Exploring Echocardiograms: A Comprehensive Guide

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Utilising sound waves to generate images of the heart, an echocardiogram is a common diagnostic test that provides insights into blood flow within the heart and its valves. The resulting images aid healthcare providers in detecting heart disease and various cardiac conditions.

Alternative names for this test include:

• Heart ultrasound.
• Heart sonogram.

Echocardiograms come in different types, tailored to the specific needs of the patient and the purpose of the test, with some variations suitable for exercise or pregnancy.

Why it's conducted:

The primary purpose of an echocardiogram is to investigate potential heart issues. By visualising blood movement through the heart chambers and valves, healthcare providers can order this test in cases of chest pain or shortness of breath.

Types of echocardiograms:

Various types of echocardiograms cater to different diagnostic needs based on the required information.

• Transthoracic echocardiogram (TTE): Also known as a standard echocardiogram or heart ultrasound, this noninvasive procedure examines blood flow through the heart and heart valves from outside the body. A contrast dye may be administered intravenously for enhanced visibility of heart structures.

• Transesophageal echocardiogram (TEE): When a standard echocardiogram lacks the required details, a TEE offers an in-depth examination of the heart and the body's main artery (aorta) from inside the body. This test is often employed to scrutinize the aortic valve, but caution is exercised if there is upper gastrointestinal bleeding, esophageal tumors, or tears.

• Fetal echocardiogram: Conducted during pregnancy, this noninvasive test checks the baby's heart by moving an ultrasound wand over the pregnant person's abdomen, eliminating the need for surgery or X-rays.

• Stress echocardiogram: Administered before and after exercise, this test evaluates how the heart responds to physical activity or stress. It is ordered if coronary artery disease is suspected, and if exercise is not feasible, medication may be used to simulate increased heart activity.

Echocardiogram methods:

Several components make up an echocardiogram, including:

• Two-dimensional (2D) or three-dimensional (3D) echocardiogram: These images provide a visual representation of the heart walls, valves, and large vessels connected to the heart. While a standard echocardiogram starts with a 2D study, some medical centers and hospitals offer 3D echocardiograms for a more detailed examination of the lower left heart chamber.

• Doppler echocardiogram: By measuring the pitch changes in sound waves bouncing off blood cells, this part of the test gauges the speed and direction of blood flow, aiding in the detection of blocked or leaking valves and assessing blood pressure in the heart arteries.

• Color flow imaging: Displaying blood flow in color, this component helps identify issues such as leaky heart valves and other abnormalities in blood flow.

Risks

Echocardiography uses harmless sound waves, called ultrasound. The sound waves pose no known risk to the body. There is no X-ray exposure.

Other risks of an echocardiogram depend on the type of test being done.

If you have a standard transthoracic echocardiogram, you may feel some discomfort when the ultrasound wand pushes against your chest. The firmness is needed to create the best pictures of the heart.

There may be a small risk of a reaction to the contrast dye. Some people get backaches, headaches or rashes. If a reaction occurs, it typically happens right away, while you are still in the test room. Severe allergic reactions are very rare.

If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. Rarely, the tube used for this test may scrape the inside of the throat. Other risks of a TEE include:

• Difficulty swallowing.
• Weak or scratchy voice.
• Spasms of the muscles in the throat or lungs.
• Minor bleeding in the throat area.
• Injury to teeth, gums or lips.
• Hole in the esophagus, called esophageal perforation.
• Heart rhythm problems, called arrhythmias.
• Nausea from medicines used during the test.
• Medicine given during a stress echocardiogram may temporarily cause a fast or irregular heartbeat, a flushing feeling, low blood pressure or allergic reactions. Serious complications, such as a heart attack, are rare.

How you prepare

How you prepare for an echocardiogram depends on the type being done. Arrange for a ride home if you're having a transesophageal echocardiogram. You can't drive after the test because you usually receive medicine to relax you.

Food and medications

Before your test appointment, ask your health care provider if you can take your medicines as usual. Make sure your provider knows about all the medicines you take, including those bought without a prescription.

You can usually eat or drink as usual before a standard transthoracic echocardiogram.

If you're having a transesophageal echocardiogram, you may need to avoid food and drink for a few hours before the test. Your health care provider gives you details on how to prepare for this test.

What you can expect

An echocardiogram is done in a medical center or a hospital.

You'll usually be asked to remove clothing from your upper body and change into a hospital gown.

When you enter the testing room, a health care provider attaches sticky patches to your chest. Sometimes they are placed on the legs too. The sensors, called electrodes, check your heart rhythm. This test is called an electrocardiogram. It's more commonly called an ECG.

What to expect during the echocardiogram test depends on the specific type of echocardiogram being done.

Transthoracic echocardiogram

This is the standard type of echocardiogram. It takes pictures of the heart from outside the body.

During a standard echocardiogram:

• The health care provider puts gel on the ultrasound wand, called a transducer. The gel works with the wand to provide better images.
• The provider presses the wand firmly against the skin and moves it over the chest area.
• The wand sends sound waves through the chest to the heart.
• The wand records the sound waves that bounce back from the heart.
• A computer changes the information into moving images. The images are seen right away on a monitor.
• During the test, you may be asked to breathe in a certain way or to roll onto your left side. If your lungs or ribs block the view, you may be given dye, called contrast, by IV. The contrast helps the heart's structures show up more clearly on the images. You may also be given a saline solution by IV to help check for holes in the heart.

A fetal echocardiogram is done in a similar way as the standard test, except the wand moves over the pregnant person's belly.

Transesophageal echocardiogram

This type of echocardiogram provides more-detailed images of the heart and heart valves. Unlike a standard echocardiogram, this test takes pictures from inside the body.

This test requires medicines called sedatives to relax you. Before the test starts, a care provider inserts an IV into your forearm or hand. The sedatives and other medicines go through this IV. The provider also numbs your throat with a spray or gel. You also receive oxygen. It flows through a face mask or a small tube with two openings that's placed in your nostrils.

During a transesophageal echocardiogram:

The provider guides a thin tube called a catheter into your mouth. The tube goes down your throat and into your esophagus. It's placed close to your heart.

The ultrasound wand goes through the catheter and moves near the heart.

The wand gives off sound waves. It records the sound waves that bounce back from the heart.

A computer changes the information into moving images. The images are seen on a monitor.

A health care provider watches your oxygen level during the test.

Stress echocardiogram

A stress echocardiogram is done the same way as a standard transthoracic echocardiogram except the images are taken before and after exercise. Some heart problems occur only during physical activity.

A stress echocardiogram often involves walking on a treadmill or riding a stationary bike while an ECG is done.

The provider takes echocardiogram pictures of your heart before and after the exercises. If you can't exercise, you might be given medicines. The medicines help the heart pump like it does during exercise. The pictures are taken before and after you get the medicines.

After the procedure

Most echocardiograms take less than an hour. If you have a transesophageal echocardiogram, you may be watched for a few hours after the test.

After imaging is done, the images will be reviewed by a health care provider. You may be asked to wait in case more imaging is needed.

Most people can go back to their usual daily activities after an echocardiogram.

If your echocardiogram looks OK, no further testing may be needed. If the results are concerning, you may need more tests. If you aren't already seeing a heart specialist, you may be referred to one. This type of health care provider is called a cardiologist.

Information from an echocardiogram may show:

• Changes in heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause thickened heart walls or enlarged heart chambers.
• Pumping strength. An echocardiogram can show how much blood pumps out of a filled heart chamber with each heartbeat. This is called the ejection fraction. The test also shows how much blood the heart pumps in one minute. This is called cardiac output. If the heart doesn't pump enough blood for the body's needs, heart failure symptoms occur.
• Heart muscle damage. The test can show how the heart wall helps the heart pump blood. Areas of heart wall that move weakly may be damaged. Such damage might be due to a lack of oxygen or a heart attack.
• Heart valve disorders. An echocardiogram can show how the heart valves open and close. The test is often used to check for leaky heart valves. It can help diagnose valve disorders such as heart valve regurgitation and valve stenosis.
• Heart problems present at birth, called congenital heart defects. An echocardiogram can show changes in the structure of the heart and heart valves. The test is also used to look for changes in the connections between the heart and major blood vessels.