Why Glenn Kessler is completely wrong about ultrasounds and fetal heart beats

There appears to be some confusion about ultrasounds and fetal heart beats.

Stacy Abrams, a Georgia Democrat politician kicked off the recent festivities by stating:

There is no such thing as a heartbeat at six weeks. It is a manufactured sound designed to convince people that men have the right to take control of a woman's body

Conservatives “pounced” on the statement, spurring an editor of the Washington Post, (and resident fact checker!) to defend Abrams’ statement by doubling down on the idea that a fetal heartbeat was manufactured. The ultrasound was apparently picking up electrical activity and converting it into sound. The fact checker did not comment on Abrams contention that the sound had been manufactured as part of a global conspiracy for men to take over women’s bodies.

I happen to be a cardiologist that spends a fair amount time doing cardiac ultrasounds on adult humans so I was more than a bit surprised to see this exchange take place. Ultrasound machines run on electricity, but they do not measure, detect or interact with electrical signals originating inside a person or fetus. They only detect reflected sound waves. We actually use electrocardiograms to pick up electrical activity from the heart.

It turns out that Stacey Abrams and Glenn Kessler are speaking in unison because they’re reading from a script provided by ‘experts’ with an agenda. The source Kessler links to for his statements features this NPR story sourced by doctors.

Dr. Nisha Verma, an OB-GYN who specializes in abortion care and works at the American College of Obstetricians and Gynecologists says:

When I use a stethoscope to listen to an [adult] patient's heart, the sound that I'm hearing is caused by the opening and closing of the cardiac valves…

At six weeks of gestation, those valves don't exist…The flickering that we're seeing on the ultrasound that early in the development of the pregnancy is actually electrical activity, and the sound that you 'hear' is actually manufactured by the ultrasound machine."

The article then proceeds to go on to explain why a recently passed Texas Abortion bill that disallows abortion providers from doing abortions after first detection of this fetal heartbeat is completely wrong and not science based. It’s pretty clearly one of those articles that goes hunting for the science to support one side of a contentious issue that has little to do with science. The larger issue of abortion is beyond the scope of what I spend my time doing professionally. I’m a cardiologist who can comment on what a cardiac ultrasound, or what cardiac Doppler is actually picking up, and I’m sorry to say that the experts Glenn Kessler and NPR are quoting are making a complete mess of things when talking about what cardiac ultrasounds do.

The history of cardiac ultrasound is one of the great successes of the modern era, and is entirely based on emitting a sound wave and capturing sound waves that bounce back. The electricity involved in this process is the electricity used to generate sound waves from piezoelectric crystals that sit in the ultrasound probe. The reflected sound waves are received into the piezoelectric crystal matrix, creating an electric signal that can then be processed to generate images and sounds. This process happens regardless of whether the heart has valves or not.

If an ultrasound device directed at the developing fetus hears something, it is because sound waves are being emitted and reflected back to the device. This video I found in approximately 0.2 seconds using google shows a modern day cardiac ultrasound that has an image on the screen that is entirely created by reflected sound waves. Notice how the sonographer identifies a structure beating in the womb, and then directs a Doppler line across that specific area of interest (the heart) to generate a “nice strong heartbeat”.

The probe being used here uses the same technology as a simple Doppler that’s available at babydoppler.com.

A sound wave is generated, and bounced back by the back and forth motion of blood in the heart. This doppler shift creates the rhythmic “spikes” seen in the video that corresponds to the beating heart moving blood.

Dr. Verma seems to be saying that any representation of the heart that can be ascertained by technology beyond a stethoscope isn’t a heartbeat. That assertion would be news to most cardiologists and seems logically difficult to defend. Do children born with valve defects that make their heart inaudible not have a heartbeat? If you can’t hear a heartbeat in a patient with severe emphysema because their diseased lungs insulate the heart, do they not have a heartbeat?

Progress in science allows for ever better ways to image the beating heart. Drawing some arbitrary line to make the stethoscope the arbiter of what constitutes a heartbeat is a pretty ridiculous contention.

Even before we can understand how the sounds or images of the heart that technology tracing back at least to the 1940s are produced, any debates about what exactly is beating in the uterus are best answered by embryology.

Twitter friend and radiologist Pradheep Shanker provides this helpful diagram found in countless embryology textbooks of the development of the heart in utero. By ~28 days, the fetal heart doesn’t look like the adult heart, but it certainly doesn’t look like a kidney. There are four chambers that beat, and that movement is moving blood through the heart.

Hand held cardiac Dopplers that anyone can buy from Amazon or babydoppler.com transmit a sound that is reflected back by blood that is moving back and forth. The more in line you can get the Doppler probe with the direction of blood flow, the louder the signal, and the louder the sound.

The sound is created in the sense that you can’t see or hear any of this without the assistance of technology. But it certainly isn’t fabricated.

When life begins is a much different topic and is much more complicated than the presence or absence of a heart beat. There are patients with severe cases of heart failure that have a heart that doesn’t beat, but are kept alive by an implanted ventricular pump (Ventricular Assist Devices) or a modified heart-lung bypass machine (ECMO) that replaces the function of the heart. Some of these individuals walk among us, and are indeed very much alive.

On the other hand, simply growing a clump of tissue in a Petri dish that beats and can be assessed visually with a microscope or by a cardiac ultrasound doesn’t make the clump of tissues ‘alive’.

But saying that a cardiac ultrasound is picking up electrical activity is a factually incorrect statement. A cardiology trainee making this statement would, or should, be laughed out of their training program.

Medical professionals have no business changing science to support social activism. I realize that it is inconvenient for abortion providers that a heartbeat is detectable early during a pregnancy, and that having a heartbeat has certain connotations that make the conversation around abortion difficult. But this deserves an adult conversation about these complex issues that acknowledge difficult realities. Changing the definition of a heartbeat, what a heart is, and misrepresenting the amazing technological advances that allow for the assessment of the heart to fit an agenda is unscientific and frankly, gross.

A willingness to change commonly accepted scientific understanding that is grounded in objective reality by scientists and doctors is an increasingly common disease that will succeed only in destroying the credibility of the scientific and medical professional class.

This story narrowly is about Washington Post fact checkers amplifying what amounts to medical activists with an agenda to create their own reality to support political activism that has nothing to do with science. But it is reflective of a much deeper problem of a system of activist-experts and their sympathetic media amplifiers using the mantle of science for political purposes.

Ultrasounds do not pick up electrical activity. They do not measure or detect electrical signals originating in persons or non-persons. Cardiologists have been using ultrasound technology to assess the beating heart since the 1940s, and the beating heart in-utero can be assessed before 10 weeks.

So, Glenn Kessler, editor and chief writer of the Washington Post is just plain wrong in every part of his clarification of Stacy Abrams’ statement. The lesson for journalists actually interested in truth, and preserving the credibility of the institutions they represent, is to seek out a much broader array of sources than the current activist class of experts they currently rely on.

They may actually learn something in the process.

Anish Koka is a cardiologist who specializes in cardiac ultrasound.