Many parents consider regular heart check-ups an absolute guarantee of their child's health. However, according to Yulia Kiyan, Deputy General Director for Scientific Work at the Center of Pediatric Cardiology and Cardiovascular Surgery of the Ministry of Health of Ukraine, interventional cardiologist, cardiovascular surgeon, and Candidate of Medical Sciences, there is no single universal echocardiography (Echo-ECG) algorithm in evidence-based medicine that would suit every child without exception. In her column for RBC-Ukraine, the expert explained in detail in which cases a heart ultrasound is truly necessary and when a healthy baby only needs a routine pediatrician's examination.
Field work under wartime conditions: thousands of children examined
Since the start of the full-scale war, the team of the Center of Pediatric Cardiology and Cardiovascular Surgery has been conducting mobile consultations in deoccupied and frontline areas of Ukraine, examining thousands of children. According to Yulia Kiyan, in cities with significant destruction and under constant shelling, pediatric cardiac examinations were, at best, limited to an ECG and a consultation with a pediatric cardiologist without an Echo-ECG, due to a shortage of medical staff. That is precisely why the center's mobile team brought its own equipment and provided a full cardiological consultation: taking the medical history and complaints, physical examination, ECG, and Echo-ECG — to the full extent required by the standard of care.
Regular echocardiography is not indicated for a healthy child
One of the most common questions from parents is this: does a child need regular Echo-ECG if they are not bothered by anything? The answer, from the standpoint of evidence-based medicine, is not as simple as it seems. There is no universal algorithm that fits everyone. At the same time, screening examinations make it possible to detect pathology in time, reduce mortality, improve quality of life, and prevent cardiovascular events. There are many indications for Echo-ECG, but for children without symptoms, without pathological findings on examination, and without a significant family history, regular echocardiography is not indicated. A comprehensive heart examination is prescribed when a family doctor suspects heart pathology during a routine check-up. In this case, Echo-ECG is informative in combination with an ECG, and in some cases additional imaging methods — CT, MRI, or exercise stress tests — will be required.
The full list of indications: from murmurs to genetic syndromes
The most common reason for a referral to a comprehensive heart examination is heart murmurs, which a pediatrician hears during a routine check-up. Any central cyanosis requires an Echo-ECG, as does shortness of breath, which may be a marker of heart failure, pulmonary hypertension, or a heart defect. Chest pain in children is of a non-cardiac nature in 95% of cases and is extremely rare, but ruling out heart pathology in such a case would not be amiss. Sudden loss of consciousness or frequent palpitations may also indicate heart problems and sometimes require an additional consultation with a cardiologist-arrhythmologist. Myocarditis, which can be a complication of many diseases and conditions, can be suspected and referred for further examination precisely through Echo-ECG. Arterial hypertension in a child may accompany heart defects and be a marker of other conditions, so here not only ECG and Echo-ECG are useful, but also keeping a blood pressure diary or 24-hour monitoring.
Genetics, infections, and prenatal diagnosis
Heart defects are often associated with genetic syndromes, and for a number of them a heart examination is mandatory: trisomy 21, Turner syndrome, Marfan syndrome, Noonan syndrome, Williams syndrome, 22q11 deletion, and other syndromes with a high risk of congenital heart defects. Echo-ECG is the primary imaging method when cardiomyopathies are suspected. An important element of a heart check-up remains the family history, since some defects and conditions have a genetic component. It is equally important to link fever with the heart: sometimes it is necessary to rule out infective endocarditis — a dangerous inflammation that is a consequence of infections. Fever will also be the main symptom when Kawasaki disease is suspected, in which case an assessment of the coronary arteries is mandatory. For MIS-C (multisystem inflammatory syndrome), a heart ultrasound is recommended for all patients with suspected or confirmed syndrome. In addition, Echo-ECG is recommended before starting potentially cardiotoxic therapy and during its course.
Prenatal diagnosis and an individual monitoring plan
Echocardiography can be started prenatally: detecting a heart defect before the child is born makes it possible to plan a treatment strategy that is safe for the child and understandable for the family. If a congenital heart defect has already been identified, subsequent examinations will depend on a number of factors and will be highly individual — depending on the type of defect, prior interventions performed, its complexity, and any associated pathology. Thus, the decision on the frequency and scope of Echo-ECG for a specific child is always made by the doctor taking the clinical picture into account, rather than by a single "calendar" principle.
