Congenital Heart Defects Detective
The device is thinner than a flash drive, elegantly streamlined and slanted at the edges like the latest smart phones. Cardiologist Margaret Bell Fischer, MD, holds the tiny steel implantable loop recorder between her thumb and forefinger as she explains the many ways this wireless device, inserted under the skin in a brief, one-suture procedure, provides important clues for her patients.
Clues are pivotal for Dr. Fischer, a cardiac electrophysiologist who treats pediatric and adult cardiac patients and specializes in the relatively new and growing population of adults with congenital heart defects. “Thanks to improved interventions, more and more children born with heart defects are surviving into adulthood,” she says. “We just are learning all the ways the conditions evolve. But since they were so small when their condition was discovered, the patients often don’t even know what their diagnosis was or how it was treated.”
According to the Centers for Disease Control and Prevention, there is currently no tracking system for older children and adults who started life with heart defects. While there are more than 40 known types of congenital heart defects, according to the Children’s Heart Foundation, there are also dozens that are unique. The difficulty for the older children or adults, says Dr. Fischer, is “that it was the parent who managed the medical interventions.”
The lucky ones, she adds, can bring the parents with them to appointments. Otherwise, “it becomes detective work, and old records often come on microfiche. We combine that with imaging and monitoring to determine what work was done.”
Not many cardiologists can bridge both pediatric and adult cardiac arenas, and very few have Dr. Fischer’s unique background. After graduating from the University of Toledo College of Medicine, she spent nine years in post-graduate training and fellowships that ranged from an internal medicine/pediatric residency to pediatric cardiology and then a combined pediatric and adult electrophysiology program. “I don’t know that many other physicians want to do that much training,” she says.
The breadth gives her unique skills for treating patients, including a 34-year-old who was born with transposition of the great arteries. He had a surgical atrial baffle reroute as a child, but his adult lifestyle led to sustained atrial fibrillation and irreversible muscle damage. “We were able to treat it with a defibrillator,” she says.
As the population of adults with congenital defects grows, Dr. Fischer is optimistic that there will be more expertise to share with other cardiologists.
The American Board of Internal Medicine is setting up the first board certification on adult congenital heart disease this year. In the meantime, physicians are com- ing to realize Dr. Fischer’s expertise. “The best part is offering these people help,” she says. “If you have a patient with a history of a hole in the heart and suddenly they feel it racing, take it seriously.”