Preventive Cardiology
Nationally ranked by U.S. News & World Report
The Preventive Cardiology program at Children’s Mercy was established by Dr. Geetha Raghuveer, and is a part of the Ward Family Heart Center. This program is designed to benefit children who are at an increased risk for early cardiovascular disease (heart attack or stroke), due to abnormal lipid or cholesterol levels and/or a significant family history. Our treatment approach aims to modify lifestyle habits prior to starting medications.
Your preventive cardiology care team
Cardiologist
Our cardiologist or nurse practitioner will review your family history, including a focus on early cardiovascular disease (heart attack or stroke before the age of 50 years) and your child’s health history. They will also perform a physical assessment, including feeling pulses over wrists and feet, and listening to heart and lung sounds. They will then review your child’s lab results for this visit compared to their previous lab results, if any.
Providers you may see include: Geetha Raghuveer, MD, Natalie M. Jayaram, MD, Jonathan B. Wagner, DO and Jenny Ecord, APRN (Wichita, Kan. location),
Nurse coordinator
Our nurse coordinator is who you will likely have the most contact with throughout. The nurse coordinator will work with you to schedule your appointments (new and follow-up), as well as providing orders for new and follow-up lab draws. During your appointment, the nurse coordinator will ensure all appropriate labs and paperwork have been completed, review what to expect during your appointment, and coordinate the sequence of your visit with a nutritionist, exercise physiologist, cardiologist, and imaging to minimize your wait time. At the end of the visit, she will schedule future appointments as needed.
Nutritionist
Our nutritionist will discuss the importance of a heart healthy diet, your child’s lab values and how various foods will affect these labs. They will obtain a dietary recall of a typical day for your child. They will review what types of foods your child likes, identifying proteins, vegetables and starches, good fats versus bad fats, and appropriate portion sizes. The nutritionist will work with you and your child to set a goal to improve your child’s diet quality.
Exercise Physiologist
Our exercise physiologist will discuss the importance of physical activity and exercise. The exercise physiologist will discuss your child’s lab values and the effects physical activity has in improving good cholesterol (HDL) and triglyceride levels. They will also guide you and your child through a detailed physical activity recall, identify sedentary habits, and work with you and your child on setting a goal to reach a physical activity level that will decrease your child’s risk for developing a chronic disease. Our exercise physiologist will also review your child’s weight status using measurements such as Body Mass Index (BMI) and waist circumference.
Improving cardiology care
To help advance the practice of pediatric preventative cardiology, our team actively participates in research.
What to expect during your visit
At least one week before your appointment, your child will have labs drawn, in order for the results to be available for review during the appointment.
During your visit, you will meet with members of our team, including a cardiologist/nurse practitioner, a nutritionist, and an exercise physiologist. These team members will work with you and your child to develop a customized plan of care.
After the age of 10 years, your child may also have imaging done during the visit. This can include an echocardiogram, a neck (carotid) scan, and a pulse wave velocity exam.
A typical visit can last up to 2 hours.
The following tests or imaging may be done at your appointment
Echocardiogram (ECHO)
An echo is an ultrasound of the heart using high-pitched sound waves sent through a transducer. This test looks at the size and function of the heart.
The Left Ventricular Mass Index is a measurement of the heart’s main pumping chamber. Enlargement and thickening of the walls of the left ventricle can be caused by the heart having to work too hard to pump blood to the rest of the body.
Carotid Artery Intima-Media Thickness (CIMT)
A neck (carotid) scan is an ultrasound of the carotid arteries. This scan assesses the thickness of the artery walls. Arteries may become thicker with high cholesterol and triglyceride levels causing plaque build-up.
Pulse Wave Velocity (PWV)
A Pulse Wave Velocity test measures the stiffness of the arteries. This test is done using a blood pressure cuff and a small sensor on the neck to measure the time it takes for a pulse wave to travel between the carotid artery (in the neck) and femoral artery (in the leg).
Step Test
The Step Test is performed to estimate cardiovascular fitness. The test consists of stepping up and down a 6-inch aerobic step for 3 minutes at a fixed pace. Heart rate is measured at baseline, at completion of test, and at one-minute intervals for five minutes post-test. Cardiovascular fitness will be determined by measuring the change in heart rate during testing and the speed with which the heart rate recovers after testing.
LDL (Low-Density Lipoprotein)
Also known as “bad” cholesterol. LDL causes build-up on the blood vessel walls. It is good to have LOW LDL.
HDL (High-Density Lipoprotein)
Also known as “good” cholesterol. HDL prevents build-up on the blood vessel walls. It is good to have HIGH HDL.
Triglycerides
Can be made in the body from eating more carbohydrates (starches and sugars) than your body needs. It is good to have low Triglycerides.
Hemoglobin A1c
Measures the average sugar present in blood from food digested over a 3 month period.
AST (Aspartate Aminotransferase)/ALT (Alanine Aminotransferase)
These can be elevated with obesity, and can lead to liver disease.
Vitamin D
A vitamin that is needed for bone and teeth formation. A low Vitamin D is linked to heart disease and diabetes. You can get Vitamin D from some foods and sunlight.
TSH (Thyroid Stimulating Hormone)
When this level is high, your body is producing too little thyroid hormone, which can lead to increased appetite and weight gain and; also high lipid levels.
Lipoprotein A
An inherited lipid that can cause early build up on the blood vessel walls and premature heart disease.
For health care providers:
Please note:
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A significant family history, without elevated lab values, should be referred to the General Cardiology clinic for initial evaluation.
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Obesity/increasing body weight, without elevated lab values, does not qualify a patient to be seen in the Preventive Cardiology Clinic. If this is the primary concern, please consider referrals to our Nutrition or Weight Management clinics.