At Boston Children’s, we consider you and your child integral parts of the care team and not simply recipients of care. We specialize in family-centered care, which means that from your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs.
For your convenience, we have 11 clinics staffed by cardiologists from the Cardiology Outpatient Service at Boston Children's Hospital who rotate to these clinics on a regular basis. In most cases the team includes a nurse, nurse practitioner, echocardiographer and occasionally a pediatric cardiology fellow.
What to expect
At the Cardiology Outpatient Clinic, patients typically undergo history and physical examinations as well as an electrocardiogram (EKG). Depending on what the cardiologist learns from these exams, additional testing may be done, including 2 or 3-dimensional echocardiography, exercise stress testing, Holter, or event monitoring.
How long will I be there?
Please expect to spend a minimum of about two hours at the cardiology outpatient clinic if you are scheduled for a clinic visit and echocardiogram.
Often, any necessary additional testing can be completed on the same day, although scheduling conflicts sometimes require a return visit.
Who performs the exams?
We have more than 50 cardiologists on staff as well as more than 43 fellows in training. Each of our patients is assigned a cardiologist that is responsible for coordinating all of their care throughout their lifetime. Often, cardiology fellows will assess a patient first and then discuss their findings with the patients cardiologist. Both cardiologists return to examine the patient and explain their findings.
In some instances, a nurse practitioner will perform the first evaluation and give the information to the staff cardiologist. Together, this team will evaluate the patient, discuss the findings and make recommendations about further testing and follow-up visits. Our entire team helps make the visit easier and more efficient for patients and their families.
In either case, the team approach provides patients and their families the opportunity to contact more than one member of our team for questions later.
Types of tests
Electrocardiograms use electrical activity of the heart to identify an increase in the size of heart chambers, as well as the pathway of conduction of electrical forces from the top to the bottom of the heart. The results can provide important clues to cardiologists about the need for further testing to assess the possibility of either structural or electrical abnormalities.
How are electrocardiograms performed?
The test is performed by a trained technician. It takes 10 minutes to complete and requires the placement of sticky patches on the chest that are connected to the recording machine. Occasionally, removal of the patches can be uncomfortable so patients can remove them later at home after a bath or shower if they choose.
Holter monitors are devices that record a person's heart rhythm for a continuous 24-hour period. They determine the heart rate and rhythm of that person during normal activities.
How do Holter monitors work?
They require the use of two leads similar to those used for electrocardiograms. The monitoring equipment can be worn on a belt under clothing, or for younger children can be set next to the infant or toddler during the monitoring period. Once completed, the monitor can be removed by the parent and returned by mail to the laboratory for interpretation. The final results are available to the cardiologist who ordered the test, within one to two weeks.
Instead of monitoring the heart during normal activity, event monitors determine a person's heart rhythm during a particular event -- a specific change in heart rhythm when it is noticed by the patient.
How do event monitors work?
There are two types of event monitors. A hand-held monitor, typically used by older patients who may have intermittent symptoms that last for some length of time, is not directly attached to the body but can be carried in a pocket or purse for use when a patient feels a change in their heart rhythm.
A loop monitor, used by younger patients or when symptoms are brief, uses two leads attached to the monitoring equipment. When a patient feels a change in heart rhythm, a button is pushed storing the previous 30 seconds of heart rhythm, recording an additional 30 seconds of heart tracing. The advantages of a loop monitor are that it can identify brief rhythm abnormalities and can be kept by the patient for a month or longer increasing the chances of finding an infrequent rhythm.
Echocardiograms (echo) are performed to assess the heart's structures and function. An echo takes a moving picture of a person's heart by using high frequency sound waves (ultrasound), and shows the direction of the blood flow through the heart.
How do echocardiograms work?
A small probe called a transducer is placed on your child's chest and sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on your child's chest in certain locations and at certain angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce (or "echo") off of the heart structures.
The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.
An exercise/stress test is performed to assess the heart's response to stress or exercise. A physician may recommend the test for several reasons: to diagnose conditions such as coronary artery disease or symptoms such as chest pain, shortness of breath or lightheadedness; to gauge exercise capacity in heart patients; or to predict potential risk of heart-related conditions.
How do stress tests work?
It is done using an EKG machine, which is monitored while your child is exercising on a treadmill or stationary bike. Electrodes — small plastic patches — are placed on a patient's chest, arms and legs, and are connected to an EKG machine by lead wires, the electrical activity of your child's heart is measured.
Getting your results
All visits to our cardiology outpatient clinics are summarized in a letter sent to the referring pediatrician. This information is also stored in the Boston Children's main computer for readily accessible, secure access by other designated care providers who are part of Boston Children's system.
Families may request copies of letters or test results. Medical records of visits and testing can be forwarded to other health care providers, schools or agencies if requested in writing to the cardiologist or the Medical Records Department at Boston Children's.
Billing
For questions regarding bills received from Boston Children's Hospital, please call 617-355-3397.
For questions related to bills received from the Boston Children's Heart Foundation, Inc., please call 617-355-6793.
Financial assistance
If you don't have insurance and you need financial assistance, please call Patient Financial Services at 617-355-7201 for more information.
Referrals
If you have questions or concerns regarding a referral, and would like to speak with someone in the Boston Children's Heart Foundation, Inc., billing office, please call: 617-355-8726.
Please fax physician referrals to: 617-739-3784
Make an appointment
For questions regarding bills received from Boston Children's Hospital, please call 617-355-3397.
For questions related to bills received from the Boston Children's Heart Foundation, Inc., please call 617-355-6793.