ECHOCARDIOGRAPHY
 

An echocardiogram is one of the pivotal investigations to assess the heart. Dr Khambadkone performs all the echocardiograms personally and has extensive expertise in all basic and advanced aspects of imaging using this technique. This is a simple painless test that involves the use of a small camera (probe) with some jelly to provide good lubrication and image quality, that is connected to a computer. It involves use of soundwaves (ultrasound) to assess the heart structure and function. It also looks at blood flow within the heart and in the large arteries and veins. The machine is an advanced computer with special modifications. The camera or probe is moved over the chest, abdomen and neck in order to take pictures of the heart.  It is a painless test without entering any part of the body and gives diagnosis of a large number of conditions. It may take anywhere between 15 to 45 minutes based on the conditions detected, co-operation of the child and ease of obtaining the images (echo windows). Sometimes, babies and infants prefer to be scanned on their parent's lap and it takes only a few minutes to do the test.

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ELECTROCARDIOGRAPHY
 

Electrocardiogram or ECG is a test that records the electrical activity within the heart generating a tracing on a special paper. Every part of the trace represents a specific activity in the heart and is helpful in assessing the speed of heart beat, its rhythm, and points to thickness or size of the heart chambers. They can help in diagnosing certain electrical problems within the heart such as Long QT syndrome. Stickers are placed over the chest wall and on arms and legs. Your child would need to lie still for a couple of minutes. The process is quite painless, but the removal of stickers can be sometimes uncomfortable and need attention. The tracing is available immediately and is interpreted by Dr Khambadkone.

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HEART RHYTHM MONITORING

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Heart rhythm monitoring involves recording of the heart rhythm for longer periods of time than an ECG. It is important to carry on with normal physical activities barring some, to increase the chances of recording an abnormal heart rhythm that occurs randomly. 24 hour Holter monitoring involves recording the heart rhythm for a day. A monitor, the size of small box is attached to a few stickers that are placed over the chest. Clear instructions are given to replace the stickers if they come off. A diary sheet is very important to record the time when symptoms occur and the success of comparing the heart rhythm with symptoms depends on meticulous recording of symptoms and time. Event recorders are used for longer recordings of heart rhythms. For 3 – 7 days, external monitors can be used. This include the ZIO patch that is stuck on to the chest and does not have any wires. Implantable recorders could be used for longer periods and require a procedure.

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CHEST X-RAY

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If required to assess the heart and its impact on the lungs, a chest X -ray may be required. A chest X ray involves taking a picture of the chest including the heart and lungs using radiation. It is performed by a radiographer in the X ray department. Based on age, children may need help to remain still for a few seconds for accurate imaging. Although it does not look inside the heart, the shadow caused by the heart and lungs gives important information. Certain rules apply; pregnant women should avoid radiation.

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CARDIAC CT ANGIOGRAPHY
 

Cardiac computerized tomography with a dye (angiography) provides a detailed imaging of the heart, blood vessels, and other structures (trachea or wind-pipe, oesophagus or food- pipe) within the chest. It provides 3 D images and is an excellent tool to look at relationships of various structures within the chest. It can be done in a very short time – within minutes. When a dye is injected, a cannula needs to be inserted in the vein, that is taken out soon after the investigation. The downside is ionizing radiation (like X rays) but with advanced scanners, the dose has reduced significantly.

 

MAGNETIC RESONANCE IMAGING (MRI)
 

This technique involves using magnetic radiation and radio waves to assess structure of the heart and blood vessels and more importantly to accurately measure flow within the circulation. It can measure the chamber volumes and accurately assess function. It requires specialized equipment and personnel with expertise to perform it. It also requires a dye to be injected through a cannula. The test takes a longer time (about 45 minutes) and requires certain breathing techniques that younger children cannot co-operate with. Hence general anaesthesia may be required.

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