What to Expect When Your Child Visits the Heart Clinic

There are a number of reasons why a pediatrician may ask for your child to see a pediatric cardiologist. While this can be a scary thing for a parent to hear, many common problems seen in the cardiology clinic are actually mild conditions and can be adequately evaluated, diagnosed and treated without extensive testing.

Before Your Child’s Heart Clinic Visit

Based on the information you used to pre-register as well as the pediatrician’s records, additional testing may be performed in the clinic before you see a doctor. Often, special vital signs (arm and leg blood pressures or pulse oximetry to check oxygen levels) and an electrocardiogram (ECG) are performed. Less commonly, a chest x-ray, echocardiogram or exercise (treadmill) testing may be done before you see the doctor.

ECGs are commonly performed at an initial pediatric cardiology visit and involve placing adhesive leads on the child’s chest and extremities. Lotions, creams and petroleum jelly can make it difficult to attach the leads to the skin and obtain a high quality tracing. Avoid these skin treatments the day of the visit.

It is very important that you bring with you any pertinent records, particularly records regarding other family members; if that is the primary reason your child is being seen.

Day of Visit

After completing a brief medical history, your child will have vital signs taken, any pre-ordered testing will be performed, and a cardiology nurse will make an initial assessment. You are then ready for the pediatric cardiologist to see your child. You may be seen by a more than one provider including a cardiology fellow in-training or an advanced practice provider (nurse practitioner or physician assistant) in addition to the attending cardiologist during your visit. Be assured, the whole team works closely together to provide the best care for your child and make your visit as easy and efficient as possible.

The pediatric cardiologist will ask questions to confirm your child’s history, perform a detailed physical examination and review test results to arrive at a diagnosis. Based on their initial evaluation, further testing may be recommended.

Additional testing may include an echocardiogram, which is an ultrasound examination of the heart to evaluate heart anatomy and size, valve function and heart muscle function. This test is generally able to be performed the same day. If necessary, exercise treadmill tests and more complex imaging studies (CT and/or MRI) likely will be scheduled on another day.

For evaluation of possible heart rhythm issues a 24 hour monitor (Holter monitor) or event monitor may be provided for use at home.

Common Conditions

The most common reasons for a referral to heart clinic are heart murmurs, chest pain, palpitations or fast heart beats (tachycardia) and dizziness or fainting (syncope).

Other reasons to be seen by a pediatric cardiologist include cyanosis (blueness of the skin or lips and tongue), genetic syndromes known to be associated with heart problems (including Down syndrome and Marfan syndrome) or a family history of certain cardiac disease in close relatives.

Fortunately, many patients have medical problems that are benign or are easily treated. If a more significant cardiac problem is detected, the pediatric cardiologist will be able to recommend testing, treatment and necessary follow-up.

• Heart murmurs may indicate a heart problem such as congenital heart disease. Many, if not most, murmurs are normal and require no treatment or follow-up.
• Non-exertional pediatric chest pain is also not usually heart-related. Additional testing may be necessary to rule out rare, but more serious, cardiac reasons for the chest pain or to assess for exercise related asthma.
• Dizziness and fainting in children are not often heart-related and may require no treatment or only simple measures such as increasing water intake and avoiding caffeine.
• Abnormal heart rate or palpitations can be evaluated and treated as needed.
• Rarely, issues may be identified that require additional treatment including medication and/or interventional procedures (cardiac catheterization or surgery) and long-term follow-up.

After the Visit

Based on the pediatric cardiologist’s findings, treatment and follow-up plans will be discussed. You will have an opportunity to ask questions and should leave with an understanding your child’s condition and the pediatric cardiologist’s recommendations. You should be an active participant in your child’s care.

It is very important for your child’s continued good health that you follow-up as recommended with any testing or scheduled clinic visits.

For more information about the Heart Center at Nationwide Children’s Hospital, click here or follow #NCHheart on Twitter.