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Echocardiogram; Indications, Preparetion, Procedures

Echocardiogram is a test that uses ultrasound to evaluate your heart muscle and heart valves.An echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. It uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.It is one of the most widely used diagnostic tests in cardiology. The heart is a two-stage electrical pump that circulates blood throughout the body. The anatomy includes four chambers and four valves. For the heart to function normally these structures need to be intact and the heart muscle needs to beat in a coordinated fashion, so that blood flows in and out of each chamber in the proper direction.It can provide a wealth of helpful information, including the size and shape of the heart (internal chamber size quantification), pumping capacity, and the location and extent of any tissue damage. An echocardiogram can also give physicians other estimates of heart function, such as a calculation of the cardiac output, ejection fraction, and diastolic function (how well the heart relaxes).

Types of Echocardiogram

There are several types of echocardiograms

Transthoracic echocardiogram – This is the standard echocardiogram. It is a painless test similar to X-ray, but without the radiation. The procedure uses the same technology used to evaluate a baby’s healthbefore birth. A hand-held device called a transducer is placed on the chest and transmits high frequency sound waves (ultrasound). These sound waves bounce off the heart structures, producing images and sounds that can be used by the doctor to detect heart damage and disease.
Doppler echocardiogram – In addition to sound waves bouncing off the solid structures of the heart, they also bounce off the red blood cells as they circulate through the heart chambers. Using Doppler technology, the echocardiogram can assess the speed and direction of blood flow, helping increase the amount and quality of information available from the test. The computer can add color to help the doctor appreciate that information. Color flow Doppler is routinely added to all echocardiogram studies and is the same technology used in weather reports.
Transesophageal echocardiogram (TEE) – This test requires that the transducer be inserted down the throat into the esophagus (the swallowing tube that connects the mouth to the stomach). Because the esophagus is located close to the heart, clear images of the heart structures can be obtained without the interference of the lungs and chest.
Transoesophageal echocardiogram (TOE) – where a small probe is passed down the throat into your gullet and stomach (your throat will be numbed with local anaesthetic spray and you’ll be given a sedative to help you relax); you may need to avoid eating for several hours before this test
Stress echocardiogram – This is an echocardiogram that is performed while the person exercises on a treadmill or stationary bicycle. This test can be used to visualize the motion of the heart’s walls and pumping action when the heart is stressed. It may reveal a lack of blood flow that isn’t always apparent on other heart tests. The echocardiogram is performed just prior and just after the exercise.
Dobutamine stress echocardiogram – This is another form of stress echocardiogram. However, instead of exercising to stress the heart, the stress is obtained by giving a drug that stimulates the heart and makes it “think” it is exercising. The test is used to evaluate your heart and valve function when you are unable to exercise on a treadmill or stationary bike. It is also used to determine how well your heart tolerates activity and your likelihood of having coronary artery disease(blocked arteries), and evaluates the effectiveness of your cardiac treatment plan.
Intravascular ultrasound – This is an ultrasound performed during cardiac catheterization. During this procedure, the transducer is threaded into the heart blood vessels via a catheter in the groin. It is often used to provide detailed information about the atherosclerosis(blockage) inside the blood vessels.
A stress echocardiogram – an echocardiogram carried out during or just after a period of exercise on a treadmill or exercise bike, or after being given an injection of a medication that makes your heart work harder
A contrast echocardiogram – where a harmless substance called a contrast agent is injected into your bloodstream before an echocardiogram is carried out; this substance shows up clearly on the scan and can help create a better image of your heart.
Fetal echocardiography – Fetal echocardiography is used on expectant mothers sometime during weeks 18 to 22 of pregnancy. The transducer is placed over the woman’s belly to check for heart problems in the fetus. The test is considered safe for an unborn child because it doesn’t use radiation, unlike an X-ray.

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Indications/uses of Echocardiogram

Atherosclerosis – A gradual clogging of the arteries over many years by fatty materials and other substances in the blood stream that can lead to abnormalities in the wall motion or pumping function of your heart.
Cardiomyopathy – An enlargement of the heart due to thickening or weakening of the heart muscle
Congenital heart disease – Defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart).
Congestive heart failure – A condition in which the heart muscle has become weakened or stiff during heart relaxation to an extent that blood cannot be pumped efficiently, causing fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling) in the feet, ankles, and other parts of the body.
Aneurysm – A dilation of a part of the heart muscle or the aorta (the large artery that carries oxygenated blood out of the heart to the rest of the body), which may cause weakness of the tissue at the site of the aneurysm.
Valvular heart disease –Malfunction of one or more of the heart valves that may cause an abnormality of the blood flow within the heart. The valves can become narrowed and prevent blood from flowing through the heart or out to the lungs and body. The valves can also become leaky with blood flow leaking backwards. An echocardiogram can also determine if there is an infection of the heart valve tissue.
Cardiac tumor – A tumor of the heart that may occur on the outside surface of the heart, within one or more chambers of the heart (intracavitary), or within the muscle tissue (myocardium) of the heart.
Pericarditis – An inflammation or infection of the sac that surrounds the heart.
Pericardial effusion or tamponade – The sac around the heart can become filled with fluid, blood, infection, and this can compress the heart muscle causing symptoms of feeling dizzy, lightheaded, or a dangerous drop in blood pressure.
Atrial or septal wall defects – Irregular channels between the right and left sides of the heart may be present at birth, or may occur form trauma, or after a heart attack. These defects occur in the upper filling chambers (atria) or the lower pumping chambers (ventricles). This may cause heart failure or put you at risk for stroke if clots or debris in the blood stream pass through these openings or defects.
Shunts – Shunts can be seen in atrial and ventricular septal defects but also when irregular blood flow is pushed through the circulation from the lungs and liver.
Heart valve disorders – Stenosis (narrowed), insufficiency or regurgitation (leaking), and endocarditis(infection of the valves)
Abnormalities of the septum – Atrial septal defect, ventricular septal defect, and patent foramen ovale
Wall motion abnormalities – Cardiomyopathy, atherosclerotic heart disease (also known as coronary artery disease), and trauma
Diseases of the pericardium (the sac that lines the heart) – This includes pericardial effusion(assessment of fluid in the pericardial sac)
Damage from a heart attack – where the supply of blood to the heart was suddenly blocked
Heart failure – where the heart fails to pump enough blood around the body at the right pressure
Congenital heart disease – birth defects that affect the normal workings of the heart
Problems with the heart valves – problems affecting the valves that control the flow of blood within the heart
Cardiomyopathy – where the heart walls become thickened or enlarged
Endocarditis – an infection of the heart valves
The size of your heart – An enlarged heart might be the result of high blood pressure, leaky heart valves, or heart failure. Echo also can detect increased thickness of the ventricles (the heart’s lower chambers). Increased thickness may be due to high blood pressure, heart valve disease, or congenital heart defects.
Heart muscles that are weak and aren’t pumping well – Damage from a heart attack may cause weak areas of heart muscle. Weakening also might mean that the area isn’t getting enough blood supply, a sign of coronary heart disease.
Heart valve problems – Echo can show whether any of your heart valves don’t open normally or close tightly.
Problems with your heart’s structure – Echo can detect congenital heart defects, such as holes in the heart. Congenital heart defects are structural problems present at birth. Infants and children may have echo to detect these heart defects.
Blood clots or tumors – If you’ve had a stroke, you may have echo to check for blood clots or tumors that could have caused the stroke.

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Preparing for the test of Echocardiogram

You may eat and drink as you normally would on the day of the echocardiogram test.
Take all of your regular medications the morning of the test.
Wear two-piece clothing and remove all jewelry from around your neck.
Allow approximately 45 minutes for the appointment.
You will need to change into an exam cape to wear during the procedure.

Procedures of Echocardiogram

Before the test, the healthcare provider will explain the procedure in detail, including possible complications and side effects. You will have the opportunity to ask questions.
Your test will take place in the Echo Lab located at J1-5. The testing area is supervised by a physician.
You will be given a hospital gown to wear. You’ll be asked to remove your clothing from the waist up.
A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph (EKG) monitor that charts your heart’s electrical activity during the test.
The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. This gel helps produce clearer pictures.
Sounds are part of the Doppler signal. You may or may not hear the sounds during the test.
You may be asked to change positions several times during the exam so the sonographer can take pictures of different areas of the heart. You may also be asked to hold your breath at times.

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Results of Echocardiogram

Your doctor will look for healthy heart valves and chambers, as well as normal heartbeats. Information from the echocardiogram may show:

Heart size – Weakened or damaged heart valves, high blood pressure, or other diseases can cause the chambers of your heart to enlarge or the walls of your heart to be abnormally thickened. Your doctor can use an echocardiogram to evaluate the need for treatment or monitor treatment effectiveness.
Pumping strength – An echocardiogram can help your doctor determine your heart’s pumping strength. Specific measurements may include the percentage of blood that’s pumped out of a filled ventricle with each heartbeat (ejection fraction) or the volume of blood pumped by the heart in one minute (cardiac output). If your heart isn’t pumping enough blood to meet your body’s needs, this could result in heart failure.
Damage to the heart muscle – During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
Valve problems – An echocardiogram shows how your heart valves move as your heart beats. Your doctor can determine if the valves open wide enough for adequate blood flow or close fully to prevent blood leakage.
Heart defects – Many heart defects can be detected with an echocardiogram, including problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth. Echocardiograms can even be used to monitor a baby’s heart development before birth.