Echocardiogram

An echo is advised if the doctor or the physician suspects any problems in the patient's heart such as poor pumping of blood from the heart or any problems in the heart muscles and valves. The echo is also considered during pregnancy, if there are any chances of congenital birth defects in the unborn fetus. According to the condition of the patient and the problem suspected, the doctor advises a particular type of echocardiogram. The various types are as mentioned:

• Transthoracic echocardiogram – This is considered as the standard and noninvasive technique. The sonographer or the technician applies a clear gel on the skin over the chest and puts the transducer over it. The transducer is pressed firmly against the patient's chest and an ultrasound beam is aimed at the heart through the chest. Then the sound waves are transmitted through it and reflections or echoes from the heart are captured. This process further forms a live image or moving images of the patient's heart. In case there is any hindrance from the ribs or the lungs, then an intravenous dye or contrast is used to enhance the image quality.
• Transesophageal echocardiogram (TEE) – Sometimes, it is a little difficult to capture clear images of the heart. In such cases, the doctor advises going for a transesophageal echocardiogram. In this type of echo, a flexible tube consisting of a transducer is put inside the mouth and guided till the esophagus of the patient. In the aforementioned condition, the transducer takes clear images of the patient's heart. This transesophageal echocardiogram will be done by anesthetizing the throat and by giving certain medications to make the patient relax during the procedure.
• Doppler echocardiogram – In this type of echo, the sound waves transmitted through the transducer, reflect back by hitting the heart's moving blood vessels. This changes the pitch and these changes are known as Doppler signals, which assist the doctor in examining the direction and speed of the blood flow or circulation in the heart. The Doppler method is mostly used in the transesophageal and transthoracic echocardiogram to understand the blood flow and detect any abnormality in the blood pressures in the arteries. In some cases, to get further more enhanced images of the heart structures, the doctor uses color echocardiogram i.e. the contrast is administered intravenously into the patient which produces colored images of the blood. This helps the doctor to very clearly pinpoint the abnormalities in the patient’s heart.
• Stress echocardiogram – Some problems of the heart are detected only while the patient is performing a physical activity like in case of the coronary artery, which supplies blood to the heart. In this type of echo, the pictures of the heart are taken before and after a physical activity e.g. walking on a treadmill.
• Dobutamine stress echocardiogram (DSE) – This is another type of stress echo. If the patient is not able to perform an exercise or walk on the treadmill, then an injection with a drug is given to the patient, which makes the heart pump faster as if the patient is exercising. This procedure is also used to determine the functioning of the heart muscles and valves.
• Intravascular ultrasound – This type of echocardiogram is done while performing cardiac catheterization. In this procedure, the transducer is put into the heart blood vessels through a catheter inserted from the groin. This technique provides the best and detailed information about any obstructions in the heart blood vessels.

The echocardiogram is advised by the doctor to detect various heart problems as mentioned below:

• Heart murmurs
• Abnormal rhythms of the heart
• Congenital heart defects
• Pulmonary hypertension
• Abnormality in heart valves
• Damage to the muscles of the heart after a heart attack
• Any blood clots after a stroke
• In patients with heart failure, to check the ability of the heart to pump blood.
• Inflammation of the heart, also known as pericarditis.
• Filling of fluid around the heart, known as pericardial effusion.
• To examine the structure and the size of the heart e.g. cardiomegaly.
• The procedure is also performed, in order to help the doctor to check or monitor any treatment progression or post-surgical improvements.

The echocardiogram is actually a noninvasive and safe procedure as it does not use any kind of radiations. It is also considered safe during pregnancy, in order to detect any risks of congenital birth defects in the unborn fetus.

However, there are some risks associated with almost all types of echocardiograms, as mentioned below.

• In the case of transthoracic echocardiogram, the patient might feel slight discomfort or uneasiness when the sonographer removes the electrodes put on the patient’s chest. The level of discomfort is similar to pulling off a band-aid from the skin.
• In the transesophageal echo, after the procedure, when the transducer is removed from the esophagus, the patient might feel a sore throat for a few hours. In rare cases, the tube put in the esophagus may cause some scrapping or injury in the inner part of the throat. Sometimes, few patients may also develop some reactions to the medicine given for sedating the throat. Also, the oxygen levels will be monitored continuously throughout the echo procedure in order to ensure proper breathing.
• In the stress echocardiogram, when the heart is put under stress i.e. when a patient is asked to walk on a treadmill, in some cases, the patient might get a heart attack. This may happen as a result of an irregular heartbeat during the stress test. But this happens very rarely.

The doctor or the sonographer will explain the echo procedure in detail to the patient. No specific preparations are required before the test. However, some points to be taken care of are as mentioned below.

• In case, the doctor advises either the transesophageal echo or stress echo procedure, the patient is advised not to eat anything for a few hours before the test.
• In stress echo, the patient is advised to wear comfortable shoes, as the patient has to walk on a treadmill.
• In the transesophageal echo, after the test is done, the patient is unable to go home alone due to the sedative medicine given before the test. Hence, it is advised to get a companion along to take care of the patient and drive back home safely.
• The patient should avoid wearing any jewelry during the procedure.
• The patients should inform the doctor of any medications he/she is taking. Accordingly, the doctor can advise of whether to stop the medication or continue before or after the procedure.

During the procedure:

An echo test is usually done in the outpatient facility and there is no need for hospitalization. The patient is asked to remove the clothes from the upper half of the body or change into a hospital gown. The patient is made to lie down on an examination table on the back. The sonographer then attaches some electrodes or test sensors to the patient’s chest with the help of some adhesive tapes. This is done in order to detect the electric currents of the patient’s heart.

In case of a transesophageal echo, the patient’s throat will be anesthetized by some gel or spray. Also, some medicines will be given to make the patient relax during the procedure. During the procedure of echocardiogram, the sonographer will dim the lights in the room, to see the images of the heart clearly. The patients will hear a “whooshing” sound which is the sound of the blood flow in the heart, recorded by the echo machine.

In transthoracic echo, the patient might be asked to turn on to the left side and the transducer will be pressed firmly against the patient's chest. This may be slightly uncomfortable but will assist the doctor to produce very clear and enhanced images of the heart.

After the procedure:

The patient is allowed to go back home after the procedure completes. It takes approximately 1 hour for the echo to complete. But this might take some more time, in complicated cases. The sonographer interprets the results and hands them over along with the images of the heart, to the concerned doctor. The doctor then discusses the report with the patient in detail.

The doctor discusses the report in detail with the patient. If the report is normal, it means that the patient’s heart if healthy and fit and no abnormality is detected. The functioning of the heart is normal including the heart muscles and valves. Also, the blood circulation and pressure inside the arteries is normal. If the report is abnormal, it means that there is some abnormality with the functioning of the heart. In such cases, the doctor will either ask the patient to go for some more tests or will start a treatment/medication, depending upon the condition of the patient and abnormality detected.

Sometimes, if the images or results are unclear, the doctor may ask to repeat the echocardiogram or advise some other investigation tests like coronary angiogram or CT-scan (computed tomography scan).

In case of an abnormal report, the below mentioned problems might be observed and detected by the doctor in the patient's heart:

• Damage to the muscles of the heart after a heart attack
• Any blood clots after a stroke
• In patients with heart failure, the ability of the heart to pump blood.
• Heart murmurs
• Abnormal rhythms of the heart
• Congenital heart defects
• Pulmonary hypertension
• Abnormality in heart valves
• Inflammation of the heart, also known as pericarditis.
• Filling of fluid around the heart, known as pericardial effusion.
• The abnormal structure and the size of the heart e.g. cardiomegaly.