Diagnostic Testing
Electrocardiogram
An electrocardiogram (EKG) is a recording of
the electrical activity of the heart muscle. This test is completed
by placing electrodes (little stickers attached to wires) on the
chest and
recording the heartbeat for about 10 seconds. If there are any
irregular heartbeats it can help determine the cause. An EKG can
also give us information about the thickness and size of the heart.
The patient lies on a table and relaxes during this painless test.
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Echocardiogram
An echocardiogram is a non-invasive ultrasound
test useful to visualize the anatomy and function of the heart.
There are no X-rays with this test. The test is performed with
the child lying on an exam table or 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 look at the actual structure of the heart, identify
any holes or valvar abnormalities and assess how well the heart
is actually working. The patient needs to be relatively still,
so for the younger patients we frequently use movies or toys to
entertain them. A sedative is rarely used during an echocardiogram.
A complete echocardiogram may take 20 minutes to one hour to obtain.
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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 do.
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Holter Monitoring
A Holter monitor is a 24-hour electrocardiographic
(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
a computer scans it and a report is printed. 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.
Back to top Event Monitoring
Event monitors are similar to a holter monitor
except that they only record an electrocardiogram for about 60
seconds. These tests are used when patients have infrequent symptoms
that are not likely to be seen on a 24-hour recording. These monitors
come in two varieties. The first is pager-size box with electrodes.
When a patient has a symptom, they turn it on and hold the device
against their chest 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 devise with the opposite hand. Teenagers
seem to like this type better. These devices are usually provided
for a one-month period.
Back to top 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 being 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.
Stress tests are also helpful to evaluate chest pain or dizziness
of non-cardiac causes.
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