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In which cases is an echocardiogram necessary, what are its types, and how is it performed? We shall address these questions in this article.
What is Echocardiography
Echocardiography is a method that uses ultrasound to obtain images of the heart, cardiac valves, and major blood vessels. It is an important diagnostic test because it provides a moving image of the heart. Using ultrasound, echocardiography gives information about the heart's shape, size, function, rhythm, the movement and thickness of its walls, and the condition of the pericardium (pericardial sac) and the functioning of the valves. Furthermore, it can provide information about the pulmonary circulation and its pressure, the initial section of the aorta, and can detect if there is fluid around the heart (pericardial effusion). Echocardiography is useful for obtaining information about heart function both at rest and after physical exertion or the administration of medication (Stress EchoCG). Thanks to the use of ultrasound, echocardiography is a type of examination that does not expose the patient to radiation (unlike X-rays, CT, etc.). Therefore, there are no absolute contraindications for this type of diagnosis.
Echocardiography images can be obtained in different modes:
• M-mode or one-dimensional mode: In this case, a narrow part of the heart is shown.
• Two-dimensional or 2D: Offers an image of the heart's anatomy (allows viewing of various structures) during movement.
• Color Doppler: Allows visualization of blood flow within the heart and arteries and measurement of its velocity.
• 3D: The images obtained have a three-dimensional representation. It is created from multiple two-dimensional images.
• There are also other informative echocardiography modes: Pulsed Doppler, Continuous Wave Doppler, etc.
The most frequently used method is two-dimensional echo.
Indications for Cardiac Ultrasound
The most common indications for cardiac ultrasound are:
• Angina pectoris
• Cardiac arrhythmias
• Congenital heart defect
• Valvular heart disease
• Acute myocardial infarction
• Heart failure
• Arterial hypertension
• Pericardial diseases
• Endocarditis
• Suspicion of thromboembolism
• Suspicion of tumor formation
Diagnostic Application of Echocardiography
Let's look closer at the main diagnostic applications of cardiac ultrasound.
Coronary Artery Disease (Ischemic Heart Disease)
This is a pathological condition characterized by damage to the heart muscle due to impaired blood flow (ischemia). Blood transport to the heart occurs via the coronary arteries, and if their lumen narrows due to atherosclerosis, ischemia develops with the appearance of characteristic symptoms. In these cases, echocardiography is useful because it allows for the detection of altered muscle function during the contraction and relaxation cycle.
Valvular Pathologies
Heart valve defects are diseases caused by structural abnormalities or functional impairments of the heart valves. Valves are anatomical structures that serve to ensure the movement of blood through the heart chambers in only one direction. During the cardiac cycle, the valves play a fundamental role in coordinating and ensuring the unidirectional flow of blood passing through the heart. For the diagnosis of ventricular function, ultrasound reveals its maximum analytical potential.
Cardiomyopathies
Cardiomyopathy is a general term used to describe pathologies that primarily affect the heart muscle, causing a reduction in its ability to contract and relax. In this case too, echocardiography plays a fundamental and indispensable role in both diagnosis and dynamic patient management.
Cardiomyopathies are divided into three main types:
• Dilated (most common): In this case, the left ventricle dilates and cannot pump blood throughout the body as effectively as a healthy heart.
• Hypertrophic: The heart has thickened walls and small heart chambers.
• Restrictive (rarest type): The walls of the heart chambers become stiff, which impairs relaxation after contraction, and this prevents the heart from completing its cycle.
Aortic Pathologies
Thoracic aortic aneurysms represent an abnormal dilation of the aorta above the diaphragm. Echocardiography is crucial in the diagnosis of dissecting aneurysm and is used to establish its exact dimensions. It is also indispensable in the diagnosis of congenital heart defects, the detection of cardiac masses, and pericardial pathology.
Types of Echocardiography
There are various ways to perform an ultrasound examination. Let's look at the characteristics of each one.
Transthoracic Echocardiography (TTE)
This is the most frequently used type. To visualize the heart, the transducer is placed on the patient's chest, usually on the left side.
Transesophageal Echocardiography (TEE)
It involves visualizing the heart using a transducer connected to a probe or tube that is inserted through the mouth into the esophagus, from where images of the heart can be obtained. Consequently, it is an invasive method. It is usually a supplementary examination to TTE, which provides similar but more detailed information about certain structures, such as the cardiac valves. Furthermore, it helps rule out the presence of thrombi (clots), tumors, or congenital heart defects that cannot be fully detected by transthoracic echocardiography.
• No food or liquids should be consumed for 4-6 hours before the transesophageal ultrasound. No oral medications should be taken during this period either.
• It is preferable for the patient to be accompanied by a family member or friend, as a sedative sometimes needs to be administered for the test.
• If the patient has removable dentures, they must be removed during the examination.
• The duration of the examination is 45-60 minutes.
• The patient should not eat any food for approximately 2 hours afterward. It is also not advisable to drive for 2-4 hours after the examination if a sedative was administered intravenously.
• Elderly patients must be accompanied for the following 2-4 hours.
Stress Echocardiography
It involves visualizing the heart using EchoCG under conditions of physical or pharmacological stress. Solid food should not be consumed for 2 hours before the examination. The doctor who recommends this examination will inform the patient whether they should take their regular medication or if its intake needs to be suspended. After a stress EchoCG, one can return to daily activities immediately.
Pharmacological Stress Echocardiography
It involves visualizing the heart using ultrasound while administering a drug that makes the heart work faster and harder. It is a non-invasive test combining the use of transthoracic echocardiography with the administration of a medication. Dobutamine is typically used. It increases the heart rate and the force of heart contraction (among other effects). Thus, this test can stimulate the heart and show how it works during effort (when we move or exercise). Images will first be obtained when the heart is at rest and then after the drug is administered. The goal of this examination is to find out if there are changes in the contraction of the heart walls, which are, in most cases, secondary to coronary artery disease.
Pharmacological EchoCG is indicated for:
• Patients who had a stress test with suspicion of coronary artery disease and the result was inconclusive.
• Patients who have already had a heart attack and for whom risk assessment is desirable.
• Patients with already known coronary artery lesions who need to determine how these lesions affect heart function before their treatment.
The patient should not consume solid food for several hours before the examination. As a rule, if the patient is taking beta-blockers, their intake must be suspended 1-3 days before the examination. But in any situation, it is important to follow the recommendations of the attending physician. Unless the doctor advises otherwise, you can return to work or household chores immediately after the examination.
Contrast Echocardiography
In this case, conventional echocardiography is used, but first, a special contrast agent is introduced through a vein, allowing for a significantly better view of the heart structures and blood vessels. This requires no special preparation.
How Cardiac Ultrasound is Performed
If it is the classic, transthoracic EchoCG, conductive gel is applied either to the patient's chest or directly to the transducer. The cardiologist will move the transducer over the patient's chest to obtain various images. The patient lies down during the procedure and remains as calm as possible. The echocardiogram is painless and does not cause any side effects. The examination usually lasts 15 to 30 minutes.
Transesophageal Echocardiography
Before the procedure, a nurse may give the patient a lozenge or an anesthetic spray for the throat. When the patient lies on the couch with their chest exposed, electrode stickers will be placed on them to monitor the electrocardiogram during the examination. The nurse may also administer a sedative medication into a vein. Then, the cardiologist will place the tube in the patient's mouth and ask them to swallow before inserting it into the esophagus, which may cause some nausea that will pass once the tube is inside. The examination will then be performed, during which, if a sedative was administered, the patient will be so relaxed that they may even fall asleep. Afterward, slight dizziness is possible. The throat anesthetic may cause a cough. Moreover, when removing the probe, it is recommended to cough to remove accumulated sputum.
Stress EchoCG
Electrodes will be placed on the patient's chest to monitor the electrocardiogram, and a cuff on the arm to measure arterial blood pressure. The patient will then step onto a treadmill or stationary bike, where they will walk for a few minutes. Afterward, they will need to return to a supine position. The cardiologist will take recordings on the echocardiograph before performing the exercise, during its performance, and immediately after its completion. During the examination, chest pain, fatigue, or discomfort may appear, which disappear afterward. Any such sensations must be reported to the doctor. The approximate duration of the examination is 30-60 minutes.
Pharmacological Stress Ultrasound
In this case, an intravenous drip will be set up for the patient. Then, electrodes will be placed on the chest to monitor the electrocardiogram during the examination. Additionally, cuffs will be placed to measure arterial blood pressure. The test consists of four phases: when the heart is at rest, at low and high doses of the medication, and the recovery phase. Once normal echocardiography images are obtained (at rest, without the drug), several echocardiographic recordings will be made during the administration of the drug. Facial tingling, facial flushing (heat), headache, tremor, dizziness, nausea, palpitations (which are almost always present due to the increase in heart rate), fatigue, or chest pain for a few seconds are possible. Any discomfort or symptoms should be reported to the doctor. The approximate duration of the examination is 45 minutes.
Contrast Echocardiography
The patient will have electrodes placed to monitor the ECG during the examination. Then, while the nurse administers several contrast injections into a vein, the transducer will be placed on different parts of the chest to examine the heart and valves from different planes. The injection is usually unnoticeable, so do not hesitate to report any strange sensations. Some noise corresponding to the speed of blood movement inside the heart may be heard during the examination. After the examination is complete, the nurse will apply a bandage or adhesive plaster to the injection site. The approximate duration of the examination is 30-60 minutes.
Advantages of Cardiac Ultrasound at Expert Clinics
Expert Clinics uses the latest diagnostic equipment that provides accurate results. The clinic also employs doctors with expertise in anti-aging medicine. After making a diagnosis, they will work diligently not only to eliminate the symptoms but also to find the root cause of the "malfunction" in the body. Methods for correcting various pathologies are selected strictly personalized but are always maximally effective.
Brief Conclusions
• Cardiac Ultrasound is an important diagnostic tool for determining the state of the heart and its functions.
• Echocardiography uses ultrasound waves to obtain images of the heart muscle, valves, and blood vessels.
• Cardiac ultrasound is useful for evaluating heart function at rest and after physical exertion.
• The absence of contraindications for ultrasound makes it a safe and widely used diagnostic method.
• Various modes of cardiac ultrasound allow for obtaining information about all aspects of heart function.
• Indications for cardiac ultrasound include angina, arrhythmias, congenital heart defects, valvular diseases, myocardial infarction, heart failure, and arterial hypertension, and so on.
Expert Clinics uses the latest technology and employs doctors with experience in anti-aging medicine, allowing them to conduct accurate, personalized diagnostics and prescribe optimal treatment that yields rapid results.
What is Echocardiography
Echocardiography is a method that uses ultrasound to obtain images of the heart, cardiac valves, and major blood vessels. It is an important diagnostic test because it provides a moving image of the heart. Using ultrasound, echocardiography gives information about the heart's shape, size, function, rhythm, the movement and thickness of its walls, and the condition of the pericardium (pericardial sac) and the functioning of the valves. Furthermore, it can provide information about the pulmonary circulation and its pressure, the initial section of the aorta, and can detect if there is fluid around the heart (pericardial effusion). Echocardiography is useful for obtaining information about heart function both at rest and after physical exertion or the administration of medication (Stress EchoCG). Thanks to the use of ultrasound, echocardiography is a type of examination that does not expose the patient to radiation (unlike X-rays, CT, etc.). Therefore, there are no absolute contraindications for this type of diagnosis.
Echocardiography images can be obtained in different modes:
• M-mode or one-dimensional mode: In this case, a narrow part of the heart is shown.
• Two-dimensional or 2D: Offers an image of the heart's anatomy (allows viewing of various structures) during movement.
• Color Doppler: Allows visualization of blood flow within the heart and arteries and measurement of its velocity.
• 3D: The images obtained have a three-dimensional representation. It is created from multiple two-dimensional images.
• There are also other informative echocardiography modes: Pulsed Doppler, Continuous Wave Doppler, etc.
The most frequently used method is two-dimensional echo.
Indications for Cardiac Ultrasound
The most common indications for cardiac ultrasound are:
• Angina pectoris
• Cardiac arrhythmias
• Congenital heart defect
• Valvular heart disease
• Acute myocardial infarction
• Heart failure
• Arterial hypertension
• Pericardial diseases
• Endocarditis
• Suspicion of thromboembolism
• Suspicion of tumor formation
Diagnostic Application of Echocardiography
Let's look closer at the main diagnostic applications of cardiac ultrasound.
Coronary Artery Disease (Ischemic Heart Disease)
This is a pathological condition characterized by damage to the heart muscle due to impaired blood flow (ischemia). Blood transport to the heart occurs via the coronary arteries, and if their lumen narrows due to atherosclerosis, ischemia develops with the appearance of characteristic symptoms. In these cases, echocardiography is useful because it allows for the detection of altered muscle function during the contraction and relaxation cycle.
Valvular Pathologies
Heart valve defects are diseases caused by structural abnormalities or functional impairments of the heart valves. Valves are anatomical structures that serve to ensure the movement of blood through the heart chambers in only one direction. During the cardiac cycle, the valves play a fundamental role in coordinating and ensuring the unidirectional flow of blood passing through the heart. For the diagnosis of ventricular function, ultrasound reveals its maximum analytical potential.
Cardiomyopathies
Cardiomyopathy is a general term used to describe pathologies that primarily affect the heart muscle, causing a reduction in its ability to contract and relax. In this case too, echocardiography plays a fundamental and indispensable role in both diagnosis and dynamic patient management.
Cardiomyopathies are divided into three main types:
• Dilated (most common): In this case, the left ventricle dilates and cannot pump blood throughout the body as effectively as a healthy heart.
• Hypertrophic: The heart has thickened walls and small heart chambers.
• Restrictive (rarest type): The walls of the heart chambers become stiff, which impairs relaxation after contraction, and this prevents the heart from completing its cycle.
Aortic Pathologies
Thoracic aortic aneurysms represent an abnormal dilation of the aorta above the diaphragm. Echocardiography is crucial in the diagnosis of dissecting aneurysm and is used to establish its exact dimensions. It is also indispensable in the diagnosis of congenital heart defects, the detection of cardiac masses, and pericardial pathology.
Types of Echocardiography
There are various ways to perform an ultrasound examination. Let's look at the characteristics of each one.
Transthoracic Echocardiography (TTE)
This is the most frequently used type. To visualize the heart, the transducer is placed on the patient's chest, usually on the left side.
Transesophageal Echocardiography (TEE)
It involves visualizing the heart using a transducer connected to a probe or tube that is inserted through the mouth into the esophagus, from where images of the heart can be obtained. Consequently, it is an invasive method. It is usually a supplementary examination to TTE, which provides similar but more detailed information about certain structures, such as the cardiac valves. Furthermore, it helps rule out the presence of thrombi (clots), tumors, or congenital heart defects that cannot be fully detected by transthoracic echocardiography.
• No food or liquids should be consumed for 4-6 hours before the transesophageal ultrasound. No oral medications should be taken during this period either.
• It is preferable for the patient to be accompanied by a family member or friend, as a sedative sometimes needs to be administered for the test.
• If the patient has removable dentures, they must be removed during the examination.
• The duration of the examination is 45-60 minutes.
• The patient should not eat any food for approximately 2 hours afterward. It is also not advisable to drive for 2-4 hours after the examination if a sedative was administered intravenously.
• Elderly patients must be accompanied for the following 2-4 hours.
Stress Echocardiography
It involves visualizing the heart using EchoCG under conditions of physical or pharmacological stress. Solid food should not be consumed for 2 hours before the examination. The doctor who recommends this examination will inform the patient whether they should take their regular medication or if its intake needs to be suspended. After a stress EchoCG, one can return to daily activities immediately.
Pharmacological Stress Echocardiography
It involves visualizing the heart using ultrasound while administering a drug that makes the heart work faster and harder. It is a non-invasive test combining the use of transthoracic echocardiography with the administration of a medication. Dobutamine is typically used. It increases the heart rate and the force of heart contraction (among other effects). Thus, this test can stimulate the heart and show how it works during effort (when we move or exercise). Images will first be obtained when the heart is at rest and then after the drug is administered. The goal of this examination is to find out if there are changes in the contraction of the heart walls, which are, in most cases, secondary to coronary artery disease.
Pharmacological EchoCG is indicated for:
• Patients who had a stress test with suspicion of coronary artery disease and the result was inconclusive.
• Patients who have already had a heart attack and for whom risk assessment is desirable.
• Patients with already known coronary artery lesions who need to determine how these lesions affect heart function before their treatment.
The patient should not consume solid food for several hours before the examination. As a rule, if the patient is taking beta-blockers, their intake must be suspended 1-3 days before the examination. But in any situation, it is important to follow the recommendations of the attending physician. Unless the doctor advises otherwise, you can return to work or household chores immediately after the examination.
Contrast Echocardiography
In this case, conventional echocardiography is used, but first, a special contrast agent is introduced through a vein, allowing for a significantly better view of the heart structures and blood vessels. This requires no special preparation.
How Cardiac Ultrasound is Performed
If it is the classic, transthoracic EchoCG, conductive gel is applied either to the patient's chest or directly to the transducer. The cardiologist will move the transducer over the patient's chest to obtain various images. The patient lies down during the procedure and remains as calm as possible. The echocardiogram is painless and does not cause any side effects. The examination usually lasts 15 to 30 minutes.
Transesophageal Echocardiography
Before the procedure, a nurse may give the patient a lozenge or an anesthetic spray for the throat. When the patient lies on the couch with their chest exposed, electrode stickers will be placed on them to monitor the electrocardiogram during the examination. The nurse may also administer a sedative medication into a vein. Then, the cardiologist will place the tube in the patient's mouth and ask them to swallow before inserting it into the esophagus, which may cause some nausea that will pass once the tube is inside. The examination will then be performed, during which, if a sedative was administered, the patient will be so relaxed that they may even fall asleep. Afterward, slight dizziness is possible. The throat anesthetic may cause a cough. Moreover, when removing the probe, it is recommended to cough to remove accumulated sputum.
Stress EchoCG
Electrodes will be placed on the patient's chest to monitor the electrocardiogram, and a cuff on the arm to measure arterial blood pressure. The patient will then step onto a treadmill or stationary bike, where they will walk for a few minutes. Afterward, they will need to return to a supine position. The cardiologist will take recordings on the echocardiograph before performing the exercise, during its performance, and immediately after its completion. During the examination, chest pain, fatigue, or discomfort may appear, which disappear afterward. Any such sensations must be reported to the doctor. The approximate duration of the examination is 30-60 minutes.
Pharmacological Stress Ultrasound
In this case, an intravenous drip will be set up for the patient. Then, electrodes will be placed on the chest to monitor the electrocardiogram during the examination. Additionally, cuffs will be placed to measure arterial blood pressure. The test consists of four phases: when the heart is at rest, at low and high doses of the medication, and the recovery phase. Once normal echocardiography images are obtained (at rest, without the drug), several echocardiographic recordings will be made during the administration of the drug. Facial tingling, facial flushing (heat), headache, tremor, dizziness, nausea, palpitations (which are almost always present due to the increase in heart rate), fatigue, or chest pain for a few seconds are possible. Any discomfort or symptoms should be reported to the doctor. The approximate duration of the examination is 45 minutes.
Contrast Echocardiography
The patient will have electrodes placed to monitor the ECG during the examination. Then, while the nurse administers several contrast injections into a vein, the transducer will be placed on different parts of the chest to examine the heart and valves from different planes. The injection is usually unnoticeable, so do not hesitate to report any strange sensations. Some noise corresponding to the speed of blood movement inside the heart may be heard during the examination. After the examination is complete, the nurse will apply a bandage or adhesive plaster to the injection site. The approximate duration of the examination is 30-60 minutes.
Advantages of Cardiac Ultrasound at Expert Clinics
Expert Clinics uses the latest diagnostic equipment that provides accurate results. The clinic also employs doctors with expertise in anti-aging medicine. After making a diagnosis, they will work diligently not only to eliminate the symptoms but also to find the root cause of the "malfunction" in the body. Methods for correcting various pathologies are selected strictly personalized but are always maximally effective.
Brief Conclusions
• Cardiac Ultrasound is an important diagnostic tool for determining the state of the heart and its functions.
• Echocardiography uses ultrasound waves to obtain images of the heart muscle, valves, and blood vessels.
• Cardiac ultrasound is useful for evaluating heart function at rest and after physical exertion.
• The absence of contraindications for ultrasound makes it a safe and widely used diagnostic method.
• Various modes of cardiac ultrasound allow for obtaining information about all aspects of heart function.
• Indications for cardiac ultrasound include angina, arrhythmias, congenital heart defects, valvular diseases, myocardial infarction, heart failure, and arterial hypertension, and so on.
Expert Clinics uses the latest technology and employs doctors with experience in anti-aging medicine, allowing them to conduct accurate, personalized diagnostics and prescribe optimal treatment that yields rapid results.
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