Michelle Rupp: Hello and welcome to this week’s edition of AFMC TV. We’re glad you’re joining us. You know, February is National Heart Month and we are going to start celebrating just a tad bit early this year. Today on the show, we have joining us, is Doctor Brian Eble from UAMS. He is a pediatric cardiologist and that is what we are focusing on today. Doctor Eble, thank you so much for coming in. So pediatric cardiology. All right. Do your patients come to you after birth? Uh do you have patients that are still in the womb when something is detected? What what’s your area?
Dr. Brian Eble: So we take care of kids that have heart problems um from the time they’re diagnosed until they’re doing great. Um And that may include babies that are that have not been born yet. Um There are some heart problems that we can detect um before a baby is born. One of the most common would be if half of the heart didn’t develop. So instead of two pumping chambers, they only have one. Um that is very likely to be picked up on a routine ultrasound. Uh and that may be a very compelling reason for the O. B. That’s taking care of that mom to refer that baby to a pediatric cardiologist even before the baby is born. Um We may not diagnose a baby with a heart problem until after they’re born. It may be that their oxygen levels are lower than normal, they may fail their newborn baby screen before they go home from the nursery, or they may um see a pediatrician or a family practice doctor at some point uh after they’re born. And their doctor may hear a heart murmur that may be a noise made by blood flowing through the heart. That may be how they get plugged in and see a pediatric cardiologist like me and get diagnosed with a heart problem. Um and we will take care of uh kids and babies and even adults that are born with heart problems. Um we even at children’s hospital we still see 30 and 40 and even 50 year old’s with heart problems that they were born with that we have become experts in because of our training, but we can’t refer them to an adult cardiologist because they haven’t been trained and some heart problems that kids can be born with. So we may even take care of 50 and 60 year old’s at Children’s hospital.
MR: Because you’ve got that history too. I mean, you’ve been with them their entire journey and you guys have all kind of learned together too. I wonder. And in some respects, you did kind of answer this. But when is it appropriate for a child to see a cardiologist? And I’m and I’m thinking more of once a child has seen a pediatrician. Um when do they get passed to you if it’s necessary.
BE: And so one of our jobs at Children’s Hospital is to train pediatricians that have finished medical school or are still in the process of medical school and are learning how to practice general pediatrics. And as cardiologists we get to train them what we think they should know in order to practice general pediatrics well. So what I try to train the pediatricians that that train with me are if there’s something that they’re worried about one of their patients, hearts that they feel like is probably ok, they hear a murmur but they think it’s a normal murmur. Um As long as their kid is doing ok. I’m ok with them continuing to follow that patient. But if they see something that they’re not confident is normal or benign, then I want an opportunity to evaluate that patient and that maybe I listen to them with my stethoscope because of my training and experience I feel better calling that a normal murmur and they don’t need any further evaluation. It may be that I know for sure that’s not a normal murmur and we need further evaluation, like an ultrasound of the heart, an echocardiogram. Um But we that’s why you would refer somebody here because we have the resources to do that diagnostic evaluation. Um If God forbid somebody goes to ground on a sports field, if somebody is playing football and passes out um and gets resuscitated or something like that, I need an opportunity to evaluate that patient. and see if that was some random thing that’s very unlikely to happen again. And we don’t need to do anything special or if there’s some underlying heart problem that we need to think of differently and may need to restrict them from playing sports anymore. Or we mean we may need to implant a defibrillator that can shock them if their heart goes into a different rhythm.
MR: Are you on the heart muscle side or are you on the electrical side? Are you a plumber or are you an electrician?
BE: I am I am more of a plumber than an electrician, but all of us have to be at least somewhat competent at both. I take care of kids that are recovering from heart surgery in the cardiac intensive care unit and so we have two electricians that are pediatric electrophysiologists. If there’s something very complex, then I usually ask their opinion. But if it’s an electrical problem that’s straightforward that I know how to take care of and I’ve seen before, then I usually can manage that on my own. Plumbing problems are my wheelhouse. So um I used to do heart caths in kids a lot, we now have a group of younger cat doctors that do that. And so we can run catheters up inside kids hearts and understand their plumbing. I spend a lot of time reading ultrasounds of the harder echocardiograms. We can get a lot of information without sticking anything through your skin simply by doing an ultrasound of a kid’s heart, understanding how their heart is formed how well their heart muscle is squeezing and how all of the valves inside their heart are working. And so I do more plumbing than electricity, but all of us do at least a little of both.
MR: And for those not familiar, a plumber, heart in this instance, works on the heart muscle, whereas the electrician is more on the electrical side of the heart, just just in case people are thinking, wait a minute plumbing, what is he talking about? Is there anything such as a typical pediatric cardiology issue? That might be something that is seen more frequently. Or are each individual cases anomaly themselves?
BE: Yes and yes, both of those are true. Um The most common heart problems that we see in kids are holes in the heart that most commonly let red blood from the left side of the heart that’s full of oxygen go across that hole into the right side of the heart. Small holes almost never cause problems. Big holes can cause way too much blood. Go to go to the uh lungs. And that may make you breathe hard, have a hard time growing, have a hard time gaining weight as a baby. Um We also see um kids that have obstruction to blood flow. So there’s narrowing either of blue blood getting out of the right side of the heart, or red blood getting out of the left side of the heart. There may be narrowing or obstruction to one of the valves that opens up and lets blood get through the heart. Um and then the most severe form of heart problems that we take care of are where one part of the heart didn’t grow or develop at all. So you may be born with one pumping chamber instead of normal too. Um So there’s lots of variation. I almost never see the same exact disease twice in one day’s worth of clinic. Um But those are the most common problems where there’s a hole inside the heart or there’s a blockage of blood flow. Or one part of the heart didn’t grow and develop normally. One of the mantras of pediatric cardiology is no flow, no grow. So if uh in utero before you’re born, if one of your valves doesn’t open up correctly, then the chamber upstream and the chamber downstream will very often not grow normally.
MR: Ok, let me ask you what drew you to pediatric cardiology.
BE: So I thought I wanted to be an engineer. Engineering made sense. You already brought up plumbing and electricity and I loved math and science and physics, and that kind of stuff made sense to me. And so I thought I wanted to be a chemical engineer. And then in college I met a lot of premed people and I’m like, I I actually like the way these guys think, and I like hanging out with them, Maybe I need to think about medicine. Um And my wife will tell you, first of all, I’m very immature. I’ve always been drawn to kids much more so than old people. uh in their thirties and forties. Um uh that’s not old anymore, but it used to be uh it used to be old. Um and so I’ve always been drawn to kids. Um I really liked internal medicine. I liked the physiology and the plumbing and the electricity behind it, but I found myself drawn towards the little kids. And then I found pediatric cardiology, it’s the physiology, it’s the plumbing the electricity. That makes sense to me. God made my brain to think like that. So that’s the part that makes sense to me. But it’s in kids, it’s they’re fun and you get to play with them and be goofy with them and they love that. Um And kids are resilient and robust and if you can get them over an illness, they almost always get better. And that was one of the depressing things that I found personally about taking care of older people um is that they don’t always get better.
MR: That will that determination to keep fighting sometimes wanes the older people get. So, my last question is, I want to know more about this pediatric exercise lab over at Children’s hospital. What is that?
BE: So, the pediatric exercise lab at Children’s Hospital is a place where we can measure how your heart and your lungs respond to exercise. So we have a treadmill and an exercise bike. What we do is it’s completely unfair, but we put a clip on your nose.
MR: As a runner. Why are you doing that?
BE: Because we’re evil. Uh that’s the only possible explanation. Um and then we have you breathe through your mouth and we collect the air that you’re breathing in and the air that you’re blowing out. Um and then we either make the treadmill faster and steeper or we make the um breaking of the bicycle harder. And so everybody fails an exercise test, you cannot win against the machine. We make it harder and harder and harder until you can’t go anymore. What we learn from that is how much oxygen you can burn when you exercise is a very good measure of how much blood and oxygen your heart pumped to your exercising muscles. And as a pediatric cardiologist, I care a lot. how efficiently your heart is working and pumping blood and oxygen to your muscles. We measure how much carbon dioxide you produce as your muscles are burning that oxygen and burning uh fat and sugar into energy so that you can contract and relax those muscles. Um We can see if you have exercise induced asthma. We can measure your lung function before and after. We can see if you were born with a heart problem, Um we can do an exercise test and then do a therapy either heart surgery and see if your exercise test gets better or we can try a medicine and see if your exercise test gets better. Um So all of those things we can safely and noninvasively measuring kids. The other things we can do is if you’re a 16 year old and we think your heart is normal, but you have chest pain every time you go run cross country, we can evaluate your heart and make sure that you’re not having some very rare coronary problem of where there’s a problem with the way your heart is pumping oxygen rich blood back to the heart muscle to keep it safe. Um So we can measure all of those things in the exercise lab. So I like it’s it’s plumbing at its finest. It’s watching a kid increase the amount of blood their heart is pumping so that their muscles can work as efficiently as possible and measuring all of that in a really intriguing and scientific way. I love exercise physiology.
MR: That sounds fascinating. And and along those lines, is there any um cardiac rehab available to Children? We hear about cardiac rehab for adults. Uh any anything for for kids?
BE: Unfortunately not. Not in a satisfying savvy way. We we are able to do cardiac rehabilitation, but it’s on a case by case basis and we don’t have enough kids to have a formal exercise rehabilitation program. The kids that have significant enough heart failure that they would benefit from a rehabilitation program almost always have to stay in the hospital waiting on a heart transplant. We’re actually getting more savvy about using artificial hearts or ventricular assist devices in kids. And over the course of my career, we’ve actually seen a miniaturization, it used to be that the only artificial hearts were adult sized, so you had to be a teenager. Now they’re actually making it in baby sizes. But fortunately heart failure in kids is rare enough. that we don’t see it so often we already have a program that we can get you plugged into. So if you are waiting if you have heart failure and you’re waiting on a heart transplant in the hospital or you’ve had an artificial heart plugged in. We use our physical therapists, Children’s, our occupational therapists, child life uh experts uh to try to get you as rehabilitated as you can. But it’s not as formal of a process as cardiac rehabilitation. Say at an adult heart hospital.
MR: Dr. Ebel how do we find you if people have questions they want to look you up online. How what’s the best website where can we direct you?
BE: Absolutely. So Arkansas Children’s hospital. Uh, my email address is [email protected]. Or you can get to me through Arkansas Children’s Hospital.
MR: Fantastic. Thank you so much for coming in.
BE: It was my pleasure. Very nice to meet you.
MR: Very nice to meet you as well. And thank you for joining us. We’ll see you back here next week for more AFMC TV.