Echocardiography (Echo-KG)

To date, one of the main methods for diagnosing heart diseases is echocardiography (Echo-KG). This is a non-invasive study that does not have a negative effect on the body, and therefore can be performed on patients of all age categories, including children from birth.

This article will discuss what echocardiography is, why it is performed, what types of this procedure exist, what can become a contraindication to its implementation, and how to prepare for it.

The essence and purpose of echocardiography

Echocardiography or Echo-KG is a non-invasive method of examining the heart using ultrasound. The echocardiograph sensor generates special high-frequency sounds that pass through the tissues of the heart, are reflected from them, and then recorded by the same sensor. The information is transmitted to a computer, which processes the received data and displays them on the monitor in the form of an image.

Echocardiography is considered a highly informative research method, since it makes it possible to assess the morphological and functional state of the heart. Using this procedure, it is possible to determine the size of the heart and the thickness of the myocardium, their integrity and structure, the size of the cavities of the ventricles and atria, to find out if the contractility of the heart muscle is normal, to control the state of the valvular apparatus of the heart, to examine the aorta and pulmonary artery. Also, this procedure allows you to check the level of pressure in the structures of the heart, find out the direction and speed of blood movement in the heart chambers and the condition of the outer shell of the heart muscle.

This cardiological examination allows diagnosing congenital and acquired heart defects, the presence of free fluid in the heart sac, detecting blood clots, changing the size of the chambers, thickening or thinning of their walls, detecting tumors and any disturbances in the speed of blood flow. The uniqueness of such information lies in the fact that it is obtained in a non-invasive way, reflects the metric parameters of the working heart, indirectly characterizes the energy and metabolic capabilities of the myocardium, and also allows you to assess its reserve capacity and the degree of restructuring, remodeling of the heart. Using this method, not only early diagnosis is possible, but also the prediction of postoperative complications in cardiac surgery patients.

Advantages of Echo-KG

Echocardiography has a number of advantages over other types of cardiac examinations.

First of all, it is an absolutely painless and non-invasive procedure that does not cause any discomfort to the patient, similar to ultrasound. No injections or any other similar manipulations are carried out before the procedure.

In addition, the procedure is completely safe for patients of any age group. It can be carried out on children, adolescents and pregnant women, since ultrasound does not have any negative effect on the fetus.

Echo-KG is affordable, since the equipment for its implementation is present in almost any medical institution. The cost of Echo-KG is much lower compared to MRI.

And the most important advantage of this type of examination is its excellent information content, with the help of Echo-KG, you can calculate up to 50 hemodynamic parameters, which allow the doctor to get the maximum necessary information and choose the right therapy.

Echo-KG indications and contraindications

Echocardiography may be recommended to patients both if they suspect that they have any cardiovascular pathology, or during therapy, in order to assess the effectiveness of the drugs used.

Indications for Echo-KG are:

• hypertension;
• suspicion of the presence of congenital or acquired heart disease, including with a hereditary predisposition to this disease;
• frequent dizziness, fainting, shortness of breath and swelling;
• complaints about a “fading” heart, about “interruptions” in its work;
• pain behind the sternum, especially if they radiate to the region of the left shoulder blade or the left half of the neck;
• myocardial infarction, diagnosis of angina pectoris and cardiomyopathy, suspicion of a heart tumor;
• preventive examination of patients who often experience emotional and physical overload;
• changes on the ECG and chest x-ray, requiring clarification of the morphological changes in the heart.

Separately, it should be mentioned in which cases echocardiography is recommended for expectant mothers. Pregnant Echo-KG should be performed if:

• the expectant mother has pain in the precordial region;
• The patient is diagnosed with congenital or acquired heart defects;
• weight gain has stopped or there has been a sudden weight loss;
• appeared unmotivated edema of the lower extremities and shortness of breath with little physical exertion;
• violation of hemodynamics during pregnancy.

It should be noted that there are practically no absolute contraindications to echocardiography. At the same time, certain types of this study are not recommended in certain situations, which will be discussed below.

Types of echocardiography

To date, there are several types of echocardiography. Therefore, what kind of research to conduct in each individual case, the cardiologist decides.

one-dimensional

Today, this type of Echo-KG is rarely used on its own, because it is considered less informative than others. During the procedure, no image of the heart is generated. The data is displayed on the screen as a graph. With the help of M-echocardiography, the doctor can determine the volume of the heart cavities and evaluate their functional activity.

B-echocardiography (two-dimensional)

During B-echocardiography, data from all heart structures are entered into a computer and displayed on a monitor in the form of a black-and-white image. The doctor is able to determine the size of the heart, find out the volume of each chamber, the thickness of the walls, assess the mobility of the valve leaflets and how the ventricles contract.

Doppler echocardiography

As a rule, this study is carried out simultaneously with B-echocardiography. It allows you to track the blood flow in large vessels and on the valves of the heart, to identify reverse blood flow and its degree, which may indicate the formation of pathological processes.

Contrast echocardiography

This study makes it possible to more clearly visualize the internal structures of the heart. A special contrast agent is injected intravenously into the patient, after which the procedure is carried out as usual. This approach allows you to study the inner surface of the chambers of the heart. Contraindications for this study are individual intolerance to contrast and chronic renal failure.

Stress echocardiography

To diagnose hidden pathologies of the heart, which manifest themselves exclusively during physical exertion, a special type of study is used – stress echocardiography. It makes it possible to identify diseases in the early stages that do not remind of themselves if the patient is at rest.

Conducting stress echocardiography is recommended to assess the condition of the vessels and their patency, to find out how high the risk of complications is before performing surgical interventions on the heart and blood vessels. Also, the procedure is carried out in order to determine how effective the therapy of coronary heart disease is and to determine the further prognosis for this disease.

There are several contraindications for stress echocardiography. It should not be performed on patients suffering from severe respiratory, renal, hepatic or cardiac insufficiency. It is also contraindicated in myocardial infarction, aortic aneurysm and a history of thromboembolism.

Transesophageal echocardiography

This is a special type of examination, during which a miniature ultrasound probe is inserted through the oropharynx through the esophagus to the required depth using an endoscope. Despite the very small dimensions of the sensor, such a study is considered quite complicated and is carried out exclusively in specialized medical centers. In addition, there are special indications for it. In particular, a transesophageal study is performed when a standard transthoracic study does not allow assessing the condition of the heart and its structures. In particular, when there are doubts about the normal functioning of a prosthetic heart valve, if an aortic aneurysm and an atrial septal defect are suspected, and also if the patient has been diagnosed with infectious endocarditis and the doctor suspects an aortic root abscess.

At the same time, this type of study has contraindications from the side of the upper digestive tract, namely, in case of any tumor formations of the esophagus, bleeding from the upper gastrointestinal tract, the presence of a large diaphragmatic hernia, or dilated veins of the esophagus. Transesophageal examination should not be performed in patients with severe osteochondrosis of the cervical spine, with instability of the cervical vertebrae, with a history of perforation of the esophagus. Diagnosis can be difficult in patients with thyroid disease.

Preparation for Echo-KG

As a rule, when performing one- and two-dimensional echocardiography, as well as Doppler echocardiography, there is no need for any special preparation. In the event that a transesophageal study is prescribed, there are a number of restrictions.

So, the last meal should be no later than six hours before the procedure. Drinking is also not recommended. Immediately before the manipulation, dentures should be removed.

On the eve of the transesophageal examination, persons with a labile nervous system are advised to take a mild sedative. After the procedure, the patient will need some time to recover, so you should not overload yourself with work until the end of the day. You must also refrain from driving.

Research methodology

For transthoracic echocardiography, the patient is placed in a position on the left side, which ensures the convergence of the apex of the heart and the left side of the chest and the most accurate visualization of the heart – as a result, all four of its chambers are visible on the monitor at once.

The doctor applies a gel to the sensor, which improves the contact of the electrode with the skin. After that, the sensor is alternately installed first in the jugular fossa, then in the area of ​​the fifth intercostal space, where it is possible to control the apex beat of the heart as clearly as possible, and then under the xiphoid process.

Of course, every doctor strives to ensure that the results of the study are as accurate as possible. It should be noted that how informative the procedure will be depends on three main factors.

First of all, the anatomical features of the patient should be taken into account. Serious obstacles to ultrasound are obesity, chest deformity and other similar factors. As a result, the resulting image may not be clear and cannot be properly interpreted. To clarify the diagnosis in such cases, a transesophageal examination or MRI is suggested.

The quality of the equipment should also be taken into account. Of course, more modern equipment will give the doctor more opportunities to get enough information about the patient’s heart.

Finally, the competence of the person conducting the survey should be taken into account. At the same time, not only his technical skills are important (the ability to position the patient in the correct position and place the sensor at the right point), but also the ability to analyze the data received.

When conducting stress echocardiography, the patient is first given a regular Echo-KG, and then special sensors are applied that record indicators during physical activity. For this purpose, bicycle ergometers, treadmill test, transesophageal electrical stimulation or medications are used. At the same time, the initial load is minimal, and then it is gradually increased, controlling blood pressure and heart rate. If the patient’s condition worsens, the examination is terminated.

All this time, electrocardiography is continuously carried out, which makes it possible to quickly respond in the event of any extreme situations. During the load, the patient may feel dizzy, increased heart rate, discomfort in the heart. After the cessation of the load, the pulse slows down. Sometimes, in order for the work of the heart to completely normalize, it is necessary to introduce other medications. In this case, the patient’s condition is carefully monitored until full recovery.

As a rule, the whole procedure lasts about an hour.

Conducting a transesophageal Echo-KG begins with irrigation of the patient’s oral cavity and pharynx with a solution of lidocaine to stop the gag reflex during the introduction of the endoscope. After that, the patient is asked to lie on his left side, a mouthpiece is inserted into his mouth and an endoscope is inserted through which ultrasound will be received and delivered.

Explanation of results

The doctor who conducted the study deciphers the results of the Echo-KG. He either transfers the received data to the attending physician, or gives directly to the patient.

It should be borne in mind that a diagnosis cannot be made based solely on the result of echocardiography. The data obtained are compared with other information available to the attending physician: data from analyzes and other laboratory tests, as well as the patient’s clinical symptoms. It is impossible to consider echocardiography as a completely independent diagnostic method.

Where to do echocardiography

Standard echocardiography is carried out both in public medical institutions (clinics and hospitals) and in private medical centers. To make an appointment for an examination, you must provide a referral from your doctor or cardiologist.

More specific types of echocardiography – transesophageal examination or stress echocardiography – can only be done in specialized medical institutions, since they require special equipment and personnel who have received special training.

Echocardiography in children

As noted above, the indisputable advantages of Echo-KG are non-invasiveness, painlessness and complete safety of this technique of cardiological examination. Manipulation is not associated with radiation exposure, does not provoke any complications. Therefore, if there are appropriate indications, the study can be recommended not only for adults, but also for children.

Diagnosis will help to timely detect congenital pathology in young children, which, in turn, will make it possible to choose the most effective treatment. As a result, the child will be able to lead an absolutely full life in the future.

Indications for echocardiography in a child are:

• murmurs in the heart;
• the appearance of shortness of breath either during exertion or at rest;
• cyanosis of the lips, the zone of the nasolabial triangle, fingertips;
• decreased or complete lack of appetite, too slow weight gain;
• complaints of constant weakness and fatigue, sudden fainting;
• complaints of frequent headache;
• chest discomfort;
• decrease or increase in blood pressure;
• the appearance of edema on the limbs.

Taking into account the fact that the method is safe, it is possible to conduct echocardiography in babies more than once in order to track the development of the disease or evaluate how effective the treatment is. In the event that any pathological changes have been identified, a study is carried out at least once a year.

Preparing and conducting the procedure for children

Like adult patients, children do not need any prior preparation. It is desirable that the child does not eat anything for three hours before the study, because with a full stomach, a high standing of the diaphragm is observed, which can distort the result.

Parents should take with them the results of the electrocardiogram made the day before, as well as the results of studies that were carried out earlier. Without fail, the baby should be psychologically prepared for the procedure, explaining that no one is going to hurt him.

In order to carry out the procedure, the baby is undressed to the waist and laid on the left side on the couch. After moving the sensor along the chest, the doctor examines the resulting image.

Fetal echocardiography

There are models of echocardiographs that can be used to examine the fetus in the uterus. In this case, neither the mother nor the unborn child will be harmed.

As a rule, echocardiography of the fetus (prenatal or fetal echocardiography) is performed between 18 and 22 weeks of pregnancy. Its main goal is the timely detection of congenital heart disease in the fetus. The study provides an opportunity to check the intracardiac blood flow of a child in the mother’s womb and dynamic monitoring until his birth. As a result, an obstetrician-gynecologist can plan the delivery, and cardiologists are able to begin treatment of the child immediately after birth.

Fetal echocardiography is performed if close relatives of the patient have a congenital heart disease, some diseases of the pregnant woman, in which the likelihood of congenital malformations in the fetus increases (diabetes mellitus, systemic connective tissue diseases, epilepsy). For prophylactic purposes, an Echo-KG of the fetus is performed if the mother took antibiotics or anticonvulsants in the first trimester. Diagnosis is also carried out, with the age of the mother over 35 years. Also an indication is the deviations detected during an ultrasound examination for a period of twenty weeks. Thus, antenatal detection of congenital heart and vascular malformations allows a qualified approach to solving the issue of managing sick children, which is extremely important, especially in terms of reducing infant mortality due to congenital heart defects. That is why methodological algorithms for the study of the fetus using the Doppler Echo-KG method are being developed, the optimal timing of the prenatal Echo-KG is determined, which allow a comprehensive study of the hemodynamics of the fetus in the norm and in the presence of cardiac pathology, as well as assessing hemodynamic disturbances in a single functional system “mother-placenta- fetus”.

Sources of