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General information about Pediatric Cardiology

A child's heart is not a smaller version of an adult's heart. It develops in the womb, changes the way it works at the moment of birth, and continues to grow and adapt throughout childhood. A pediatric cardiologist diagnoses and treats heart disease, congenital heart defects and arrhythmias - in fetuses, newborns, children and adolescents, and sometimes also in adults who were born with a heart defect.

Most children who see a pediatric cardiologist leave the visit with a completely healthy heart. A large part of the work is exactly that: examining a finding that sounds worrying - a murmur, chest pain, a fast heartbeat - and reaching a clear answer that reassures the parents or points to the right treatment when it is needed.

The most common reason for referral is a murmur - a sound the doctor hears through the stethoscope. Most murmurs in children are "innocent": it is simply the sound of blood flowing through a healthy heart. Similarly, chest pain in children almost never comes from the heart, unlike in adults.

At the same time, there are signs that should not be ignored — mainly symptoms that appear during exertion, such as chest pain or fainting. A pediatric cardiologist knows how to tell the two apart.

Pediatric Cardiology Tests

The main test is an echocardiogram — an ultrasound that shows the structure of the heart, the valves and the blood flow. It is painless and carries no risk. Alongside it, an ECG is used to check the heart's electrical activity, and when needed, a Holter monitor — a small device that monitors the heart rate over 24 hours.

When to See a Pediatric Cardiologist

When the pediatrician hears a murmur and refers the child for further evaluation, when chest pain appears during exertion, after fainting - especially during physical activity - when the child describes a fast heartbeat that does not settle at rest, or when there is a family history of sudden death at a young age.

Frequently asked questions about Pediatric Cardiology

The doctor heard a heart murmur - what does it mean?

The words "heart murmur" sound frightening, but in the vast majority of cases they describe something completely routine. A murmur is a sound the doctor hears through the stethoscope between heartbeats. Just as you can hear water flowing through a healthy pipe, you can sometimes hear blood flowing through a healthy heart. Such murmurs are called "innocent", and they are very common: in more than two-thirds of school-age children, a murmur like this can be heard at some point. It may become louder when the child is excited, stressed or sick with a fever, and it usually disappears as the child grows. A child with an innocent murmur has a healthy heart - they need no treatment, no follow-up and no restriction of any physical activity. Fewer than one percent of the population have a murmur caused by a heart problem. To find out which group the child belongs to, the pediatrician may refer them to a pediatric cardiologist. In newborns, a murmur that persists or appears after the first 48 hours requires evaluation by a cardiologist.

What is an echocardiogram, and is the test painful?

An echocardiogram (heart echo) is an ultrasound of the heart, based on the same familiar and safe sound-wave technology used in pregnancy scans. The test is painless, non-invasive and involves no radiation or risk of any kind. All it requires is applying a little gel to the chest and placing a small transducer, which sends a live video image of the heart in action to the screen in real time - including the movement of the chambers, the thickness of the walls, the opening and closing of the valves and the blood flow through them. This detailed imaging allows the cardiologist to assess the structure of the heart with great accuracy, measure the strength of the muscle's contraction, and identify congenital defects or changes in valve function. The main challenge with babies and toddlers is the need to lie still for about twenty minutes. Pediatric cardiology clinics are used to this: the test takes place in a calm atmosphere, with the parents sitting beside the child, and often includes watching a video, playing with a favorite toy or feeding.

"A hole in the heart" - does it close on its own?

"A hole in the heart" is the common name for an opening in the wall (septum) that separates the chambers of the heart. The most common case is an opening in the wall between the ventricles (VSD) - the most common congenital heart defect. The good news is that most small openings close on their own. In a large population study from Denmark that followed newborns with VSD using echocardiography, about 83% of the openings closed spontaneously by age one - most of them within the first six months. Small openings in the wall between the atria (ASD) also tend to close on their own: most openings smaller than 3 millimeters close, and many of those between 3 and 8 millimeters close by age three. The chance that the opening will close depends on its size and location. That is why the pediatric cardiologist monitors it with echocardiography and decides whether and when treatment is needed.

Does a child need a heart check-up to play sports?

It depends on the type of activity. Under Israel's Sports Law, athletes who compete within clubs, associations and federations must undergo a medical examination before taking part in competitions. For competitive athletes, the examination is carried out at a licensed sports medicine center every year before the start of the season, and includes a medical questionnaire, a physical examination and a resting ECG. In contrast, children who take part in regular sports classes, with no underlying conditions and no complaints, do not need a medical evaluation or special approval. If your child faints, complains of chest pain during exertion, or there is a family history of sudden death at a young age - it is worth having them checked before they start a sports activity, even if the law does not require it.

How are heart defects detected in newborns?

Every newborn in Israel is examined by a pediatrician within the first 24 hours of life, and again before discharge from the hospital. During this examination, the pediatrician also listens to the heart. In addition to the physical examination, every newborn also undergoes oxygen saturation screening before discharge: a simple, painless measurement of the oxygen level in the blood, in the hand and foot, after 24 hours of age. The goal is to detect life-threatening congenital heart defects as early as possible - and to start treating them before they cause damage.