A pediatric and fetal heart specialist has this ability. With his knowledge, detailed history and examination, as well as the use of paraclinical methods such as electrocardiography, echocardiography (fetus and child), angiography, Holter, and exercise testing, he can diagnose all types of heart problems from the fetal period to adolescence. ### History and examination: The beginning of this work begins with a history and a detailed examination by a pediatric heart specialist. You can tell by looking at the appearance and color of the skin and mucus of a child. He diagnosed some syndromes associated with heart problems, such as Down syndrome. In many cases, bruised skin has a heart cause. The appearance of the chest and movements of the chest can. It indicates some possible heart problems. In the era when there were no modern paraclinical methods, many heart problems were diagnosed by listening to heart sounds. Today, listening to abnormal heart sounds is very helpful in the initial diagnostic steps. According to recommended specialist and subspecialist books, any abnormal heartbeat in children's cardiac auscultation requires a full examination by a pediatric cardiologist.

### Echocardiography of fetal heart A pediatric and fetal heart specialist has this ability. To diagnose all kinds of heart problems in the fetus by performing fetal heart echo. In a fetal heart echo, the fetal heart specialist observes and examines the structure of the fetal heart completely. It examines the size of heart cavities and valves, and if there are heart defects, it is identified and expressed. It detects all kinds of abnormal rhythms. Checks the pressure inside the heart chambers. In special centers under supervision and observation with echo, therapeutic interventions are performed on the fetal heart. Related article: Is it necessary to perform echocardiography of the fetus? #### time of fetal echo The best time to do this procedure is the 18th to 22nd week of pregnancy. In Iran, according to the country's laws, legal abortion is allowed until the end of 18 weeks (18 weeks and 6 days). After this time, if the heart problems are very complicated. There is no legal abortion. It is possible in certain cases. This echo should be repeated at other times during pregnancy. #### accuracy of fetal echo In terms of accuracy, depending on the skill of the person, the accuracy of the echo machine, the time of visit, the position of the fetus and the state of the mother such as obesity or thinness, the accuracy of the work is different. But in the most ideal conditions, this accuracy is ninety-five percent. Mostly severe and acute problems are identified. It remains a detail that it is recommended to check the baby's heart with an echocardiogram after birth, and the appropriate time for this is usually from 10 days after birth to one month after birth. #### Counseling after the echo of the fetus After diagnosing the problem in the heart of the fetus, the pediatric heart specialist consults with the family about the type of heart problem and different methods for treatment. In rare cases where the fetal heart problem is very complicated and almost untreatable, it is necessary to be referred to the forensic medicine regarding the determination of the final assignment.

### Echocardiography of children's heart From the early hours after birth to adolescence, a pediatric and fetal heart specialist can use echo. Diagnose types of congenital heart problems in children. Sometimes following some acquired diseases such as Kawasaki disease or acute rheumatic fever with echocardiography, the heart complications of the disease are determined. With children's echocardiography, not only heart disease is diagnosed. Rather, in many cases, they determine the effectiveness and follow-up after the treatment with echo. Sometimes a heart surgeon is needed. to have a pediatric cardiologist by his side to assist the surgeon. In this way, the pediatric cardiologist examines the areas that are not visible to the surgeon with an echocardiography device to help the surgery. Or immediately after repairing a point and closing the place, it checks the completeness and immediate complications with echocardiography. Also, in the care of the special departments after the operation, the pediatric heart specialist checks the course of treatment and possible complications with echo.

### Angiography Angiography is one of the diagnostic and treatment methods for heart diseases in children. which is performed by a pediatric cardiologist. In this method, by putting the patient to sleep, they enter the heart and the vessels connected to it through special devices. Using contrast material and X-rays, they take detailed pictures of the structure of the heart. They determine the pressure inside different parts. In certain cases, they perform therapeutic interventions with specialized devices. ### Holter monitoring and exercise testing A pediatric heart specialist checks heart rhythms accurately and specifically with a Holter and exercise test. If there are abnormal heartbeats, after the diagnosis, he consults with the family about the treatment method.

Treatment of pediatric heart diseases

### Consultation with family: A pediatric and fetal heart specialist has this ability. To distinguish the normal and abnormal heart rate in the fetal echocardiogram and also in the interpretation of a child's ECG. In cases of abnormal heartbeats or cardiac arrhythmia, he has examined different treatment methods. Consult with the family for treatment and suggest different treatment methods. Arrhythmia treatment: There are different treatment methods for this type of heart disease. But in most cases drug therapy is the first line of treatment. In some materials, in a method similar to angiography called EPS (Electrophysiological Mastery), abnormal pathways inside the heart that cause arrhythmia are burned. In special cases that are mostly hereditary. Paediatric heart specialist recommends safety recommendations and certain drug avoidances to prevent arrhythmia attacks to the family. In fetal arrhythmias, drug treatments are sometimes needed to control abnormal heartbeats in the fetus. Considering the possible effects and side effects of these drugs on the mother's heart, she should treat abnormal fetal heartbeats with the participation of an adult cardiologist in a joint collaboration. ### Introduction for heart surgery: Some heart problems have a surgical solution. And the disease is treated in one or more stages of surgery. Deciding what kind of surgery and at what age should be done for the existing heart problem. It is determined by a pediatric and fetal heart specialist. Sometimes, in complex cases, decisions are made in a medical council including several pediatric heart specialists and pediatric heart surgeons. **Dr. Saeed Bitrafan answers your questions *free* in the question and answer section of his website.** **Dr. Saeed Bitarafan, pediatric and fetal cardiology specialist**