Medical Services

What is a Pediatric Cardiologist?

A pediatric cardiologist is a pediatrician who specializes in the diagnosis and treatment of cardiac abnormalities, both congenital and acquired. The science of pediatric cardiology includes an understanding of how the heart is formed, the functions of the heart, how abnormalities develop and determining how to treat and repair abnormalities medically and surgically. The treatment of congenital heart disease can begin before birth and can continue into adulthood.

When a pediatrician detects a potential heart problem, the patient will be referred to a pediatric cardiologist for further evaluation. A referral to a pediatric cardiologist could be for a heart murmur, cyanosis, chest pain, palpitation, dizziness or tachycardia. Pediatric cardiologists are trained to conduct and interpret diagnostic tests such as an electrocardiogram, echocardiogram, fetal echocardiogram, holter monitor, event monitor, stress test and cardiac catheterization. When patients have a significant heart problem that might require surgery, a pediatric cardiologist and pediatric cardiac surgeon coordinate to deliver care to their patient. The pediatric cardiologist is also responsible for the continuing care of the patient after heart surgery.

Diagnostic Testing

Electrocardiogram

An electrocardiogram (EKG) is a recording of the electrical activity of the heart muscle. This test is performed by placing electrodes (little stickers attached to wires) on the chest and recording the heartbeat for about 10 seconds. An EKG can also give us insight into the thickness and size of the heart. The EKG allows the physician to diagnose and treat arrhythmias and irregular heart beats.

Echocardiogram

An echocardiogram is an ultrasound of the heart. The test is performed with the patient lying on an exam table or for infant and toddlers, in the parent’s arms. An echocardiogram machine is a computer that uses a hand held probe (transducer) placed over the patient’s heart. The transducer sends and receives sound waves creating a moving picture of the heart which is viewed on a television screen. A clear gel is used to help maintain good contact with the skin. With this information, we are able to see the heart structures, size, function, blood flow patterns and the blood vessels attached to the heart. The patient needs to be relatively still, so for the younger patients we frequently use movies or toys to entertain them. A complete echocardiogram may take from 20 minutes to one hour to obtain.

Fetal Echocardiogram

A fetal echocardiogram is very similar to a “regular” echocardiogram except that the patient is inside the mother. This makes the test more challenging. Technology has advanced to where we can start to visualize the heart of a fetus after about 18 weeks gestation. Today it is more common for obstetricians and perinatologists to refer pregnant mothers to a pediatric cardiologist to help evaluate the fetal heart. If a problem is identified early, it is much easier to deal with once the baby is born. Sometimes we use this information to decide if a baby should be delivered at a local hospital or one that specializes in newborn heart surgery. The cardiologist will frequently spend considerable time explaining the findings to the parents. Since the fetus is so small, sometimes not all abnormalities can be identified early on and follow-up studies may be needed. This test can take one or two hours to perform.

Holter Monitoring

A Holter monitor is a 24-hour electrocardiogram (EKG) recording of the heartbeat. This is very helpful for patients with chest pain, palpitations, irregular heartbeats or dizziness. Four electrodes are placed on the chest and attached to a pager-sized monitor that records the heartbeat on a computer chip. After the recording is complete, the device is returned to the office where the information is downloaded into a computer. The information is then reviewed by the physician. Patients are asked to keep a diary of their daily activities and record the time of any experienced symptoms. The device is not waterproof, so care must be taken to prevent it from getting wet.

Event Monitoring

Event monitors are similar to a holter monitor except that they only record an electrocardiogram when the patient activates the recorder. These tests are used when patients have infrequent symptoms that are not likely to be recorded in a 24-hour period. These monitors come in two varieties. The first is pager-size recorder with electrodes that are attached to the patient. When a patient has a symptom, they press a button and a recording of the heartbeat is obtained. This recording can then be transmitted over the telephone. The other type is a device that is worn like a watch. The recording is activated by touching the “watch” buttons.

Stress Test

A stress test, also referred to as an exercise test, is used to assess cardiac performance during exercise. Many times a patient may have complaints about their heart only during exercise and not at rest. During a stress test, the level of exercise is increased every three minutes while the patient is asked to walk and then run on a treadmill as long as they can or until symptoms occur. During the test, the electrocardiogram and blood pressure are continually monitored by the physician. The information obtained allows the physician to evaluate the heart under stress and use that information for medical therapy, as a guideline for exercise at school and sports, or illustrate the need for surgical intervention.

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If you have any concerns about your own health or the health of your child, you should consult with a physician or other healthcare professional.