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Learn about the different tests and procedures that may be used within the Pediatric Heart Care program.
Tests you may experience in the pediatric heart care program
During the course of treatment, the pediatric cardiology staff might perform the following tests:
Cardiac Cath/EPS (Cardiac catheterization and electrophysiology study)
About cardiac catheterization and electrophysiology studies
A cardiac catheterization is a procedure used to both diagnose and treat congenital heart disease. It provides information used to decide if there is a need for medicines or surgery. Interventions can also be done during a cardiac catheterization to treat problems that may have needed surgery.
The cardiologist doing the procedure will go over the plan in detail and answer any questions you may have. If you are not sure about what is going to happen during the catheterization, please ask questions. It is our job to make sure you are comfortable with the care plan for your child before the procedure.
Cardiac catheterizations take place in the catheterization lab, also know as a cath lab.
A cardiac catheterization is a procedure which involves threading a thin flexible tube (catheter) through the arteries and veins of the heart and lungs, often from the groin (see illustration). With the use of X-ray and contrast dye, the procedure team can define structure and function of the heart and lungs. This information is then used to determine the best therapies for treating congenital heart disease. We call that a diagnostic catheterization. If the doctor is also going to treat a type of congenital heart disease during the procedure, it is called an interventional catheterization. A number of interventions can be performed in the cath lab.
Is it painful?
Most cardiac catheterizations done in children with congenital heart disease are performed with general anesthesia. You will meet with a dedicated pediatric cardiac anesthesiologist before the procedure who will review your child’s medical history to make sure anesthesia is safe and effective. The anesthesiologist will monitor your child during the entire procedure. Your child will sleep through the procedure without pain or anxiety. After the procedure, there may be slight discomfort at the insertion sites. Pain medicines are given as needed. Pain management is a priority at American Family Children’s Hospital, and you can expect pain to be treated and controlled during the hospital stay. We also have a dedicated team of Child Life specialists experienced in supporting and distracting children during hospital visits. If support from a Child Life specialist would be helpful for your child, please let us know so it can be arranged ahead of time.
Usually, there is at least a 2- to 3-hour wait from the time your child leaves for the procedure until you are reunited in the recovery area or in an inpatient room at American Family Children's Hospital. The cath lab team, along with the recovery room or inpatient nurse, will let you know where to wait and when you can come into the room, once your child is settled after the procedure.
Where do I wait during the procedure?
At the start of the catheterization, staff will bring family members and guests to the Cath Lab Waiting Room. Cath lab staff will be available during this time to assist you, and food and restrooms are either in or near these areas while you wait. During the procedure, cath lab team members will give you frequent updates about the progress of the catheterization.
An electrocardiogram, also known as an ECG or EKG, is a test that records the electrical activity of the heart. This is used as a screening tool to determine if a heart problem may be present. The test is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart (such as a pacemaker).
An ECG is very useful in determining whether a person has heart disease. If a person has chest pain or palpitations, an ECG is helpful in determining if the heart is beating normally. If a person is on medications that may affect the heart or if the patient is on a pacemaker, an ECG can readily determine the immediate effects of changes in activity or medication levels.
An ECG is painless and will only take a few minutes to complete. Parents can be in the room with their child.
During the test, the child will be asked to lie down. Some younger children may not feel comfortable laying down and can be held in their parent's lap. To get the best tracing, the child will be asked to hold still for about 30 seconds. Electrodes (stickers) will be affixed to each arm and leg and a few to the chest. These electrodes will record the:
Rate and regularity of heartbeats
Size and position of the chambers
Effects of drugs or devices such as a pacemaker to regulate the heart
The results are recorded on graph paper.
An ECG is painless. When first applied, the disks may be cold and in rare circumstances, a localized rash or irritation may develop where the patches are placed. When the electrodes (stickers) are removed they may feel slightly uncomfortable, although they are less sticky than a band-aid.
There is little preparation needed for the test. Please do not apply lotion the day of the visit as the electrodes (stickers) may not stick to the chest. The child will be asked to change into a hospital gown and remove all jewelry.
An echocardiogram, sometimes called an "echo," is a non-invasive test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray images and involves no radiation exposure.
The echocardiogram allows doctors to see the heart beating and to visualize many of the structures of the heart. It is a very good test for detecting structural heart disease in patients that a physician is concerned about.
To make your child feel relaxed, please bring along any toys or other objects your child finds comforting (special blanket, stuffed animal, snacks, pacifier, bottle, etc.). You can also bring DVDs for your child to watch during the exam.
Children will be asked to remove their shirt for the exam. Young girls will be given a hospital gown to wear during their test. For infants and toddlers, please bring bottles with milk or juice and snacks, favorite toys and/or DVDs that may help make them comfortable during the exam.
In the Pediatric Cardiology Clinic, children are brought into a special Echo Room where the lights can be dimmed during the test. Parents can be with their child throughout the process. Three electrodes will be placed on the child’s chest. A trained sonographer will then use an instrument called a transducer to perform the test.
In order to obtain images, a special gel is placed on the transducer, which helps the transducer glide across the child’s chest. The transducer transmits and receives high-frequency sound waves (echoes). The echocardiography machine converts the data that is received into moving pictures of the heart.
The test is painless. Children will be asked to stay as still as possible. For especially young children, parents may be asked to sit with them. There is a television for patients to watch during the test and a special “starry sky” above them. The test will take approximately 30-60 minutes.
The echocardiography sonographer performing the exam cannot give you the results right away. If your child has a clinic appointment in Pediatric Cardiology, you will learn the results of the echocardiogram that day. Otherwise, the pediatric cardiologist will send the results to the health care provider who ordered the echocardiogram by no later than the next business day. Your healthcare provider will contact you with the results.
Treadmill (Exercise Stress Test)
About exercise stress tests
An exercise stress test is a screening tool to test the effect of exercise on your child's heart. The test gives a general sense of how healthy the heart is.
A stress test is performed to determine causes of chest pain, the exercise capacity of the heart and to identify rhythm disturbances during exercise. There may be additional reasons that your health care provider requests this test.
To prepare for the test:
Don't eat or drink anything containing caffeine at least three hours before the test
You can continue to take medications
Wear comfortable, loose clothes and shoes such as tennis shoes or sneakers
The exercise stress test is a non-invasive test. Small electrodes will be placed on the child's chest, arms and legs. These electrodes will measure the electrical activity of the heart.
Before the test begins, baseline measurements of heart rate and blood pressure will be gathered.
During the test, your child will walk on a treadmill and blood pressure readings will be taken throughout. This will measure the heart's reaction to the body's increased need for oxygen.
The test will continue until the child reaches a target heart rate, unless complications such as chest pain or an exaggerated rise in blood pressure develop. She or he will continue to be monitored for 10 - 15 minutes after exercising, or until the heart rate returns to normal.
Sometimes, an echocardiogram will also be done before and after the test. Your healthcare provider will let you know if an echocardiogram will be conducted.
Electrodes (conductive patches) will be placed on the child's chest, arms, and legs to record the heart's activity. These electrodes may cause a mild burning or stinging sensation.
During the test, the child will wear a blood pressure cuff on his or her arm. During the test, the cuff will be inflated every few minutes, producing a squeezing sensation that may feel tight.
Once the test begins, the child will start walking on a treadmill. The pace and incline of the treadmill will gradually be increased. This may cause fatigue as the test progresses.
Treatments you may experience in the pediatric heart care program
After evaluation, patients may be treated with the following surgical and/or catheterization treatments: