We may not realize but our hearts are like electric generators, inducing a small bit of electric current every time they beat. The electricity generated is a very small amount enough to activate heart functions. This electric current generated by the heart can be used to assess the condition of the heart. An electrocardiogram (ECG test) measures and records the electrical activity of the heart through a non-invasive test using electrodes placed on the skin. Doctors use this as a test of the heart all the time, using an instrument called electrocardiogram, or ECG for short.
The ECG measures the electrical activity of the heart and produces a waveform on a graph paper. Doctors look at these waveforms to make an assessment of the health of the heart, whether it is beating normally or is abnormal. On the graph paper what appears is a combination of several waveforms, as the heart is a complex system and several things happen inside its chambers every time it beats. Doctors use their expertise and experience to draw conclusions from these complex waveforms.
Abnormal electrical activity can be recognized from the heart of an unborn baby (fetus). Although ECG cannot be performed on the fetus as it is inside the pregnant lady, doctors make an assessment using echocardiogram. In order to treat such problems medicines are given to mothers until the baby is born. If it is left untreated it may lead to heart failure and demise of the fetus in some situations.
Certain other conditions of the heart come to attention only after the baby is born. In such situations either the heart beats too fast or too slow. Again ECG is very helpful in reaching the diagnosis and then starting appropriate medical treatment. These conditions are difficult to pick up as the babies cannot tell us that their heart is beating too fast. It is only when a child specialist examines the baby or when the baby becomes too unwell to feed that it comes to attention.
An efficient and experienced pediatric cardiologist does appropriate medical diagnosis and effectively treats the abnormal electrical activity of the heart.
Older children and adolescents can present with a similar condition but in these instances, they convey that there is something wrong. At times it is a fleeting disturbance and it requires specialized instruments apart from ECG to catch the electrical activity. Some of them require interventions in which the abnormal pathways are burned inside the heart with the help of special catheters without taking a cut and without opening the heart. Some of these procedures are really life-saving measures.Abnormal electrical activity can also lead to fits/ seizures, faints. It can run in families. Therefore, high level of suspicion is necessary when dealing with such children.
In summary, ECG is very helpful in diagnosing abnormal electrical activity of the heart. It can present from the unborn child to adolescents and adults. Although most conditions are not life-threatening some can be dangerous. Indeed abnormal electrical activity of the heart is one of the reasons for the sudden unexplained death of an infant.
Congenital heart disease (CHD) is the leading cause of mortality in the first year of life in children. The rate of Congenital Heart disease varies from 4/1000 to 10/1000 live births. In different studies, it is observed that 3/1000 live births are in severe conditions & needs expert cardiac care. This fact emphasizes the importance of diagnosing CHD early in life. Now it is possible to detect CHD early in Fetal Life by Fetal Echocardiography.
What is Fetal Echocardiography?
Fetal Echocardiography is an ultrasound test done during pregnancy to check the status of the heart of the unborn baby. In Echocardiography heart’s structure & function is evaluated. This is done when a woman is about 18 to 24 weeks pregnant.
Fetal Echocardiography is a safe, non-invasive tool. Fetal Echocardiogram is performed by specially trained sonographer & the images are interpreted by a pediatric cardiologist. Due to fetal echocardiography, the problem is detected at early stage. Due to fetal echocardiography, the incidence of CHD can be reduced. It can reduce the incidence of CHD by leading therapeutic abortion for complex heart disease. By detecting CHD helps to detect associated non-cardiac malformations & chromosomal anomalies.
CHD may be missed at birth. Because some babies with a congenital heart defect are sent home undiagnosed. 25% of the neonates with complex CHD are discharged from the hospital after delivery undiagnosed. Some of those who come for treatment have high perioperative mortality& morbidity due to late referral.
Hence detection of CHD is very important so that significant improvement can be done after birth.
In the current situation, the field of fetal cardiology is considered promising & treatment of CHD has become standard in India.
Some Questions related to Fetal Echocardiography
1) Is Fetal echo necessary in every pregnancy?
A:-Echocardiography gives information about whether the fetal heart. It’s not necessary for all women to have a fetal echocardiogram during pregnancy.
2) Why does it?
A:-To detect CHD at an early stage it is necessary to perform echocardiography. So that if CHD detected, treatments can be performed. Many heart defects are completely curable and parents get the time to prepare for the problems. Now survival rates for CHD kids have increased by 90%.
- When to do it?
A:-Echo can be done when a woman is about 18 to 20 weeks of pregnancy.
- Who should go undergo fetal echo?
A:- 1. Elderly mothers >35 years.
- Having the previous child with heart disease.
- Mothers getting the viral fever, rash, joint pain in the first 3 months of pregnancy.
- Routine ultrasound showing other malfunctions of the fetus.
- Routine ultrasound showing very high very slow heart rates in the fetus.
- Unexplained repeated abortions
- Unexplained early child deaths
- Family having a history of heart disease.
- Which doctors perform fetal echo?
A:-Usually pediatric Cardiologist or fetal medicine specialists perform fetal echo. Then a pediatric cardiologist explains you about the type of heart problems, the treatment for it, & treats the child after delivery.
- Are there any side effects of fetal echo?
A:-No, it is painless without any side effects on baby and mother.
- Benefits of fetal echo?
A: – 1. It allows parents to understand the heart problems in the unborn baby and prepares them psychologically at the time of delivery.
- In extremely complicated cases termination of pregnancy is advised.
There are many misunderstandings about Congenital Heart Diseases. The Congenital Heart defect is a serious problem & can limit child’s prospects for a full life. In contrast, many heart defects can be cured or can be made significantly less severe through surgical or interventional procedures. Here are some common myths, which everyone believes. These myths must be removed from everyone’s mind because myths can create the biggest problems in one’s life.
1) The children born with congenital heart defects cannot survive long life.
Truth: Survival rates for children with congenital heart defect were low in the past decades. But now the situation has changed. Today children with CHD can survive long life. Many heart defects can be cured or can be made significantly less severe through surgical or interventional procedures.
2) The children born with congenital heart defects cannot have an active Life.
Truth: Children with CHD can have an active life as they want through surgical corrections. Of course, not all children with congenital heart disease will be able to be that active, but many will. The objective is to have any child born with heart disease lead active life as much as possible. If All things considered, being active can be a part of leading a heart-healthy life.
3) The child has to be of certain age and before the heart disease can be operated upon.
Truth: Child suffering from congenital heart disease can be operated even at birth. The timing of operation depends upon when it is necessary than the age or the weight of the child. In certain heart diseases if you wait too long the diseases can become inoperable.
4) Congenital Heart disease affects only children.
Truth: Congenital Heart Disease is the common birth defect in children, affecting 1 out of 100 babies. But now Congenital Heart Disease in adults is increasing approximately five percent each year. Many children born with congenital heart diseases are growing into adults. Adult congenital heart disease requires life long care.
5) Congenital heart disease means a hole in the heart.
Truth: Hole in the heart is just one type of congenital heart disease. There are hundreds of different types of heart diseases. It could be valve blockages, abnormal connections of blood vessels, blockages of blood vessels, underdeveloped heart chambers, etc
6) There is increase in the incidence of congenital heart diseases
Truth: There is increased awareness about detection of congenital heart diseases. There are skilled doctors who are exclusively trained to look after children with congenital heart diseases and there is better equipment. As more and more children with heart diseases are detected early, it appears that the number is increasing.
7) Whenever a pediatrician advises echocardiography test, it’s going to be a serious problem.
Truth: The children are referred for echo test when a child specialist hears an abnormal heart sound which he/she calls heart murmur. Heart murmurs are very common in children and not all of them are associated with serious heart diseases. In fact, many murmurs disappear spontaneously and are called benign murmurs. In any case, even if it turns out to be significant heart problem it is best to know about it sooner rather than delaying it.
8) Rather than consulting child heart specialist we can wait to resolve the congenital heart defect on its own.
Truth: All congenital heart diseases do not resolve spontaneously. Some of them requires proper treatment. You may have come across children with a heart condition with the good or bad outcome, do not apply it to your own child.
9) All heart operations require open heart surgery
Truth: This is not true, some heart defects can have only open heart surgery, and others can be fixed without opening the chest through a tube passed through one of the blood vessels in the leg. There are some heart defects which require a combination of both.
10) Can the patient with congenital heart disease have a child?
Truth: For most adult congenital heart disease patients, successful pregnancy is possible. But there are risks you should assess before pregnancy, or as early in the pregnancy as possible. Depending upon your condition, your child might be in danger of low birth weight, respiratory distress syndrome, or premature delivery. Before pregnancy guardians must talk with adult congenital cardiologist about the issues they may face during pregnancy.
11) The cost of treatment for congenital heart disease is too much.
The cost of treatment for congenital heart disease is related to the seriousness and age of the youngsters and the materials utilized as a part of the operation. Some congenital heart diseases are not severe, so they will cost low but some congenital heart diseases can be severe so they may cost very high. Therefore, in different cases, different treatment costs.
What is congenital heart defect (CHD)?
A congenital heart defect is an issue with the structure of the heart. It is present from birth, hence called congenital heart defect (CHD). Congenital heart defects are the most widely recognized kind of major birth defects. Each 1 infant out of 125 suffers from congenital heart disease. 50000 infants die each year in our nation before their first birthday because of their untreated congenital heart defects. Of all the deaths due to congenital malformations in children less than 1 year of age, half are due to congenital heart diseases. 25% of congenital heart diseases are undiagnosed even in school-age children. These facts are alarming; therefore, there is an extensive drive in developed countries to analyze congenital heart diseases during childbirth before children die undiagnosed and untreated.
Most congenital heart disease can be effectively diagnosed in pregnancy between 18 to 20 weeks of gestation by ultrasound of the heart. This can enable guardians in crucial choices: like whether to proceed or not with the pregnancy. This also helps guardians who wish to proceed with the pregnancy and prepare financially and mentally for the surgery etc
What is the treatment for congenital heart defect?
In the past, children born with a heart issue normally required open heart surgery. A kid may require open-heart surgery if his or her heart defect can’t be fixed using a catheter procedure. In some cases one surgery can repair the defect completely; in other cases they require multiple surgeries. Cardiovascular specialists may use open-heart surgery to:
- Close holes in the heart with stitches or a patch
- Repair or replace heart valves
- Widen arteries to heart valves
Once in a while, babies are born with multiple defects that are too complex to repair; these children may require heart transplants. In this system, the youngster’s heart is replaced with a solid heart from a deceased kid. The heart has been given by the deceased child’s family.
2) Catheter Procedures
In many cases, therapeutic cardiac catheterization enables particular patients to keep away from cardiovascular surgery/scar.
Cardiac catheterization is a technique done through a vessel in the leg, without opening the chest. The advantage is that it doesn’t involve a scar on chest, doesn’t involve intensive care/ventilation and in particular, the patient is up and about that day, prepared to go home next day.
Surgeries/catheter interventions can be offered at any age and at any weight. One doesn’t need to wait for the child to grow if the surgery is indicated.
Heart surgeries/catheter interventions should be done in a convenient manner according to the guidance of doctor taking care of the child. A pediatric cardiologist is a physician who has received extensive training in the diagnosis and treating children’s cardiac problem. Evaluation and treatment may start with the fetus since heart problem can now be detected before the birth. He/she is also trained to care adults who were born with heart issues. There is a typical misconception that a pediatric cardiologist can just take care of kids, in fact, it is easier for a pediatric cardiologist to intervene on adults who are borne with heart disease but never knew about it.
When should one consult a pediatric cardiologist?
1) Pregnant women who have diabetes, heart diseases or previous child with a heart disease, who are on certain medications, for example, anticonvulsants/antidepressants. 18 – 20 weeks of gestation is the perfect time for fetal echocardiography.
2) Child with irregular heartbeats.
3) Child with poor or no weight gain.
4) Child with the heart murmur.
5) Child having cyanosis (blue lips/blue fingers)
6) Child having hypertension.
7) Child with heart failure
8) Child who have had past heart surgeries.
9) Adults who are referred to have heart illnesses, for example, a hole in the heart since childhood.
What can a pediatric cardiologist offer?
The pediatric cardiologist has a wide range of a population to serve from pregnant women, infants, children to grown-ups with congenital heart diseases. He/She is unique in a way that not just he/she can diagnose heart diseases and treat with medications yet additionally operate on the majority of them without opening the chest by a strategy called cardiac catheterization. Pediatric Cardiologist can offer,
1) Fetal echocardiography for pregnant women between 18 – 20 weeks of gestation.
2) Echocardiography for youngsters and adults born with heart diseases.
3) Procedures for different inborn heart diseases, for example, ASD, VSD, PDA, coarctation, stenosis and so on without opening the chest through cardiovascular catheterization
These procedures are offered to kids as well as to adults and in fact easier in adults as they are technically less challenging.
What is Childhood obesity?
Obesity is an unusual collection of body fat, normally at least 20% over a person’s ideal body weight. Obesity is related to the increased danger of sickness, disability, and death. Childhood obesity is a complicated medical problem. It happens when a child is well above the ordinary or healthy weight for his or her age and height. The reasons for abundance weight gain in youngsters are like those in grown-ups, including factors, for example, a man’s behavior and hereditary qualities. Our country’s general increase in obesity is impacted by a person’s community. Where individuals live can influence their capacity to make healthy choices.
BMI is a valuable measure of overweight and obesity. It is ascertained from your height and weight.BMI is an estimate of muscle to fat ratio and a good gauge of your risk for illnesses that can happen with more muscle to fat ratio. The higher your BMI, the higher your hazard for certain diseases, for example, coronary illness, hypertension, sort 2 diabetes, gallstones, breathing issues, and certain growths.
The body mass index (BMI), which gives a guideline of weight in relation to height, is the accepted measure of overweight and obesity. Utilizing the rules of BMI we can decide if our kid is the obsessed or not. Your child’s specialist can help you to make sense of if your child’s weight could pose health issues by utilizing growth charts, the BMI and, if necessary, other tests.
Causes for Child Obesity-
Heredity: Just as tall guardians have tall kids, overweight guardians are exceptionally liable to have overweight kids. Up to 1/fourth of instances of adolescence obesity are said to be contributed by genetic components. Once in a while, certain hereditary conditions, for example, Prader-Willi disorder are related to childhood obesity.
Eating Habits: Nowadays, a day out means heading off to the closest shopping centre and gorging on high-calorie foodstuffs in the food court. Eating out has turned into a need nowadays with the two guardians working; kids are sustained sugary and fatty substances, which are high on calorific value, however low on nutritive substance.
Lifestyle: The child’s developing condition plays an immense part. Frequently guardians are unmindful about their youngsters being overweight, as in their eyes they are perfect. Gone are the times of walking to the local market; they use to go via auto or bicycle. Exercise as outside play is absent in the action sheet of youngsters because of a few reasons. They invest more energy gazing at the screens of cell phones, TVs, PCs or playing computer games, instead of going out to play amusements that include physical exertion. The lack of playing spaces in urban zones is additionally a factor in decreasing play time.
Lack of exercise: Children who don’t practice much will probably put on weight since they don’t consume the same number of calories. An excess of time spent in stationary exercises, for example, staring at the TV or playing computer games, also contributes to the problem.
Psychological factors: Personal, parental and family stress can expand a youngster’s risk of obesity. A few youngsters overeat to cope with issues or to manage feelings, for example, stress, or to battle fatigue. This results in overweight of the children. Their folks may have comparable tendencies.
Rest: Lack of sleep is likewise one of the significant explanations behind adolescence obesity.Youngsters that don’t rest properly have larger amounts of ghrelin in their body, a hormone discharged by the stomach that initiates hunger, making them eat more. Additionally, an absence of rest is related to low levels of leptin, a hormone that is in charge of halting the sentiment hunger. Having lower levels of leptin implies that the kid doesn’t know when to quit eating and that further expands his weight.
Effects on Health-
Consequences of Childhood Obesity on Coronary Heart Disease
Around 20 to 30% of obese youngsters (weight> 120% ideal) between the ages of 5 to 11 year have elevated systolic or diastolic blood pressure. Forthcoming information from the Muscatine Study demonstrates that Obese young men and fat young ladies (BMI > 90th percentile)are 9 to 10-fold more inclined to grow hypertension as young adults than non-obese kids. Also, overweight young people (BMI > 75th percentile) are 8.5-fold are more prone to have hypertension as grown-ups than lean teenagers. Adolescent obesity, especially in males, is related to injurious effects upon adding up to cholesterol and LDL-cholesterol in adulthood. The association of elevated cholesterol and strange lipoprotein levels, with the level of childhood obesity, is reliably stronger among males.
Other effects on Health:
• Asthma: Youngsters who are overweight or fatty may probably have asthma.
•Type 2 diabetes: This chronic condition influences the way your child’s body utilizes sugar (glucose). Obesity and an inactive way of life increment the danger of sort 2 diabetes.
•Metabolic disorder: This group of conditions can put your child in danger of coronary illness, diabetes or other medical issues. Conditions incorporate hypertension, high glucose, high triglycerides, low HDL (“great”) cholesterol and excess stomach fat.
•Sleep disorders: Obstructive rest apnea is a conceivably serious disorder in which a youngster’s breathing over and over stops and begins during sleep.
•Nonalcoholic fatty liver disease (NAFLD): This issue, which as a rule causes no manifestations, makes fatty deposits build in the liver. NAFLD can lead to scarring and liver damage.
Social and emotional complications
•Depression: Low confidence can create overwhelming feelings of sadness, which can lead to depression in a few kids who are overweight.
•Behavior and learning issues: Overweight kids have a tendency to have more nervousness and poorer social skills than typical weight kids do. These issues may lead youngsters who are overweight to act out on and disturb their classrooms at one extreme or to withdraw socially at the other.
Regardless of whether your child is in danger of getting to be overweight or at present at a healthy weight, you can take measures to get or keep on the right track.
•Limit your kid’s utilization of sugar-sweetened drinks.
•Provide a lot of Fruits and vegetables.
•Limit eating out, particularly at fast-food restaurants.
•Limit TV and other screen time.
• Tell the child advantages of fruits & disadvantages of Junk food, so that in the absence of their parents they will not dare to eat junk foods.