Testing
The following is a brief description of cardiac testing services available at the Pediatric Heart Center.
Electrocardiogram (EKG)
An EKG is a quick and painless test that records the heart's electrical activity on graph paper. An EKG helps identify heart rhythm abnormalities, and can tell about the size and thickness of the heart chambers.
The test is performed by placing 10 stickers called electrodes on the chest, shoulders, and legs. The electrodes are attached to a wire that sends infomation about the heart's electrical activity to a small computer. An EKG requires the patient to be still for a few seconds so that a good quality recording can be obtained. The most uncomfortable part of the EKG is removing the stickers (electrodes) after the test, which is similar to removing a band-aid.
The test is performed by placing 10 stickers called electrodes on the chest, shoulders, and legs. The electrodes are attached to a wire that sends infomation about the heart's electrical activity to a small computer. An EKG requires the patient to be still for a few seconds so that a good quality recording can be obtained. The most uncomfortable part of the EKG is removing the stickers (electrodes) after the test, which is similar to removing a band-aid.
Echocardiogram
Photo by B Canaday
An echo is an ultrasound of the heart, similar to ultrasounds that are obtained during pregnancy. This is a safe and painless procedure that allows us to see the structure and function of the heart. Pictures of the heart are taken using a transducer and some gel that are placed on the patient's chest and abdomen. This test takes about 30-45 mintues.
Echocardiograms are performed by pediatric cardiac sonographers, who are specially trained in working with children and evaluating congenital heart defects. The exam room is equipped with toys and a DVD player to help keep pediatric patients entertained while the test is being performed.
The sounds you hear during the echo are the sounds of blood flowing from one chamber to another, or of the heart valves opening and closing. The colors you see on the screen tell us which direction the blood is moving.
Better quality pictures and more accurate information is obtained when the patient is still during the test. Because of that, some young children (usually under 3 years of age) may require sedation for the echocardiogram. If your child is scheduled for sedation, please see the pre-sedation instructions.
Echocardiograms are performed by pediatric cardiac sonographers, who are specially trained in working with children and evaluating congenital heart defects. The exam room is equipped with toys and a DVD player to help keep pediatric patients entertained while the test is being performed.
The sounds you hear during the echo are the sounds of blood flowing from one chamber to another, or of the heart valves opening and closing. The colors you see on the screen tell us which direction the blood is moving.
Better quality pictures and more accurate information is obtained when the patient is still during the test. Because of that, some young children (usually under 3 years of age) may require sedation for the echocardiogram. If your child is scheduled for sedation, please see the pre-sedation instructions.
Pre-sedation Instructions
When a child is sedated for an echocardiogram, a sleeping medication is given by mouth or through the nostril. It can take anywhere from a few minutes to a half hour or longer for the child to fall asleep. In some cases, the child will not fall asleep but the medication will help the child remain calm while the test is being performed.
Before a child can be sedated they must have an empty stomach. The following guidelines should be followed:
Age 0 to 5 months: No milk or solid food for 4 hours before the scheduled procedure.
Age 6 to 36 months: No milk or solids for 6 hours before the scheduled procedure.
Older than 36 months: No milk or solids for 8 hours before the scheduled procedure.
Clear liquids (apple juice, Kool-aid, 7-Up, cranberry juice. etc.) can be taken up to 2 hours before the test for all children being sedated.
A registered nurse will remain in the room with your child while he/she is under sedation. Your child's breathing, oxygen, heart rate, and blood pressure will be continuously monitored during this period. Most children wake up as the echocardiogram is being completed, or soon after.
If your child is ill, it may be unsafe to proceed with sedation. Therefore, if your child currently has a fever or a respiratory illness, please contact our office so that your appointment can be rescheduled.
Before a child can be sedated they must have an empty stomach. The following guidelines should be followed:
Age 0 to 5 months: No milk or solid food for 4 hours before the scheduled procedure.
Age 6 to 36 months: No milk or solids for 6 hours before the scheduled procedure.
Older than 36 months: No milk or solids for 8 hours before the scheduled procedure.
Clear liquids (apple juice, Kool-aid, 7-Up, cranberry juice. etc.) can be taken up to 2 hours before the test for all children being sedated.
A registered nurse will remain in the room with your child while he/she is under sedation. Your child's breathing, oxygen, heart rate, and blood pressure will be continuously monitored during this period. Most children wake up as the echocardiogram is being completed, or soon after.
If your child is ill, it may be unsafe to proceed with sedation. Therefore, if your child currently has a fever or a respiratory illness, please contact our office so that your appointment can be rescheduled.
Exercise Test (Stress Test)
An exercise test is performed by having the patient run on a treadmill while an EKG is being performed and blood pressure is being measured. This allows us to see the activity of the heart during exercise, and to determine whether the amount of exercise a person is able to do is normal for their age and gender.
Our treadmill is equipped for both adults and children, which allows us to evaluate patients of nearly all ages. Exercise testing helps evaluate symptoms that occur during exercise, and helps us determine whether it is safe for a person to exercise vigorously.
We often combine exercise testing with pulmonary function testing, so that we can obtain information on both the heart and the lungs for patients that are having exercise-related symptoms. During a pulmonary function test, the patient blows into a tube; this gives us information on how well the lungs are functioning. Sometimes, abnormalities cannot be detected unless testing before and after exercise is compared.
Our treadmill is equipped for both adults and children, which allows us to evaluate patients of nearly all ages. Exercise testing helps evaluate symptoms that occur during exercise, and helps us determine whether it is safe for a person to exercise vigorously.
We often combine exercise testing with pulmonary function testing, so that we can obtain information on both the heart and the lungs for patients that are having exercise-related symptoms. During a pulmonary function test, the patient blows into a tube; this gives us information on how well the lungs are functioning. Sometimes, abnormalities cannot be detected unless testing before and after exercise is compared.
Ambulatory Monitoring
Courtesy of Lifewatch
Holter monitors and cardiac event monitors give information about a patient's heart rhythm beyond that obtained by looking at an electrocardiogram.
A Holter monitor is similar to an electrocardiogram (EKG), but is taken home and worn for 24 to 48 hours. The Holter monitor records every heartbeat during the monitoring period. Your child should continue to participate in normal activities as much as possible while wearing the Holter monitor. The monitor will provide your doctor with information such as minimum and maximum heart rates, periods of abnormal heart rhythm, or what is happening to the heart rhythm while symptoms are occurring. Holter monitors can also be used to monitor the heart's response to some medications. While the Holter monitor is worn, you will be asked to keep a detailed diary of symptoms and activities. This diary is very important, since findings on the Holter monitor need to be correlated to diary entries to help determine whether the findings are normal or abnormal. After the Holter monitor is returned to the clinic, the information on it is downloaded into a computer, scanned by a technician, and reviewed by a cardiologist. Results are available in 1-2 days.
A Holter monitor is similar to an electrocardiogram (EKG), but is taken home and worn for 24 to 48 hours. The Holter monitor records every heartbeat during the monitoring period. Your child should continue to participate in normal activities as much as possible while wearing the Holter monitor. The monitor will provide your doctor with information such as minimum and maximum heart rates, periods of abnormal heart rhythm, or what is happening to the heart rhythm while symptoms are occurring. Holter monitors can also be used to monitor the heart's response to some medications. While the Holter monitor is worn, you will be asked to keep a detailed diary of symptoms and activities. This diary is very important, since findings on the Holter monitor need to be correlated to diary entries to help determine whether the findings are normal or abnormal. After the Holter monitor is returned to the clinic, the information on it is downloaded into a computer, scanned by a technician, and reviewed by a cardiologist. Results are available in 1-2 days.
Courtesy of Lifewatch
In order to be certain of a diagnosis that involves a heart rhythm abnormality, your doctor needs to see the abnormal heart rhythm right when it is happening. For patients having symptoms that do not occur on a daily basis, evaluation with a cardiac event monitor is often helpful. This type of monitor can be worn by the patient for a month. Although the monitor continually records the heart's rhythm, it stores this information only when it is prompted to do so. This information is then transmitted to your cardiologist through a telephone. You will be shown how to activate your monitor when the monitor is given to you. Sometimes, patients may be unable to activate the monitor in time for it to capture an abnormal heart rhythm, or patients may be unaware that an abnormal rhythm is occuring; for these reasons, the monitor can also be programmed to self-activate, for example when the heart rate gets too high or too low. There are several types of cardiac event monitors. Most of these involve wearing electrodes (stickers similar to those used for an EKG) on the chest. There are also monitors that do not need to be worn continuously, but need to be readily available so that they can be placed on the chest when symptoms occur. Your cardiologist will help decide which type of event monitor is most appropriate for you.
Rarely, we are unable to confirm an abnormal heart rhythm even though the patient's symptoms are very suggestive of one. Usually this is because the symptoms are occurring too infrequently to be documented with a cardiac event monitor, or because the patient is experiencing syncope (fainting) and is unable to activate the cardiac event monitor. In these cases, another tool available to us is an insertable loop recorder. These are special monitors, about the size of a finger, that can be placed under the skin and worn for a period of 1-2 years. These monitors are programmed to automatically record abnormal heart rhythms and heart rates, so that an appropriate diagnosis can be made.
For more on ambulatory monitoring, click here.
Rarely, we are unable to confirm an abnormal heart rhythm even though the patient's symptoms are very suggestive of one. Usually this is because the symptoms are occurring too infrequently to be documented with a cardiac event monitor, or because the patient is experiencing syncope (fainting) and is unable to activate the cardiac event monitor. In these cases, another tool available to us is an insertable loop recorder. These are special monitors, about the size of a finger, that can be placed under the skin and worn for a period of 1-2 years. These monitors are programmed to automatically record abnormal heart rhythms and heart rates, so that an appropriate diagnosis can be made.
For more on ambulatory monitoring, click here.