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.

How ECG Works?

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%.

3. When to do it?

A:-Echo can be done when a woman is about 18 to 20 weeks of pregnancy.

4. Who should go undergo fetal echo?

A:-  1. Elderly mothers >35 years.

2. Having the previous child with heart disease.
3. Mothers getting the viral fever, rash, joint pain in the first 3 months of pregnancy.
4. Routine ultrasound showing other malfunctions of the fetus.
5. Routine ultrasound showing very high very slow heart rates in the fetus.
6. Unexplained repeated abortions
7. Unexplained early child deaths
8. Family having a history of heart disease.
9. 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.

6. Are there any side effects of fetal echo?

A:-No, it is painless without any side effects on baby and mother.

7. 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.
8. In extremely complicated cases termination of pregnancy is advised.