Echocardiogram- Cardiology, Neurology

Echocardiography, also known as cardiac ultrasonography, is an imaging test done to view the heart. The test allows your doctor to see the heart in real-time as it beats and pumps blood in order to assess its function and check for any diseases.

Indications

An echocardiogram is ordered when your cardiologist suspects that you might have a problem with your heart or one of the surrounding structures. These are some common scenarios where your doctor might order cardiac ultrasonography:

• If you’re having symptoms like leg swelling or shortness of breath, your doctor will want to see if your heart is pumping well
• If your cardiologist hears a murmur on their stethoscope while examining your heart, an echocardiogram can help them assess your valves
• After a heart attack, your doctor needs to check and see your heart’s function
• During pregnancy, fetal an echocardiogram can help detect cardiac malformations

Cardiac ultrasonography can help your doctor:

• Assess the pressures in your heart and lungs
• Observe the pericardial space (the sac surrounding your heart)
• Check if there are any blood clots in your heart
• Assess your large blood vessels and see how the blood is flowing
• Check if there is any narrowing or incompetence in your heart valves

Depending on the clinical scenario, several types of cardiac ultrasonography can be ordered. 

Types

Transthoracic echocardiography (TTE)

This is the simplest and most commonly performed type of cardiac ultrasonography. This imaging technique is not invasive and causes no pain.

You will be sleeping on your back and might be asked to sleep on your left side for part of the exam. After you take your shirt off, the technician will place the lubricated transducer (a handheld probe) on your chest and move it to various positions to view the heart from different angles. They will use the computer to take images and adjust the settings while passing over different regions of your chest. The test might take around 10-15 minutes to complete.

Transesophageal echocardiography (TEE)

Transesophageal echocardiography is a more invasive test, and it’s usually reserved for cases with a strong suspicion of heart disease, despite a normal transthoracic echocardiogram. The reason is that transesophageal echocardiography can allow the sonographer to better visualize some parts of the heart that might have been missed by TTE.

Before the procedure, a nurse will insert an IV line and give you a mild sedative. Your throat will be numbed by a special spray to suppress your gag reflex. The transducer -which is much smaller than the one used in TTE- will be advanced through your mouth and into your esophagus, until it is adjacent to the heart. The esophagus is the muscular tube that connects your mouth to your stomach, and it passes right next to the heart. The procedure usually takes 30-60 minutes to complete and you can get back to your normal life after the sedative wears off.

Stress echography

This test is done using the usual transthoracic echocardiography method, however, your heart is observed under stress in this special test to see how efficient it is. This means that transthoracic echocardiography is done after you do a brief exercise (less than 10 minutes), or after taking a special medication to increase your heart rate.

3D echocardiography

This is a technique that can be applied in either transesophageal or transthoracic echography. During this test, the computer uses an advanced image rendering technology to create a 3-dimensional (3-D) image of your heart. This method is particularly useful in diagnosis structural malformations in children and when planning cardiac surgery.

Fetal echocardiography

If the doctor suspects that the fetus may have a congenital heart problem, they might order a fetal echography to assess their cardiac function. During this test, a transducer is placed over the woman’s belly, and the doctor tries to find the baby’s heart. The test is considered harmless to both the baby and the mother since it emits no radiation at all.

Risks

Ultrasonography is by itself harmless. Unlike other forms of imaging like X-ray and computed tomography (CT), Ultrasonography emits no radiation and produces images using harmless sound waves.

Transthoracic echocardiography is a very safe procedure. You might experience some discomfort if the technician presses the probe over some regions to get a better image, but that’s the extent of it. If your doctor decides they want to give a contrast injection to enhance the image, there’s a rare chance you might experience an allergic reaction. If you have a history of contrast allergy, make sure you inform your physician before the test.

Transesophageal echocardiography is a relatively safe procedure, however, due to its invasive nature, there are some involved risks. Patients most commonly report a sore throat after the procedure. Since the test involves inserting a probe into the esophagus, there’s a slight chance that the esophagus may be scraped. In extremely rare instances, the esophagus may be perforated, which can lead to life-threatening complications.

Since stress echocardiography involves putting your heart under stress, it can precipitate a heart attack or an irregular heart rate if you are at risk. For this reason, this procedure is always supervised.

Preparing for an echocardiogram

There is usually no special preparation needed before getting an echocardiogram. If you are getting a transesophageal echocardiogram, you will probably be instructed to fast for a few hours before the test, to avoid vomiting when the probe is advanced into your mouth. If going in for stress echocardiography, you might want to wear some comfortable clothes suitable for exercise.

Results

After the test is finished, the images and video will be sent to a cardiologist for analysis, and a report is made out with all the findings. The findings usually relate to:

• Size: If your heart (or part of it) is enlarged, this may indicate problems like hypertension or cardiomyopathy.
• Valves: your valves may be too narrow, too wide, or are moving abnormally.
• Pumping strength: If your heart is not pumping with enough strength, this might indicate heart failure.
• Wall movements: The walls of your heart usually move in a synchronous predictable manner. If there’s asynchrony, this might indicate ischemic heart disease.
• Congenital defects: sometimes abnormal connections can exist between heart chambers, or the heart and large nearby blood vessels.

During the next follow-up, your doctor will take a look at the report to know if you have any heart problems.

If you happen to have a cardiac problem, your doctor might order further testing and will devise a proper treatment plan to suit your condition.

Sources:

• https://www.nhlbi.nih.gov/health-topics/echocardiography
• mayoclinic.com/health/echocardiogram/MY00095
• nhlbi.nih.gov/health/health-topics/topics/echo/types.html

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