Thank you for watching this program tonight with the best physicians of the region.

My name is Dr. Luis Munoz and I'm the President of El Paso County Medical Society.

It is our hope that you will find this program informative and interesting.

We at El Paso County Medical Society invest in community education with our programs.

I hope you'll find this program very informative, with great medical advice and great medical information.

Thank you again for watching this program tonight.

And have a great night.

Big hearts versus small hearts.

Physiologically, they're very different.

Pediatric cardiologists diagnose, treat and manage children's heart issues very differently than adults.

Surgeries on children's hearts can be very intricate and very specialized.

Pediatric cardiology is a growing need in the borderland.

And today we're going to be focusing specifically on structural heart disease.

This evening's program is underwritten by the El Paso Children's Hospital.

And we also want to thank the El Paso County Medical Society for bringing this program to you for 28 years now.

I'm Kathrin Berg, and you're tuned into the El Paso physician.

Thank you so much for joining us today.

We're talking about pediatric cardiology and that it's such a growing need in the borderland.

We have Dr. Schuster with us, who's been with us in the past.

And I feel like I've known him for 30 some odd years.

But Dr. Jeffrey Schuster is the pediatric cardiologist and chief medical officer for the El Paso Children's Hospital.

Thank you so much for being our veteran and for being here today.

Thank you.

We also have Dr. Muhammed Asif Qureshi, who is a pediatric cardiology as well.

And we are going to be speaking a lot about the little ones and how treating little ones is so different than treating the big guys.

So on that note, Dr. Schuster, if you could talk about a little bit so the audience can get to know you a little bit.

So, yes, you're the chief medical officer for the El Paso Children's Hospital.

What a job.

But in general, how did you get there?

How long have you been doing cardiology?

Are you in El Paso?

El Pasoan?

So I was born and raised here in El Paso.

Yes.

I went to all the local schools here in El Paso, went off for college in the Louisiana, back to San Antonio for medical school, Galveston, Gainesville, Florida, Chicago, and then back to El Paso, 37 years ago.

Oh, my goodness.

So I've been here longer than I've been away at this point for a while.

It wasn't that case, but I've been trying to take care of all the hearts that we have here in El Paso.

So it's it's kind of funny at times when I tell people that I'm a pediatric cardiologist, some of them think I take care of little baby heart attacks.

And heart attacks are extremely rare in pediatric cardiology.

They do occur, but it's not something that we take care of on a day to day basis.

So and we will talk about how things really began.

And I and I love we were talking a little bit prior to the program beginning.

We are going to speak specifically about babies even before they're born.

Right.

And how you look at specialized ways of helping, even prior to that.

Dr. Qureshi, so let's talk about you.

You are a pediatric cardiologist and you are, my goodness, you were just give me all kinds of notes for the audience here.

Note this is what my notes look like.

And we haven't even started yet.

And there is there's just like chicken scratching everywhere.

So I very much appreciate that because it helps me prep even on top of the prep we've had before coming here.

So in general, what is your background?

Well, I just want to first say thank you, Kathrin, for having us here.

This is a good platform to let the people know that what we do, I actually I have done my medical school back home in Karachi, Pakistan.

Mm hmm.

And I moved about 32 years ago here in the United States.

I've trained in New York with the New York Medical College for my pediatric residency training program.

And after that, I did like almost like a you not going to believe, but I did like a nine years of general Pediatrics.

And after that, I went into a pediatric cardiology program from 2005 to 2008.

Okay.

So you do big hearts and little hearts.

I well, I did a pediatric so, you know, in big hearts, not that interesting, but it's really a really, you know, I mean, it's really challenging, you know, because they born with the situation and conditions, you know, that they are not I mean, this is kind of a big puzzle to solve.

Yeah.

So I started my cardiology career or pediatric cardiology career here in in Texas.

So my first destination was all the way now and the panhandle with there, Texas Tech University in Amarillo, Texas.

I spent like a four years over there.

Then I moved to Baylor Scott and White which is now it's it's and that's been like almost four or five years over there and after that I ended up so as you can see that I was in up north and then I was in the the the middle of Texas and I ended up in McAllen, which is all the way south.

Mm hmm.

At that.

And that was the honestly, like a great experience.

Or they're working at the border with the private practice, which is a kind of a little bit of different practice, like we practice and the big institutions.

Right now you're here at El Paso Children's, so welcome to El Paso.

We're very thank you so much.

I'm so excited.

I started like in November of last year.

Great.

And I met with Dr. Schuster.

Obviously, he is the he knows the whole history of El Paso.

Yeah.

I need to sit down with him at some time.

I love to learn all that kind of history, learn that, you know, pediatric cardiology history from him here.

So I think the main thing, we're just kind of excited for me to be here because I've been most of the places that it is like a little bit of a more challenging here at this point.

And why is that, would you say?

I would say it's not you know, are like it's it's a border town.

That's one thing.

I did work on the border time before.

So sometimes you come across to the diseases which were not diagnosed way before, you know, So they cross the border, they come to us and sometimes the diseases were supposed to be diagnosed over earlier.

Then we diagnosed them right here.

And then the border Patrol, like they bring the kids and all that.

We diagnosed like not a I think I would say like maybe two weeks ago we had an interesting three years old and they called me from the emergency room.

He was stable, though, but we did have a very rare kind of a condition in that child.

We made a diagnosis.

The child was stable and the final destination was in California.

And what was that condition?

Are you able to speak?

Yeah, yeah, yeah, absolutely.

You know, so sometimes the, as I said, is interesting.

So sometimes they bond with like, if I would like you to just to show from this model, if that is okay.

Sure , since we are on that topic and then we'll start with the very beginning of babies in the womb.

Yeah so what happens that the lure to chamber they kind of a twisted.

Mm hmm.

So instead of a this bigger artery is supposed to come out from the left lower chamber.

I just wanted to show.

Yeah.

So the cameras can see it.

So as you can see that, let me just.

If I can take this thing off, You know, this is kind of my story.

It's easily breakable heart, you know?

So I just want to let you know so you can.

It's a male heart.

Male hearts are very much more delicate.

I love them to.

Look at you.

I kind of love everything about that.

They are, aren't they?

I well, you know, that's what Doctor Schuster opinion, you know, So what I want to do to let you know that these two lower chambers that want to just do so if you see that and this is the these are the two lower chambers, the are mainly the the pumping chamber, we call them on the ventricle in medical term, these pumping chambers to the left, one is the one which actually pushed the blood up into these major arteries called aorta, which supply the all the good oxygenated or oxygen rich blood to the body.

And the right side, when it comes back to the right side by side, push the blood to the lungs.

So the lungs is like a grocery store for oxygen.

Right?

So we get the grocery down, oxygen thing.

It goes back, come back to the left, upper chamber, goes to the left side.

And that particular child, which I just want to let you know, is that give.

Me the age.

So it just gives us perspective on the age of this child.

He was like three years old.

Oh, so little.

Yeah, he was three years old.

So what happens that he was not diagnosed because his those two chambers kind of swap.

So the right side actually left side went to the right side, left side went to the left side without any change.

You get these two bigger, Artery, supply the blood to the lungs and to the body.

So this was a s it is a congenital?

Yeah, we there is a name for that.

So we call it a congenital corrected transpo position means like it's transpose, you know, transposition of the great arteries.

Right.

There's no name for that.

And how was it diagnosis performed.

Like what kind of a procedure he's having?

What symptoms, for example, what are his symptoms?

And then how do you figure out what tests you need to perform to diagnose?

Well, that's a great questions.

The thing is that as you can see, that he was there and he was diagnosed.

I think he was I don't know which country he was from.

I'm not recalling that, but he has a some kind of a diagnosis.

And he was told the mother was told that, hey, you can just provide as much love as you can to the child because this child is not going to, you know, live very long.

He's going to need a new heart and things like this.

The mother was so stressed out.

And what were his symptoms?

Was he having a heart?

Yeah, he was laying here when he actually came to the emergency room.

I think there was a complaining of a little bit of a shortness of breath and stuff like that, which was not related to the underlying heart condition.

It was most likely that he was in a place where too many crowd it was was crowded.

So he had that kind of feeling.

So they ended up the only time we make a diagnosis when they called me and they said, Hey, we wanted to have an echocardiogram done on this child because he had a prior history of some kind of a heart condition.

And mother was told that he's not going to live very long.

So when I saw the echocardiogram and it was like a quick, you know, because you see all the morphologies of the different part and it was like it it didn't take very long it to just to make a quick diagnosis.

If you can explain to the audience what is an echocardiogram like, what does it happen?

It is like it's it is more like an ultrasound, like the people have an ultrasound.

So it's like the sound wave.

And we say all the sound is like the sound.

We cannot hear it right.

So those sound waves actually goes and it's made kind of different kind of pictures.

In our case, we when we do like it, it's the same thing.

It's like a, you know, echocardiogram is the same.

Like it produces the same kind of a sound waves.

It goes there and and then it comes back, reflected back, and then it make like an image right there.

And we can see all that image.

We see that color flow.

It tells us where the blood is flowing, to which direction.

Right.

And then we have the other ways to check how fast it is going.

So which is going in all day long?

Yeah.

So that's what it did.

I was glad that I actually had a good time with that.

Mom and I explained everything very well and she was happy and I told her, Well.

We know it is what's happening exactly.

Excellent.

We can get a diagnosis.

Yes, sir.

With Echo in almost all of our patients.

Nice.

So before there was ultrasound, we had to do some very dangerous procedures.

Now we're talking 30, 40, 50 years ago.

But the echocardiogram really provides a diagnosis.

Almost always.

Okay.

And I love how you're talking about that.

So we were talking about echos while the child is already a child.

Not that they're not already a child, but I do want to focus on what we talked about prior to the show is when in utero, when the child is yet born and there is a an ultrasound, a sonogram that's sometimes it's normally done, that there are ways that you can find structural issues in those cases.

So I'd love for you to start, because I know that you talked about this earlier.

I was just fascinated, just listening to you talk about how old in the womb does a child have to be to find something wrong.

I mean, if we're looking at a couple of months, we look at not until five, six, seven months, kind of take it from there.

So first we can discuss, well, why would we look at a fetus as part.

Mm hmm.

So there are some really good indications to do that.

If a mother was born with congenital heart disease, she has a substantial risk of passing that on to her kids.

Exactly.

Okay.

Despite what I said earlier, the father is not unimportant, but he's a less important.

Siblings are also a very big indication.

If anybody in the first degree family has congenital heart disease, the chance of it recurring are worth looking for.

Okay, now there are other things that we can also have to do.

El Paso has a lot of women with gestational diabetes, and that is an indication to look at the baby's heart.

Other things is sometimes the obs can draw certain blood tests and we'll get out concerning things there.

So if we have those kind of indications and well, the number one yield indication for a fetal echocardiogram is if the OB or the maternal fetal medicine doctor says, I think there's something wrong with this heart.

Hmm.

Now we get a very good yield on that gestational diabetes.

You can do 50 and find nothing.

Okay.

But and one what the doctors say, I think something's wrong with this heart.

Like what would be the indication?

Well, so one of the things that they might say, I think this kid has a three chambered heart and you're supposed to have four chambers.

Because they can hear that in the echo.

Well, so they can see it.

They can.

Actually physically see it and.

They can say, well, and one of the things that we see is, for instance, in babies with Down's Syndrome, they'll have one valve instead of two between the upper and lower chambers.

And they are very good at identifying that.

So we have indications from the MFM, the maternal fetal medicine or the OB doctor, and then we can go now if we find something that's really important because the chance of dying and I'll use that word.

You have to be right because.

I mean there are some lethal heart diseases at birth that can go home with mom, the baby goes home with mom, and you go, Oh my God, how could this happen?

Well, it does.

And so when you say that it's not caught prior to the child.

Right.

The baby.

Well, okay.

Or even after birth.

Okay.

Now you can't have a baby in America without having two ultrasounds.

Okay.

So we are catching more and more of it.

But there are still I mean, here in El Paso, we have mothers who haven't had any maternal pregnancy care.

And so sometimes you get surprised.

And so you were talking about early and I thought this number was quite startling.

So congenital heart defects, you got about one in a hundred and you said it used to be about eight in a thousand.

So that's up quite a bit.

Is that due.

To it's up 25%.

Or is that due to actual issues?

Well, actually, I think the number has climbed a little bit.

Okay.

I mean, we went with 8000 for the longest time and now I'm quoting one and a hundred, which is ten per thousand.

So we may be seeing more.

Do you think there's a reason for that?

And I'm asking that question that should be the crystal ball, you know, that sometimes I ask questions that are not hypothetical, that wondering.

Not that I can identify for us at this point.

Okay.

And so when you're looking at congenital so we've got a couple of here that we we're going to talk about in general and we talked Kawasaki disease.

So I feel like I've heard that here and they're scattered around, but I'm not quite sure what it is.

I think we've heard the word, but if you were to give that a definition for our audience, well.

You are in good company.

Okay.

Because Kawasaki is disease is a post, infectious inflammatory disease that we don't really understand completely.

So if you say, well, what causes Kawasaki disease?

And we said we have all sorts of ideas, but we cannot put our finger on it completely.

Oh, interesting.

So Kawasaki's almost always less than six years of age, high fever.

That just won't go away.

You develop a rash, you develop changes in your skin, your eyes, your mouth, all sorts of things.

And you have a high fever.

And the bloodwork, which you'll have if you've had high fever for three days, the doctor's going to order some blood work on right?

They will show a very big inflammatory response.

And unfortunately, like I teased the medical residents as well, just do the Kawasaki test.

There isn't one, huh?

There you.

It's a clinical diagnosis of you have five things you need at least four of them.

And then you have to have supporting stuff.

So Kawasaki's is very important for kids under six.

Okay, Now kind of interesting.

Another acquired heart disease.

We are seeing some cardio cardiac effects of COVID.

Oh, yeah.

So the problem with Kawasaki's is they develop coronary aneurysms.

I'll never forget the first Kawasaki's I ever saw was a two year old who was bouncing off the walls.

And when you looked at his EKG and you looked at his echo, he had had a heart attack.

You know, I said.

You think of aneurysms with children, you know, you don't.

We're like you said, heart attacks and aneurysms.

It's not something you think of with cardiology, but with children.

And in COVID, we're also seeing coronary problems.

Well, so again, it's post infectious.

It's older kids.

I mean, it used to be if somebody called me up and said, I have a nine year old with Kawasaki's, I would say, no, you don't.

Nowadays, I pay attention to those because maybe they had COVID.

A lot of COVID never gets diagnosed.

And so like the presentation in Kawasaki's and long COVID, the presentations relatively similar.

So for long COVID, I was seeing quite a few patients in like 2022 where they'd had COVID and they go to their pediatrician and say, he's tired all the time.

He really can't get back into his physical activities that he did before COVID.

Now, the good news is that most of those kids actually don't have anything wrong with their heart.

And I would refer them to the pulmonologist because the pulmonologist actually will find some restriction in their lung function and things like that.

But COVID, we now know also causes a myocarditis, a viral infection of the heart that can be quite serious And that would that and this is a question, too, that would be different with every individual.

How long might that last?

Anywhere from a couple of months to a couple of years, because we're talking several years.

And it's certainly I mean, it depends on the severity of the damage.

There's probably damage that happens at a certain point.

Usually there's not ongoing damage.

Okay.

But then you have the evolution of how the heart reacts to the Well, part of the heart muscles damaged.

The heart does react to that.

It tries to continue doing its best job despite the fact that part of the heart's not working well.

And the heart damaging.

I think years and years ago we did one of the first cardiology shows.

They said a heart attack just means that there's a part of your heart that didn't get blood and it's dead.

I remember thinking, Boy, that's pretty drastic, but maybe you can explain when someone has heart damage, does that part of the heart ever get better?

Well, so that's why you want to be a kid.

Because kids heal better than adults do in almost all directions.

And for instance, I'm doing it again.

We have another cause for a heart attack in a kid less than six months of age.

And if you fix what's causing that, I have seen kids.

I can't tell there was ever anything wrong with them.

When they're five years of age, they have a scar from here to here, but they have recovered very well.

Absolutely right.

I totally concur with Dr. Schuster about it.

Okay.

So that throws something into the mix.

What's ALCAPA?

Yeah.

So when we have like a coronary arteries, the coronary arteries are the one which supply the blood to the heart muscles.

So when we say outcome wise means they get abnormal origin of the left coronary artery from the pulmonary artery, it's going to be good if I explained, you know, through that you mean.

So I love model.

Yeah.

Feel free to be.

Yeah.

So if you see that, I just want to let you know that that the quantity is usually arises from right at the base of the bigger arteries right here and they supply the blood to the heart muscles all over this, supply the blood to the heart muscles.

And that's what we talk about.

The adult, when they have a coronary artery problem, they have a less of a blood going.

And that's how they start with the heart attack.

Okay.

Well, this is different than the what I'm talking about right now.

So in in pediatrics or in in babies or newborn, they born with the anomalies of the coronary artery, which means like that, that during embryology what happens that the coronary arteries they don't they do not come off of this bigger artery they actually going to creep on.

They just go towards that and kind of attach to that area if they're normally attached.

There's a baby's normal coronary arteries.

They are go and abnormally attached either to the there are few is called aorta or one of them kind of make a little twist.

And instead of attaching to the bigger artery or it attached to this artery, which is actually supplying the blood to the lungs.

And is there a cause for that or is that just something that's just.

Well, this is something unfortunately, and real logical.

Okay.

And even before the moms know, most of the time when they are pregnant, the heart is completely formed.

So it has nothing to do with the fact that the mother has done something wrong, did not have enough, you know, orange juice or pains and all that has nothing to do with that.

No one has to be blamed for that.

Yeah, lets not even go there.

I just want to let you know.

So what happened this with ALCAPA which I'm saying, like anomalous means, like abnormal origin of the left coronary artery, which is supposed to be like coming from the left sinus right there.

And it comes off from this bigger.

It is called a pulmonary artery.

Okay.

With the period of time.

And now this is the one when we can say that the baby can have a heart attack, because once, once the baby's born, they're pressure on the both side of the chambers are almost equal.

Hmm.

But over time, the lungs pressure decreases.

And that's how you know, that's how that's like a natural way of doing it about like it's six weeks to two months of age to all the pressures in the lungs is almost like obvious pressure, you know, like a normal adult pressure.

That's pretty quick.

Okay.

So with that that if you have the blood supply, which is coming off of not the normal would be abnormal on bigger artery when the pressure drop at the same time is going to still happen.

And since though the blood going from the abnormal coronary artery to the heart muscle is going back in there, you know, to the lungs.

So the baby start having like a heart attack.

Yeah, right.

They cry, but baby do cry.

We don't know unless sometimes it happens to be like for some reason the baby has a heart murmur and we check it.

We saw, Hey, this is like an abnormal or anomalous origin.

Or when the baby comes, like, around, like a three months of age when they start having all that kind of what we call a congestive heart failure.

Right.

The heart can get bigger.

And something that I think's kind of interesting.

So when we were talking about in the womb, about how many months in the womb is when the heart is completely formed.

Well, the heart's pretty much formed within six weeks.

Within six weeks.

Within six weeks, we start doing fetal echocardiograms, usually around 18 weeks of gestation.

You can do them a little bit earlier.

You can actually do a fetal echocardiogram at six weeks of age, but that's not on your abdomen.

Jeez.

So and mainly you can see the heartbeat.

Yes.

You can't really get much.

You just remember you can hear the heartbeat.

But I didn't know that it was that quick.

So when you're looking at that, then you really can almost diagnose.

I mean, once you're able to see I don't even know what how I'm trying to ask that question.

We can see pretty much the entire heart on fetal echocardiogram.

Now, for my patients, they always want to be on their stomachs so that I have to image through their back.

Oh, so it's interesting.

Well, it's a complaint that's new, but you can see.

Yeah, pretty.

Well.

Now, there are some things that we go, okay, well, this is suspicious, but not definitive.

But we're definitely going to do an echocardiogram after birth.

Okay.

Any time I have any question about a fetal echocardiogram, I definitely tell mom and pediatrician baby needs an echo at birth before going home so that we don't miss anything.

So.

So if I'm if I'm going I'm going off script a little bit here.

I know that you all are not surgeons.

However, are there are certain conditions, heart conditions, cardio conditions that can be fixed with surgery in utero and in what are those?

And again, I will throw the disclaimer out there.

I know that you're not surgeons, but I'd love to hear a little bit about because I just find that that's.

Making it is bleeding edge therapy if you have it.

I mean, what you would do is you would see a baby that you say this baby's not going to get big enough ever to survive.

In other words, you're going to lose this baby before viability.

I mean, if you're at 22 weeks with Major heart disease and you deliver, there's not a whole lot that can be done.

So, for instance, not actual surgery, but you can actually, for instance, if the aortic valve is severely blocked, you can actually try to open up that valve with a catheter through mother's skin, through the baby's chest and open up that valve.

Now, that is amazing to me.

It is.

It has associated risks, for course.

Of course.

But I mean, you've got no survivals at all.

And then you might have some survivals if you're able to get that valve open and things like that.

Another one would be in a very malformed heart.

If the upper chamber, if the upper wall between the upper chambers is intact, it will cause huge amounts of trouble and make the baby non-viable pretty quickly so we can try to do things there.

They have done actual surgeries.

I mean, they have kept the baby connected to the mother through the umbilical cord, put them over here, do things surgically on them, put them back.

Oh my goodness.

And because Mom's the best incubator we've got.

Wow, That's amazing.

That's amazing.

I feel like we can spend so much time on that.

I do want to get to some some issues with heart.

You mentioned the word heart murmur.

And and I get it.

You know, you say heart murmur in the old days, like, oh my God, they have a heart murmur.

How many?

I mean, a lot of people have a heart murmur.

So let's first debunked the idea of if you hear the word heart murmur that something's really wrong and then go into palpitations, chest pains, fainting, etc..

I mean, some of the electrical issues because, you know, I always think about electrical issues of the heart and I know I came in with that today.

But if you could, Dr. Qureshi, talk a little bit about that.

Yeah, let's talk about the first, the heart murmur.

So this is I usually explain to the, you know, the parents that this is like a kind of a whooshing sound.

You know, you can hear that no heart murmur does not always mean that you have an underlying heart condition or a hole in the heart and all that.

Yeah, but when I try to explain about the heart murmur, I would say like, let's, let's say that there is there is a water hose, you know, and there is, there is.

You didn't put like a thumb in front of it, right?

So the water is kind of streaming.

The water is like a streamlined is kind of flowing.

Okay.

Without any turbulence.

Right.

So you don't hear any sound as soon as you put this finger right there in front of it, you make like a little turbulence of this water and any turbulence makes kind of sound.

So basically the heart murmur is kind of a turbulence thing.

And now this turbulence can happen like an inside of the cavities of them off the heart without having any kind of underlying heart condition or valve or anything like that.

Yeah.

So we call it exactly the benign thing.

But, you know, sometimes they have like a holes in the, you know, lower especially with a lowering in between the two chambers of the heart, the wall there and that we call a ventricular septal defect.

And those are the one if you have a someone born with really a big atrial septal defect, that just means that there is a big hole in between the upper two chamber.

Usually you know, you don't hear, but if you really concentrate, I would say that maybe the cardiologist only can hear that sound, you know, which is the diastolic type of a murmur or flow my mind up on area.

If he can come back with, you know, not with the other topic like if you say that about from heart murmur to the palpitations.

Perfect.

Let's talk about palpitations and arrhythmia and.

Right.

So all this combination of palpitations simply means that if someone have been, like, aware of his heartbeat, the awareness of the heartbeat is like we call upon palpitation.

Mm hmm.

Now, usually when we all run, we have to be aware of our heartbeat, you know, because we are running, be exerting.

We have our heart is going to be fast, but if someone is just sitting not doing anything, do not have a fever, do not have any other problem, no anxiety.

like no upcoming test and things like that.

Once they feel like the feeling of oh my heart is fast What is that?

You know?

Mm hmm.

And that will be called And then we wanted to investigate further to make sure that we are not missing any electrical problem of the heart.

So when we say electrical, this heart actually has electrical cables there.

There are one generator.

They are the second generator, one generator which generates electrical activity.

The second one, which kind of kind of control and this synchrony of that electrical activity and the whole heart muscle is actually everywhere.

They are ticklish.

They can produce more electrical activities.

You know, they're ticklish.

I love that.

They also marry that now with arrhythmia.

So, Mary, that now with beats that are missed or a couple of fast beats and the not another.

Yeah when when we say arrhythmia it's just kind of like a misnomer.

Arrhythmia means like a normal rhythm.

Obviously, if you have no rhythm, you're not alive.

Right.

So more appropriate term, you know, is like a just read me add and disturb rhythm.

I will just say it is still we use arrhythmia, but it's a disturbed arrhythmia.

So it can be like extra beat.

It can be like a skip beat.

It is dangerous.

Is that something people should look out for?

Well, I know you know, back and forth, whoever's listening, they're going to take that with every age.

So I have said, would a child know to ask about that?

Would a child know, hey, I'm skipping beats and it's a little bit fast and a little bit slow.

So you got to bring that.

Absolutely.

And then the you know, I can tell you that, uh, the children's, when they come, they're smart, good.

What they say they usually you don't say my heart is beating fast or I have tachycardia.

Those are medical terms.

They said that my heart beat.

My heart beat.

Hmm.

And you know, exactly like a beep.

You know.

Like a horn.

Yeah, yeah, yeah, yeah.

Like, it's like.

It's like that.

And you need to figure it out, right?

So we, we ask mothers and all that to how often and how does it happen and all that.

And then we have those things we call an electrocardiogram.

Mm hmm.

We do that.

And in some instances we need to do like, a prolonged monitoring of that electrical activity of the heart.

We have a certain monitors.

One is like a Holter monitor.

We can use, we can use event recorder we and there are multiple others.

And some of them, if you do not find it, believe me, that they insert like it, right here.

And it goes for a long time like a bottle ear, you know, recording.

Right under the skin that side of the skin.

So let's say we do have a child now that has arrhythmia, and it's arrhythmia that's concerning right from there.

What is it that you all as cardiac ologist do to help?

I don't know, bring that harpy back into rhythm.

I know there's ablation.

I think I've only spoken about that with with adults.

But in general, what is the treatment for a child that has pretty major arrhythmia that's concerning.

So arrhythmias can be very serious.

And we have medical treatments.

We have medicines that can be taken by mouth, which are very good at controlling things usually.

But with all this white hair comes the huge of change that we have seen.

So we used to have I mean, I had kids, I had them on for medicines with some control, not good control, but some control.

And back then that's all we had to offer, especially in a small child.

Nowadays, is I never have kids on for medicines anymore because I'll send them for ablation.

Oh, really?

Yeah.

So that is an option.

So you can ablate a newborn.

Okay, very.

Before we go further, for those that don't know what ablation is, let's describe what that is.

Let's define.

So ablation is either or is with a catheter from the groin into the heart.

Find the part of the heart that is not acting like it should.

It either is acting as a bridge that we don't need or an area that is going off on its own.

I like to call it Terrell Owens.

He just wants to do his own thing.

So ablation you go with a catheter, locate that and either freeze it or burn it.

Okay.

And the last kid I had on four different medications, he was two and a half years old.

Oh, my goodness.

And I you know, I talked to the doctor who does the ablations and I said, you know, I've got him on four meds and he breaks through and he says, Well, I'll take care of it, huh?

And so two and a half years old.

Yeah.

Cardiac ablation.

Yeah.

So.

Okay.

So I love hearing all that.

Well.

I do want to say, please, the most common cause of palpitations are palpitations.

In other words, you don't have any arrhythmia.

Okay.

Okay.

So of the patients referred for arrhythmias, if I have 100 people for palpitations, if I have 100 people referred for palpitations, then I find something wrong with them.

Rarely.

Hmm.

So a lot of it is anxiety and you can usually tease that out by saying, okay, well, when was your last episode?

Right?

Well, it was when Mom was yelling at me.

Right?

Or even I know I have a big test.

I was talking to my boy friend on the phone.

Right.

And things like that.

So most common cause of palpitations is palpitations.

It's probably the most like when you say that anxiety is something that it's just it's thrown out right and left These days.

We are I mean, COVID continues to cause problems.

In 2025, the loss of interaction for the kids in school is going to take years to go away, and we certainly hope it will.

The my son and I were just talking about that he went through his senior year.

So he didn't get to graduate.

All the fun stuff you're supposed to do as a senior, but it truly has lasting effects mentally and physically, too, and with kids too, with COVID.

And I don't know if you've experienced this visiting, being pediatricians and being pediatric pediatric cardiologist, sorry, it's hard to get out.

So with kids and the undiagnosed COVID and are you seeing children that, oh my gosh, you must have had COVID somewhere along the line because these are what we this is what we're seeing now.

And it seems to be an after effect.

I feel like I'm hearing a lot more about that now in 2024 or 2025.

And I think we will going forward.

Do you find that that's the case?

Well, so when we have somebody whose heart's not working well and the muscle just is not doing the job it's supposed to, and we're going, oh, what's what's mean?

His coronary arteries are normal.

Yeah, everything else looks normal.

This valve leaks, but this is a result of the heart not working well.

Rather than a cause, we can do imaging that will show scarring.

And if there's nothing else that we can figure out and it is temporally related to COVID, then we might have the effects of myocardial fibrosis after COVID.

And that's so interesting.

So I, you know, a decade from now, it would be very interesting to do this show and ask that same question because there's going to be so much more.

I mean.

By that time you're going to be having a tequila somewhere and resting speech because you should eventually retire.

Hopefully, I will be, too.

I want to talk about some structural heart defects and very beautifully we have ASDs VSD, PDAs and interventional cath procedures.

So let's start with ASD, which is atrial.

Atrial septal defect.

Thank you very.

Much.

It's a hole in the wall between the upper chambers of the heart.

Okay, so here we go to I'm going to I'm going to pass that on to you.

And we need these guys eventually.

Eventually.

Yeah.

Well, these are.

So this is the upper chamber of the heart wall.

And now we're looking in there's a tricuspid valve, but this is an intact wall.

The atrial septum.

Now, it is extremely common for a newborn to have a communication here, but that usually goes away.

But sometimes we see an actual hole.

And because of the blood from the left side, left upper chamber, the left atrium goes over to the right side.

We start seeing enlargement of the right side of the heart.

Heart function is still normal and the data says that if you fix an atrial septal defect soon enough, you will have no consequence at all.

So say that again.

How can the heart function still be normal?

Maybe I'm missing.

There's a lot of reserve in the heart, thank goodness.

Okay.

Okay.

So you're mildly enlarged.

There are changes.

And so, you know, I've had a and a testes are more common in girls and boys, and that's about the only one.

So I've had a teenage girl when I have diagnosis.

And I said, well, back then we need to operate on this.

And of course a teenage girl and the word operation do not go together very well.

Right.

And and I tell them, look, your heart function is going to be normal afterwards.

And things like that.

They are still very reluctant.

It's a very frequent cause of a second opinion, because if you know somebody says, well, I feel fine and you want to ruin my bikini, they will go get a second opinion.

And I've done multiple myself.

And so we look at the echo usually as all require, and we say that now, nowadays if you have an SD in the right position, in the right size, we can close those in the cath lab without any incision at all.

Without any incision.

So you know, well, how then are you going to.

Well, so usually in pediatrics it's from the groin up.

Okay.

And so you come to the incisions.

From the groin in the groin.

I mean, in this area.

It's a it's a needle.

Oh, my God.

There's no real incision at all.

And so and some of these are being closed in young adults and adults here in El Paso.

So that is a step forward that El Paso has managed so far.

Now, the smaller kids are there, they're harder to do, and a lot of the time don't need to do it immediately anyhow.

So but it is nice because, I mean, you get lost second opinions.

Yes.

You're crazy, Doctor.

Yeah.

There's no way they need to cut me open and stuff like that.

So a surgical surgery with little ones is always kind of a hard one.

Okay, let's move on to VSDs.

And I know we have ductile artery, which is the PDAs, which you talked about earlier, but VSD is ventricle ventricle.

So probably the most common structural heart defect is a ventricular septal defect.

It's a whole.

Set, slow.

Ventricular septal defect.

Okay.

Gotcha.

And that's a hole between the pumping chambers.

The lower.

Okay, gotcha.

And they can run from that big to that small, small ones in the right location we don't do anything about.

Hmm.

Well, the heart eventually closing, or is it.

Just a lot of.

Functioning?

A lot of them will close.

Okay, now we see them down in the muscle.

We say, okay, we have a very good chance if you're up near the valves, you have to watch them.

I see.

Because with the Venturi effect, you can actually the valves and even though it's a small hole, you have to go in and fix it.

Right?

Right.

So now cutting edge, bleeding edge, not El Paso so far is we can close some of these with catheters also.

Mm hmm.

So it is it's a much bigger deal.

Mm hmm.

Um, but, uh, I mean, there are places where there are no surgeons, uh, and they use catheterization to close via STDs, even near the valves.

Okay.

And you were talking earlier, too.

So currently there are some surgeries that are being done out of town.

But I always like thinking about the future of what do you foresee in El Paso with pediatric cardiology?

You said the borderland is in need of a little bit more.

So I always that's the favorite part of the program for me is what are we looking forward to?

So in 2025, in El Paso, Texas, we are not doing any open heart surgeries here in El Paso.

So if somebody needs an open heart procedure, they have to go out of town.

A pediatric open heart procedure.

Right.

Okay.

And so we're partnering with various people who can provide the best care for our kids.

And for instance, for VSDs, it's it's simple.

Hmm.

Tell that to the mother who gets to wait for 4 hours waiting for their child to come out of the operating room.

But it is one of our goals.

You know, we would like to say, okay, well, I don't think we're going to be doing heart transplants in El Paso any time soon.

But there are a lot of things that we think that we can step up eventually and get done here in El Paso so that you don't spend ten days in one of the big cities of Texas.

Exactly.

So now you wearing the hat of chief medical officer for El Paso Children's Hospital.

I know that there are gosh, there's meetings and there's more meetings and more meetings.

What is that process just for people who are wondering, how is it that, you know, as in we are on El Paso is getting so many fantastic different procedures to town.

How does that start?

Where What are the baby steps?

How many meetings, who are you meeting with and how does it actually happen?

Well, so if we're thinking about cardiology, I've been here for 37 years.

We've also unfortunately had three or four pediatric cardiologists come to town and leave town.

So we need to have enough to get everybody seen, identify those who do need surgery and eventually move towards being able to do something for them there.

There are all sorts of sub subspecialties in pediatric cardiology.

There's the arrhythmia doctors.

There are the doctors who can close the holes with catheters.

There are there's a big one right now, which unfortunately is heart failure.

There is heart failure in little ones.

In little.

Ones.

So that's such a big like a broad word, heart failure.

Well, it means your heart is not able to do the job it needs to do on a consistent basis.

I mean, if you're if you are we talked about perhaps with COVID, you have myocarditis and my myocardial fibrosis.

And we haven't talked about that.

Yet.

The heart doesn't work as good as it could.

And so there are all sorts of steps before we think about a heart transplant.

But I have patients that have I think I've had 11 hearts transplanted.

Oh, wow.

Oh, from all across Texas and I saw one the other day he was transplanted in Denver.

Huh, Because he's from New Mexico.

I gotcha.

Wow.

Okay.

That's big.

And where was that procedure taking place?

In Denver?

Yes, at Children's Colorado.

Okay.

Gotcha.

Big place.

So I know that we're kind of running out of time here.

I do want to talk a little bit about high risk pregnancies only because this, again, is a pediatric cardiology show.

And in general, if we're looking at a population of mothers, you did talk about gestational diabetes.

So that is a risk factor.

Are there any other risk factors that we can kind of throw out there quickly so that people might think, okay, well, maybe that sonogram I should have a little bit earlier or just be on the lookout of things, what might be some high risk?

Well, so the family history is probably the biggest factor.

It is.

This is an adult show, right?

So when I get a young lady who has serious congenital heart disease and she turns, it depends on the mom, I think she turns 14.

She turns 16.

Certainly by the time she's 18.

I say, look, you need to recognize that you have congenital heart disease and your risk for having a baby with congenital heart disease is significantly increased.

It's six times the risk now.

The risk is one in 100.

So we're talking six and 100, but that's a 600% increase.

Oh, my goodness.

Right.

And she needs to go in to try.

And so even at 14.

Right.

And they always roll their eyes at me.

Mm.

And I say and I've also got some patients who I say you have to plan any pregnancies, you cannot just come onto the doorstep pregnant because some heart diseases really don't get along with pregnancies.

And we use a lot of medications that can also damage the fetus.

So in that case, when you say planning them that they should make sure that they're in good shape as they possibly can before they get pregnant so that they can carry the baby through the pregnancy because the mother themselves not at risk, but are having a hard time with the pregnancy.

The baby also is at risk of having.

The mothers can have problems.

I mean, a pregnancy requires a mother's heart to do so.

I saw climbing mountains all day long for nine months.

Yes, I, I remember.

So it's and unfortunately, there are situations where we might say you're probably need to adopt instead because we don't want to lose you.

Right.

Because guess what?

I know how much you want a baby, but you may not get that dream.

Yeah, and that those are the hard realities.

I know we have a whopping 3 minutes left.

Is there anything, Dr. Qureshi, that we want to talk about?

Yeah, or just quick.

You know what Dr. Schuster said when we talk about it?

Heart failure.

So in the babies, when you say we see like a congestive heart failure, which means like a simply leg and more blood is going to the lungs, so it's not the muscles in wall.

It so much more blood going to the lungs.

The babies have a hard time kind of breathing because the longest kind of flooded, you know, with blood.

So that is a thing we call a congestive congestion or congestive heart failure.

The other type of a heart failure you talk about is that muscle itself have a disease.

Are they?

It can be anything.

It can be a virus.

This can be some drugs like those who are on chemotherapies and all that They unfortunately can have.

You know, we need to kind of have a surveillance for them every year to check.

Right.

Make sure that your heart muscles are okay.

So one is the one is mainly like a more of a congestion, you know, to do the lungs.

And the other thing is that that the muscle itself do not have they are weak they cannot pump that and unfortunate sometimes you see like a teenager they come for like great you know, athletes and all that.

And all of a sudden you find out, hey, they have a different kind of a heart condition.

Some of them have a thick heart like it.

We call it hypertrophic.

Cardiomyopathy, thick heart.

That's something that they.

Are quite a bit right.

Here.

And then the big heart means like a big really to why we call it like enlarged heart.

So those are the thing.

Unfortunately, when you go and tell them, hey, you know, we don't now one third of them is going to get better, not completely.

One third of them is going to have a heart transplant and one third of them probably is not going to survive.

You know, So those are the unfortunate realities, you know, But, uh, well, this, this I would say that this is when we when we talk about, like in the rhythm of of a heart failure.

So those are the kind of little different things about that.

Well, I looking forward to both your talking about the future of how this is.

Again, research is great and everyone's in it to win it.

So thank you so much for being here.

Dr. Schuster.

It's always an absolute pleasure seeing you out and about and then having you here on the program.

And Dr. Qureshi, it was an absolute pleasure meeting you.

Thank you.

So if thanks again for watching.

This has been a pediatric cardiology a growing need in the borderland.

I'm Kathrin Berg and this has been the El Paso physician.

Hello, I'm Dr. Alison Days a past president of the El Paso County Medical Society, the El Paso County Medical Society is a nonprofit organization established in 1898 that unites physicians to elevate the health of the El Paso community.

We have been bringing the El Paso physician to your home for the last 27 years on PBS El Paso.

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