behera urges any parents with concerns to talk to a doctor.

“If a child or teenager complains of persistent palpitations, it is important to undergo medical evaluation. Currently, there are a lot of children who are anxious due to major pandemic-related changes, and it can be challenging to differentiate between anxiety, benign palpitations, and arrhythmias, such as what Lena had,” Dr. Behera said.

“Regardless, anxiety also may require treatment, as we know that there has been a significant rise in mental health concerns during the pandemic,” she added. “If children have palpitations whether due to a cardiac cause or anxiety, it is important to let the primary care provider know to determine the need for further evaluation and treatment.”