Cardiac echocardiography – what does it detect and how does it proceed? Types and indications for echocardiography

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Cardiac echocardiography is used to diagnose certain cardiovascular diseases. In fact, it is one of the most widely used diagnostic tests for heart disease. It can provide a lot of useful information, including the size and shape of the heart, its pumping force, and the location and extent of any tissue damage. It is especially useful for assessing heart valve disease.

Cardiac echocardiography provides information on:

1. the size of the heart, for example, when there is a change in ventricle size, enlargement or thickening
2. blood clots in the heart chambers
3. it flows around the heart,
4. problems with the aorta, which is the main artery connected to the heart,
5. problems with the proper functioning of heart valves,
6. pressure in the heart.

The echocardiogram of the heart is the key to determining the condition of the heart muscle, especially after a heart attack. It can also reveal heart defects or abnormalities in unborn babies.

Taking a heart echocardiogram is painless. The risk is only very rare with certain types of echocardiograms or when contrast is used.

One of the measurements that is usually performed on a cardiac echocardiogram is the heart’s ejection fraction. When working properly, the heart squeezes (contracts) and then relaxes. When the heart contracts, it pumps (or ejects) blood from the lower chambers. When the heart relaxes, the chambers fill with blood. No matter how much the heart contracts, it never ejects all the blood from the ventricles. The ejection fraction refers to the percentage of blood that is pumped out of the ventricle with each heartbeat.

Since the left ventricle is the heart’s main pumping chamber, doctors usually measure left ventricular ejection fraction. This is called left ventricular ejection fraction, or LVEF. The LVEF for a healthy heart ranges from 55% to 70%. LVEF may be lower if the heart muscle has been damaged as a result of a heart attack, heart failure, or other heart disease.

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The echoes are transformed into images on the TV monitor, creating images of your heart in motion. Stands out:

1. unidimensional or M-mode echocardiography – it is one ultrasound beam directed towards the heart. Doctors most often use M-mode echocardiography to see only the left side (or main pumping chamber) of the heart.
2. echocardiography dwuwymiarowa – gives a wider, moving image of the heart. Two-dimensional echocardiography is one of the most important diagnostic tools for physicians
3. Doppler echocardiography – measures blood flow through the arteries and shows the flow pattern through the heart.

Read: Heart valves – structure, functions and defects of heart valves

Cardiac echocardiography – study objectives

A heart echocardiogram may be performed to further evaluate signs or symptoms that may suggest:

1. atherosclerosis – atherosclerosis is characterized by the presence of atherosclerotic plaques inside the arteries. Echocardiography of the heart will reveal the presence and location of an accumulation of atherosclerotic plaques in the arteries,
2. cardiomyopathy — cardiomyopathy is an inherited disease that affects the heart muscle. The disease makes the muscles larger, making it harder for the heart to pump blood to the rest of the body. Echocardiography of the heart can easily detect a cardiomyopathy by measuring the thickness of the heart muscle.
3. congenital heart disease Congenital heart disease refers to any heart disease that occurs at birth. Fetal echocardiography can detect the disease in the unborn child at 22 weeks of gestation. In difficult cases, a three-dimensional echocardiographic examination may be recommended.
4. congestive heart failure- This is a chronic disease that changes the heart’s ability to pump blood to the rest of the body. Over time, fluid can build up around your heart, causing it to malfunction. In order to detect this disease, a two-dimensional echocardiographic examination or a Doppler examination is recommended.
5. aneurysm – orefers to the weakening of the walls of the arteries, creating a bulge in the artery. The condition is easily detected with a normal echocardiographic test.
6. valvular heart disease – as the name suggests, this disease affects one or more heart valves. The cardiac echocardiogram is the main test recommended for the diagnosis of valvular heart disease. An electrocardiogram or chest X-ray may be used to detect early symptoms.
7. heart tumor – heart tumors are abnormal, cancerous or non-cancerous growths in the heart. These growths can cause blood flow problems, so surgery is usually recommended. A heart echocardiogram can detect the exact position of these growths.
8. pericarditis – pericarditis is an inflammation of the fibrous sac surrounding the heart, commonly known as the pericardium. The symptoms of this condition include severe pain in the chest, arms, neck, and back. Detection of pericarditis is carried out using echocardiography of the heart.

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Heart echocardiography – types

There are three techniques for performing cardiac echocardiography. These are the techniques:

1. transstageal,
2. transesophageal,
3. intracardiac.

The most common technique is echocardiography echocardiography przezklatkowa (TTE). In TTE, the transducer is placed along the left or right edge of the sternum, at the apex of the heart, in the suprasternal notch (to allow visualization of the aortic valve, left ventricular outflow path and descending aorta) or over the xiphoid area.

TTE provides 2 or 3 dimensional tomographic images of most of the major structures of the heart. TTE is a relatively inexpensive and non-invasive imaging technique for diagnosing right and left ventricular function and wall movement, ventricular size and anatomy, valve structure function, aortic root structure, and intracardiac pressures.

In transesophageal echocardiography (TEE), the transducer at the end of the endoscope allows the heart to be visualized through the stomach and esophagus. TEE is used to assess heart disorders when transthoracic examination is technically difficult, such as in obese people and in people with chronic obstructive pulmonary disease (COPD). It reveals more details of the small abnormal structures and posterior structures of the heart (e.g., left atrium, left atrial appendages, atrial septum, pulmonary vein anatomy) because they are closer to the esophagus than to the anterior chest wall. TEE can also produce images of the ascending aorta, which is formed behind the third costal cartilage, structures <3 mm (e.g., thrombi, vegetation), and valve prostheses.

In intracardiac echocardiography (ICE), the transducer at the end of the catheter (inserted through the femoral vein and threaded into the heart) allows you to visualize the anatomy of the heart. ICE can be performed during complex structural cardiology (e.g., percutaneous closure of an atrial septal defect or patent foramen ovale) or electrophysiological procedures. ICE provides better image quality and shorter treatment time compared to TEE during these procedures.

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Two-dimensional, contrast echocardiography, Doppler and other echocardiographic examinations that provide additional information are the most commonly used.

Contrast echocardiography is a two-dimensional echocardiogram performed when a dye – a contrast agent (or other ultrasound contrast agent) is injected into the heart.

Echocardiography spectral Doppler can record the speed, direction and type of blood flow. This technique is useful for detecting abnormal blood flow (e.g., due to feedback) or speed (e.g., due to constricted lesions). Doppler spectral echocardiography does not provide spatial information about the size or shape of the heart or its structures.

Color Doppler echocardiography combines XNUMXD and spectral Doppler echocardiography to obtain information about the size and shape of the heart and its structures, as well as the speed and direction of blood flow around valves and drainage pathways. Color is used to encode blood flow information, by convention, red is towards and blue is away from the transducer.

Tissue Doppler imaging uses Doppler techniques to measure the rate of contraction of heart muscle tissue (not blood flow). The movement of the heart muscle tissue can also be assessed for which it uses algorithms to track myocardial echo spots (the characteristic echoes of the heart muscle during ultrasound) from cage to cage.

Stress Imaging uses this data to calculate myocardial load (percent change in length between contraction and relaxation) and the rate of stress on the heart muscle (rate of change in length). Strain and strain rate measurements can help assess systolic and diastolic function and identify ischemia during exercise testing.

Increasingly, three-dimensional echocardiography is used, special heads can obtain a three-dimensional image of the heart structures in real time. Three-dimensional echocardiography is particularly useful in assessing the mitral valve apparatus for surgical correction.

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During it, the patient has to undress from the waist up, and then lie on his back. The doctor conducting the examination will first apply a special gel to the skin to help the head slide over the skin. This head emits sound waves and then absorbs the heart’s echo. The image shown on the monitor allows you to locate possible abnormalities and changes in the structure and work of the heart.

Transthoracic echocardiography can also be performed with the help of a contrast agent, the so-called contrast. It is injected into the patient’s veins during the examination, which allows for a more accurate and better picture of the heart. The only contraindication to the examination is the inability to put the transducer on the patient’s skin, e.g. when a plaster dressing is applied.

If the patient has been referred for transesophageal echocardiography, he should be shown on an empty stomach. The patient is first given local anesthesia and sedatives, and when testing younger patients, general anesthesia is also sometimes used. The test is performed using a probe (its diameter does not exceed 1 cm), which the doctor introduces through the esophagus and places it at the level of the heart.

The proximity of the examined heart allows for a more detailed examination of its structure. Contraindication to transesophageal echocardiography are esophageal burns, its rupture or limited mobility in the cervical-spine section.

Cardiac echocardiography – risks

Cardiac echocardiography is not invasive and does not carry any risk. The patient may experience discomfort in positioning the probe as it may apply pressure to the body surface. For some people, the need to lie still on the couch for the duration of the procedure may cause some discomfort or pain.

Read: Doppler ultrasound – what is it, when to perform it and what it diagnoses

Not all pregnant mothers need an echocardiogram. Standard prenatal ultrasound can provide information about whether the fetal heart has developed in all four chambers, and most pregnant women do not require further testing. Situations where you may need to have a fetal echocardiogram include:

1. if siblings were born with a congenital (present at birth) heart defect,
2. a family history of congenital heart disease (e.g. parents, aunts or uncles or grandparents)
3. a chromosomal or genetic anomaly detected in a fetus,
4. if the mother was taking medicines that could cause a birth defect of the heart, such as anti-epileptic drugs or prescription acne medications.
5. if the woman has abused alcohol or drugs during pregnancy,
6. if a woman has phenylketonuria or a connective tissue disease such as lupus
7. routine prenatal ultrasound detected possible abnormalities in the heart,
8. pregnant woman has gestational diabetes,
9. has recently had infections such as rubella, coxsackie virus infection, parvovirus,
10. pregnant woman has autoimmune disorders,
11. multiple pregnancy or after IVF.