Cardiac Diagnostic Tests

Our pediatric cardiologists from the Nemours Cardiac Center also travel to sites throughout the Delaware Valley, so you can continue to get our top-quality pediatric cardiology care at a location that’s convenient for you. We see families at our Nemours duPont Pediatrics (primary and specialty care) offices, as well as collaborating hospitals.

We can do evaluations, follow-ups, and some diagnostic cardiology tests at these locations. If your child needs further testing, hospitalization, or surgery, we may have you come see us here at the Nemours Cardiac Center or other hospitals we work with, so you can get the best, most comprehensive care.

Learn More About the Nemours Cardiac Center »

Our pediatric cardiologists at the Nemours Cardiac Center may recommend or order one or more of the following heart tests during your initial visit:

• Electrocardiogram (also called an "EKG" or "ECG"): This test measures the heart’s electrical activity and is completely painless. A series of electrodes (small metal tabs) are simply fixed to your child’s skin in a few locations with tiny sticky papers. Then the information is transferred to a computer, where it’s stored and printed as a graph.
• Holter monitor: This is an EKG that’s performed over a long period of time, usually 24 hours or more. Electrodes are connected to the chest and the wires are attached to a portable EKG recorder. Your child will be encouraged to continue normal daily activities, but must be careful to not get the electrodes wet (that means no swimming, showering, or activities that cause a lot of sweating). There are two kinds of Holter monitoring: continuous recording (when the EKG is on throughout the entire monitoring period) and event monitoring (when data is recorded only when the child feels symptoms and then turns the Holter monitor on).
• Telephonic monitor: We may use this type of testing to help
  diagnose a heart rhythm problem. This kind of device is worn by your child and transmits the information from the EKG to your child’s doctor over the telephone.
• Cardiopulmonary exercise assessment (also called an “exercise test” or a “stress test”): While attached to an EKG machine, your child’s heart rate and rhythm are measured while exercising — for example, riding a stationary bicycle or walking on a treadmill under supervision. If your child has or might have a heart problem or has undergone heart surgery, this test will help you to know which kinds of physical activities are OK and which ones aren’t. It can also pick up abnormalities in the heart’s rhythm that aren’t obvious during rest.

To evaluate your child’s heart structure and function, we use advanced imaging (also called “medical imaging”) tests. Our sophisticated pediatric cardiology equipment lets us produce precise diagnostic images of the heart so we can figure out exactly what’s going on and create the very best treatment plan for your child.

We can perform any kind of imaging test your child might need, either within the Nemours Cardiac Center itself or the hospital’s Radiology Department.

Echocardiography (or “echo,” for short) is our most frequently used imaging tool. It’s a specialized form of ultrasound that builds a picture of your child’s heart (an “echocardiogram”) using sound waves. Echocardiograms can be done anywhere within our facility — often right at your child’s bedside — to make the experience as stress-free and comfortable as possible.

Our Echocardiography Department received a three-year accreditation for pediatric transthoracic (chest) echocardiography by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), which is the country’s highest level of achievement in the specialty.

Four types of echocardiography are available at the Nemours
Cardiac Center:

• Transthoracic echocardiography: This test produces images of your child’s heart from the surface of the chest and upper abdomen.
  Often, these images are so precise that invasive testing (inserting an instrument into the body) isn’t needed. It can be used to diagnose a heart problem and monitor changes in the heart as your child grows. These studies can be performed with ease in both the inpatient and outpatient settings. We also offer 3-D echocardiography, which allows us to visualize the structure of the heart valves and other heart structures in even greater detail.
• Transesophageal echocardiography: Also called a TEE, this test is performed by inserting a small ultrasound probe into the mouth and through the esophagus (the food pipe that connects the throat with the stomach and lies directly behind the heart). This is often used for older, larger children and gives the best close-up view of some otherwise hidden regions of the heart. It’s extremely useful for obtaining images during surgery and cardiac catheterization.
• Fetal echocardiography:This is an in-depth ultrasound study used
  to view the structure, function, and rhythm of a baby’s heart while in
  utero (still in the mother’s womb) – as early as the eighteenth week into the pregnancy.
• Intravascular echocardiography: Called ICE, for short, this test is sometimes done during cardiac catheterization by inserting a thin plastic, flexible tube (called a “catheter”) with a tiny ultrasound probe at the tip through the blood vessels. This ultrasound catheter is advanced to the heart to take a close look at defects and guide any treatment given during the cardiac catheterization.

Your child’s doctors may also order one or both of these other
imaging tests:

• Cardiac magnetic resonance imaging (MRI): An extremely helpful and safe imaging tool, this test doesn’t require inserting anything into the body. A pediatric MRI produces strikingly clear, complete pictures of your child’s heart and the blood vessels that connect to the heart. A cardiac MRI allows doctors to analyze the structure and function of the heart, as well as the area surrounding the heart (that are less visible with other diagnostic tools) – specifically the lungs, airways, and the esophagus. Because kids must be completely still for MRI, sedation or anesthesia may be required.
• Cardiovascular computed tomography (CT or CAT scan): By injecting a small amount of contrast agent (or dye) into your child’s circulation (a safe technique), the doctor can get an accurate image of the important blood vessels attached to the heart and identify any abnormalities (in the heart and other structures in the chest such as the lungs and airways) in a matter of seconds. The latest technology rapidly produces pictures of many layers of the heart. And because CTs don’t take very long at all, some smaller children can be evaluated for potential problems without having to be sedated.

Depending on your child’s specific signs and symptoms and what initial testing reveals, our Nemours Cardiac Center team may recommend further diagnostic evaluations such as:

• Myocardial perfusion scan: This test is used to look at blood flow to the heart muscle during rest and stress.
• Lung perfusion scan: In this test, we examine blood flow distribution to the right and left lung.
• Tilt-table testing: This diagnostic approach is used to look for a
  cause of fainting. We’ll monitor your child’s blood pressure and the heart’s electrical activity on an EKG as your child is attached to a table that moves.
• Diagnostic cardiac catheterization and angiography: This is a completely painless test used to evaluate the blood vessels. Performed under sedation with local or general anesthesia, it’s done by inserting a catheter into an artery and vein that lead to the heart, and advancing it to the heart to take measurements and pictures with X-ray.
• Transesophageal or intravascular electrophysiologic study: A catheter is placed in the esophagus or in a blood vessel near the heart to study the heart’s rhythm.

In our state-of-the-art cardiac catheterization suite, our Nemours Cardiac Center team is able to use advanced techniques to determine the exact details of your child’s heart and how it functions. And, if your child requires anesthesia or sedation, we have our very own pediatric cardiac anesthesiologists on-site who work exclusively with our young heart patients.

Learn more about pediatric Cardiac Catheterization »

At the Nemours Cardiac Center, we offer families a special clinic dedicated to evaluating fetuses, infants, children, and teens with signs and symptoms suggesting an arrhythmia (irregular or abnormal heartbeats or heart rhythm usually caused by an electrical “short circuit” in the heart).

Signs of an arrhythmia may include:

• palpitations (a sort of fluttering feeling in the heart)
• very fast or slow heart rates
• dizziness
• chest pain
• fainting (also called syncope)

To diagnose an arrhythmia, our pediatric cardiology team will implant an arrhythmia detecting device to pick up any abnormal heart rhythms.

About two-thirds of children with critical heart disease are diagnosed while still developing (before birth) or soon after. Thanks to our highly skilled team and advanced technology, most children — even newborns only hours old – who are born with a heart condition can be treated right away.

If you’re pregnant your family obstetrician and/or perinatologist (a doctor who specializes in high-risk pregnancies) suspect your baby may have a heart condition, our diagnostic cardiac team and fetal cardiologists will work together to see what’s going on inside your baby’s tiny ticker.

As early as the 18th week of the pregnancy, we can perform fetal echocardiography (fetal “echo”) – an in-depth cardiac ultrasound study that allows us to view the structure, function, and rhythm of a baby’s heart while still in the womb.

We can do these special fetal ultrasounds:

• here at the Nemours Cardiac Center
• at Nemours duPont Pediatrics locations in Pennsylvania (Collegeville, Newtown Square and Philadelphia), New Jersey (Vineland and Voorhees), and in Delaware (Dover, Middletown and Seaford)
• in consultation with maternal-fetal medicine specialists at two of our collaborating health care facilities, Thomas Jefferson University Hospital (in Center City Philadelphia) and Lankenau Medical Center
  (in Wynnewood, PA)

In cooperation with the Nemours Partners for Perinatal Management Program, we’ll help you understand your baby’s condition, coordinate consultations with a pediatric cardiologist, and plan for any necessary treatment at or soon after the birth.

Learn More About the Nemours Partners for Perinatal Management Program »