First Time Visits
First time visits last about an hour on average. Upon your arrival, you, the guardian, will complete any forms not already completed ahead of time. The medical assistant will then escort you and your child into the clinic where your child will get weighed and the height will be measured. Once in a room, a small machine will measure the heart rate and oxygen saturation. The blood pressure may be taken either with a hand-held blood pressure cuff or using a blood pressure machine. The medical assistant will then ask a series of questions about your child’s medical history, the family’s medical history, and other questions about the social and physical activity aspects of your child’s life. The medical assistant may also perform a painless electrocardiogram (ECG or EKG) on your child.
The heart doctor will then take over from the medical assistant and talk to you and your child about the current reason why you are visiting (the chief complaint). He will then perform a physical exam on your child. This will mainly focus on the heart, the lungs and the blood vessels in the body. It is not a full physical such as would be performed by the regular doctor. The heart doctor may then review the ECG performed and then perform an echocardiogram. This is also a painless procedure that takes about 20 to 30 minutes. It is usually an enjoyable experience for those old enough to understand that it is their heart that is on the screen being looked at. Sometimes other tests are necessary but all testing done in this office are non-invasive. That means that they are usually painless, requires no uncomfortable positions and requires no sedation. If your child is nervous about the testing, a DVD player is available in each room along with a wide variety of favorite family movies is available for distraction.
Following all diagnostic procedures, the heart doctor then talks about what he has found and what is necessary to do next. For many problems, a single visit is sufficient to identify the cause of the problem and discuss what to do about it. Other times, it is necessary to send your child home with a special monitor to wear (Holter monitor or Event Recorder) or to obtain blood tests. About half the time, a second visit is necessary to follow-up additional tests or procedures.
At the end of each visit, your child is always invited to visit the treasure chest to pick out a toy. This will help insure that the visit was an enjoyable one for them.
Follow-up visits last about a half-hour on average. Upon arrival, usually no paperwork is necessary unless it has been a long time since the last visit. The medical assistant will escort you and your child into the clinic for height, weight, and vital sign measurement. The assistant may ask a few questions to update the record and then the heart doctor will take over.
This visit may be to perform a repeat ECG, or echocardiogram to check the status or progression of a problem with the heart. It may also be to discuss the findings of a Holter monitor or event recorder which was worn between visits. It may also be to discuss blood tests obtained after the last visit. Another reason for a follow-up visit is to undergo exercise testing and pulmonary function testing.
Exercise Stress-Testing Visits
These visits are to assess your child’s heart and lung function during the stress of exercise. This visit usually involves both an exercise stress test and full pulmonary function testing.
The exercise stress test may be either running on a treadmill or riding a bicycle ergometer. Usually, your child is asked to run or ride until they are exhausted and can go no further. At this point, they are allowed to stop. The pulmonary function testing is simply breathing into a plastic tubing connected to a machine. Instructions are given at the time on how to breath into the tubing. In preparation for a visit that involves an exercise stress test, your child must bring comfortable shoes and clothing appropriate for running. If they are coming from school or going to school afterwards and need to shower and change, this is possible as we have a shower and changing room in the clinic (bring a towel). It is important to neither be too hungry or too well-fed before an exercise stress test. In general, it is best if a small meal of bland food is eaten about an hour before testing. Beginning a stress test while hypoglycemic from missing a meal can lead to dizziness and fainting during the study. Beginning a stress test just after having eaten a heavy or spicy meal can lead to discomfort and premature termination of the study without getting any useful information.
Blood testing is sometimes necessary as part of the evaluation. Blood is never drawn in this clinic. In the event it is necessary to have blood tested, the heart doctor will complete a requisition form for you to take and then refer you to a nearby lab drawing center. Sometimes it is necessary to fast before blood is drawn. In this case, the timing of the fasting and blood draw should be planned ahead of time. A fast is 12 hours and so it is usually a good idea to begin a fast at 8PM in the evening, after dinner, and plan to have blood drawn first thing in the morning before breakfast at 8AM. Only water may be consumed during the 12-hour fast.