For children I try to understand the cause of a complaint or symptom, it is important to have as much clinical history as possible. This involves the Paediatric Cardiologist asking many questions about the nature of the complaint, when it happens, what makes it better or worse and how long it has been going on. I will ask the parents if there is any family history of any similar congenital heart defect or acquired cardiac condition or symptom in the family. For this reason it is important to bring all previous letters and files available to the consultation with me.
Examination is the basic part for diagnosis of heart diseases
Examinations of child:
- Inspection : This is very important part of examination (e.g. only by inspection we can diagnose whether the child has cyanotic or acyanotic heart disease).
- Palpation : We can feel the heart beat and murmur (thrill) by putting palm on chest of the child.
- Auscultation : By stethoscope we can hear different types of unusual sound/murmur of different heart diseases.
The ECG consists in the recording of the electrical activity of the heart on paper. ECG is performed by applying 10 small electrodes to the child skin, 6 on the chest and one each in each arm and leg. The electrodes have the purpose of picking up the heart’s electrical signals. The ECG takes less than 5 minutes to complete and is completely pain free. After the test the electrodes are easily removed from the skin and the test result is available immediately.
A chest X-ray involves exposing the chest briefly to radiation to produce image of the shape of the heart and vascularity of the lungs by which we can diagnose different types of the heart diseases.
An echocardiogram is a test that uses sound waves (ultrasound) to create images of the heart. A Doppler test uses sound waves to measure the speed and direction of blood flow. By combining these tests, a Pediatric Cardiologist gets useful information about the heart’s anatomy and function. Echocardiography is the most common test used in children to diagnose or rule out heart disease and also to follow children who have already been diagnosed with a heart problem. Echocardiography diagnoses cardiac problems, and also guides heart surgery and complex cardiac catheterizations. This test can be performed on children of all ages and sizes including fetuses and newborns.
Specialized echocardiography services are offered in our hospital including:
- Transthoracic echocardiography (TTE)
- Transesophageal echocardiography (TEE)
We are providing 2D,3D and color doppler echocardiography of children with international standard reports.
We are doing Tissue Doppler imaging and speckle tracking also.
What are the different types of echocardiogram?
There are special types of echocardiography:
- Doppler echocardiography
The Doppler technique is used to measure and assess the flow of blood through the heart’s chambers and valves. Also, Doppler can detect abnormal blood flow within the heart, which can indicate such problems as an opening between chambers of the heart, a problem with one or more of the heart’s four valves, or a problem with the heart’s walls.
- 2-D (2-dimensional) echocardiography
This technique is used to see the actual structures and motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart’s structures can be observed.</p
- 3-D (3-dimensional) echocardiography
3-D (3-dimensional) include eliminating geometric assumptions, quantifying complex geometric shape volumes, viewing structures of the heart from any perspective, assessing lesion in simultaneous multiplanes or multislice mode
- Color Doppler
Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.
- M-mode echocardiography
This is the simplest type of echocardiography, and produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart’s pumping chambers, the size of the heart itself, and the thickness of the heart walls.
A Holter monitor is a battery-operated portable device that measures and records the activity of the heart of baby (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to the skin. The Holter monitor and other devices that record ECG as child goes about his daily activities are called ambulatory electrocardiograms.
Cardiac magnetic resonance imaging (MRI) is a safe and completely non invasive test that creates detailed pictures of heart. Cardiac MRI produces both still and moving images of the heart and major blood vessels. Doctors use cardiac MRI to get pictures of the heart while beating and to look at how it is made and functions.
Heart surgery in children is undertaken to repair heart defects a child is born with (congenital heart defects or CHD) and heart diseases a child gets after birth that needs surgery. The surgery is needed for the child well being.
Cardiac catheterization is a medical procedure used to diagnose and treat some congenital heart defects and conditions in babies and children. A long, thin, flexible tube called a catheter is put through a blood vessel in the groin (upper thigh) or neck and threaded to the heart. Through the catheter, doctors can do some diagnostic tests (like measure pressure in the cardiac chambers and lungs) and carry out treatments on the heart.
Device closure :
I have been closing the atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) by device which are nonsurgical procedure.
I am also doing Balloon Atrial Septostomy (Raskind procedure), pericardiocentesis and temporary pacemaker implantation (TPI) which are life saving procedure.