Build It Beat It Gosh

[Tamela]

Ventricular ectopics are a type of arrhythmia or abnormal heart rhythm. It is caused by the electric signals in the heart starting in a different place and travelling a different way through the heart. If it happens occasionally, it should not cause any problems but if it happens a lot, you will need to have treatment. This page from Great Ormond Street Hospital (GOSH) explains ventricular ectopics and how they can be treated.

The heart has an electrical system that makes it pump. The normal electrical impulse starts in a specialised area of heart tissue in the right atrium called the SA Node. It then passes from the right atrium through to the ventricles via the AV node.

With ventricular ectopics, the electrical impulse starts from the ventricles before an electrical impulse can be made by the atrium and causes the heart to beat in a different way for that beat before resuming a regular rhythm.

The normal heart beat causes the ventricles (pumping chambers) to squeeze or contract at the same time (in synchrony). When you have an ectopic beat, the heart beat starts on one side of the muscle of the ventricles so one side contracts and pumps blood before the other. This is very unlikely to cause any harm if this is happening occasionally. However, if this becomes more frequent it can affect how your heart works.

If symptoms are present, they can include dizziness, palpitations, tiredness, feeling your heart miss a beat, fainting (syncope) or almost fainting (pre-syncope). If you are having episodes of fainting or collapse you need to let your doctor know. If you are experiencing symptoms in the red flags box you should seek immediate medical attention.

An Echo is an ultrasound scan of the heart. A picture of the heart is produced from which an accurate assessment of the size and function of the heart can be made. The scan takes from 30 to 40 minutes. As before this test is not painful, but children sometimes find the jelly on the probe a bit uncomfortable. Children can watch their favourite videos during the scan.

An exercise test is a specially modified test that assesses the rhythm and function of the heart at a faster rate, while the child is on an exercise bicycle or a treadmill. Blood pressure and breathing are also monitored during the test. This test is usually only performed on children over the age of eight years due to their size.

Exercise testing also provides us with an objective measurement of improvement, stability or worsening of heart function over time. The test takes approximately 45 minutes and allows symptoms not obvious at rest to become apparent when the heart is working harder. We recommend children to wear loose comfortable clothing for the test.

Medication, usually a beta blocker or a calcium channel blocker, help to control the area sending out the extra heart beats and improve symptoms. Sometimes when you start these medication you may feel dizzy and tired but this should settle over time.

A procedure called an electrophysiology study and ablation may be suggested. The doctor will use either radio frequency ablation (heating therapy) or cryoablation (freezing therapy) on the affected area, which should stop the abnormal signals. Ablation works by using a targeted beam of energy to destroy the tissues causing the abnormal signals.

Conditions can progress and it is therefore important to keep you under monitoring. Sometimes the percentage of ventricular ectopics naturally decreases and no further monitoring is required. In rare cases, they can be an early sign of more serious conditions that have not fully developed, which is why you will be followed up and you should make any medical teams know in the future that you have had these investigations.

You can get in touch with the Arrhythmia Service on 020 7405 9200 extension 5298, email them on gos-ecg...@nhs.net or contact them via MyGOSH once you have registered. More information about MyGOSH is at www.gosh.nhs.uk/your-hospital-visit/mygosh

I'm the kind of girl who likes Pokmon spin-offs more than the main games. Don't get me wrong, the generations I've played have been some of my all-time favorite experiences: I put 350 hours into Pokmon Diamond, working towards finishing the National Dex (I was 18 off in the end, thanks to an inability to get anything from Johto) and constantly re-battling the Elite 4 for fun. I'm really looking forward to Pokmon Sword (for one reason only) and I just finished trying out a fan-game, Pokmon Insurgence, which was really solid.

But at the end of the day, the Pokmon experiences that I've revisited time and time again have been the offshoots. The weird games that were RPGs in some ways but not the exact catch-em-all that the money-makers are. The big ones for me are easily the first couple of Mystery Dungeon titles; Blue Rescue Team and Explorers of Time formed so much of my early emotional reactions to games as a medium. Blue Rescue Team was heartbreaking to me as a 12 year-old, and the second entry in the series further wrecked me. I've even thought several times about getting a copy of PokPark for Wii to see what the heck that is.

Pokmon Ranger is a really different kind of game from other Pokmon titles. There are RPG mechanics, but the only thing that levels up is your styler. Pokmon are treated as weaker/stronger than others, but they do not have levels. In fact you don't even catch them; you 'capture' them, which in a way kinda sounds more insidious than it actually is. Capturing involves the player drawing circles around the Pokmon which wanders and attacks on the bottom screen. Completing a circle helps convey feelings of friendship towards the Pokmon, and upon capture it elects to help you either capture other Pokemon or clear targets out in the field, and then it heads back to its native habitat.

Rangers are a weird organization, because they aren't cops; those exist already. They're more like...a catch-all set of do-gooders who do whatever the population of a region requires them to do. Put out a forest fire? They've got it covered. Help an elderly couple solve an argument? They'll be there with bells on. Take on an evil organization trying to build an army of evil Pokmon? Rangers do that before breakfast. There are Area Rangers that are situated in towns, and Top Rangers who roam around their region (or potentially the world) to perform acts for the benefit of people and Pokmon.

Ranger is easily the worst game in the sub-series. While the two latter games have completed loops fill in a capture bar, Ranger requires the player to complete a set number of loops without lifting the stylus or having the line break. It was very tedious, especially when some of the final bosses required 40+ loops. If you have any interest in checking these games out, I would suggest skipping this one.

Shadows of Almia is my favorite entry. It introduced Generation 4 Pokmon to Ranger, my favorite group of the series. The aforementioned change to the capture bar was very welcome, and the overall story is generally solid: It's a Pokemon game so it's not this grandiose, really dark tale, but it's still competent enough.

So, after loving Shadows of Almia back in 2010 or so and 100%ing it multiple times, it's a wonder it took me nearly a decade to get to Guardian Signs. On face, what I saw of the final installment in the series always looked off-putting; it focused again on the legendary dogs (easily some of my least favorite legendary Pokmon), you were forced to have a specific partner Pokemon instead of the diverse choices in Almia, and the enemy team was called "Pokmon Pinchers."

I forget how I got on this kick, but I glanced at the Wii U Virtual Console listings, and seeing the list of DS games included Guardian Signs was a great surprise, since all those games are now quite expensive, and I was in the mood for more Ranger.

Guardian Signs is really interesting because of where it places you as a Ranger, and the ways it shakes up what you can do. The past two titles had you just starting out, but the player character of this game is a seasoned Ranger, potentially a Top one considering they do technically move between regions and run all around the place. The game lets you skip some tutorials; it feels like this is a game meant for people who played Almia and are here for one last ride. Additionally, you get to use the titular Guardian Signs to summon Pokmon like Entei and Latias at any time to help you clear obstacles.

In previous Ranger games, Pokmon assists came in the form of a one-time move that would help the player capture a Pokmon. In Guardian Signs all of the player's party Pokmon have assists that are on a timer; as long as the Pokmon isn't hit by an attack, their move can be used again. It was really surprising to me at first, and then it helps feed into the narrative of you being more experienced and better at building bonds with Pokmon than past titles. I like this change on principle, but it was implemented awkwardly; activating an assist immediately puts the Pokmon on the field, and they don't always send their attacks towards whatever you're trying to capture. More than once I sent something out only to be frustrated at its ineffectiveness.

Puzzles in Ranger are extremely simple and require the player to capture certain Pokmon to perform a "Target Clear," which can involve destroying a boulder, putting out a fire, or some other task that removes an obstacle to progress. Guardian Signs goes beyond the previous games and lets you utilize several Pokmon at once. It's a small thing that goes a long way. All of this comes together to make you feel like more of a *Ranger* than ever before, albeit with a worse execution.

The story of Guardian Signs is an odd one. The ideas here are neat and the stakes get really high towards the end, but it feels like a step-down from Almia for most of the ride. The whole thing feels like it could have been a DLC campaign for Almia, until the last hour-and-a-half when things ratchet up to 'fate of the world' stakes are put into play. There are some returning characters that are a welcome presence, but their role feels too minimal in the grand scheme of things, and I was left a bit disappointed by how the whole thing shook out.

c80f0f1006