Echo, Transthoracic Echocardiogram

Ultrasound imaging of the heart and the blood flow though it

This is a test that uses inaudible ultrasound waves to create images of your heart to determine its structure and function. The ultrasound beam passes out from the probe and is reflected back from the cardiac structures. It provides the doctor with information about the size and shape of your heart and how well your heart’s chambers and valves are working. A part of the echocardiogram is a Doppler analysis of blood flow across heart valves allowing assessment of valvular disease. Echo is particularly useful in investigation of breathlessness and murmurs. During transthoracic echocardiography (TTE), ECG leads will be attached to your chest and a wand-like device called a probe will be placed on the chest wall in various positions to allow acquisition of images. The whole test takes about 20-30 minutes and is not painful. Images are then stored in electronic archive and report is produced.

Echocardiography allows measurements of dimensions of the heart chambers and structures, assessment of the pumping function the heart (contractility, systolic function) using parameters such as ejection fraction (EF) and the relaxation of the heart (diastolic function). In combination with Doppler analysis, it is possible to evaluate the presence and degree of valve disease (aortic stenosis / regurgitation, mitral stenosis / regurgitation, tricuspid stenosis / regurgitation, pulmonary stenosis / regurgitation) or congenital heart disease (e.g. atrial or ventricular septal defect, pulmonary and aortic stenosis, coarctation of the aorta, tetralogy of Fallot, transposition of the great arteries).

Echo will be normally performed during the first appointment with Dr Ruzicka. Echo is usually not necessary during follow-up appointments with the exception of patients with valve disease or new symptoms.

Indications

  • Murmurs of unknown cause with suspicion on valve disease or congenital heart disease
  • Patients who are being investigated for breathlessness, dizziness and blackouts (syncopes)
  • Patients with abnormal ECG (e.g. suspicion on left ventricular hypertrophy, i.e. thickening of heart walls, usually due to hypertension)
  • The screening of patients with established ischaemic heart disease, i.e. a past history of heart attack (myocardial infarction), revascularization with PCI (angioplasty/stenting) or CABG (bypass surgery)
  • Patients with heart rhythm problems such as atrial fibrillation or atrial flutter
  • Some patients with palpitations and blackouts (syncopes)
  • Screening relatives of patients with cardiomyopathies (diseases leading to abnormal structure and function of the heart muscle)
  • Previous valve replacement or valve repair
  • Known congenital heart disease

Risks and complications

There are no known side effects or risks in using ultrasound for diagnostic assessments. In order to get good quality images, a firm contact of the ultrasound probe with chest wall is necessary. Sometimes this can be a little uncomfortable but it will not be painful. The jelly used for the test is hypoallergenic and is for people with sensitive skin.

Before the procedure

The echocardiogram, if indicated, will normally be performed by Dr Ruzicka or one of the cardiac physiologists during the consultation. He will describe the procedure to you and you will be offered the opportunity to ask any questions about the test. Since direct access to the chest is needed, ladies are advised to wear trousers or a skirt rather than a dress. You will be asked to remove all your clothing above the waist including bra and to lie on a couch on your left side so that your lungs drop out of the way of your heart. Your privacy will be protected by covering you with a sheet or gown and exposing only the necessary skin. Three electrodes (plastic stickers) will be placed on your right side, left and right shoulder and attached with leads to the echo machine.

During the procedure

Jelly will be put on the ultrasound probe and it will be placed on your chest, this will be moved as Dr Ruzicka looks at your heart from different angles. Images will be acquired and stored electronically in the echo machine. You will hear Doppler sounds from the machine; these are not real sounds produced by the heart but represent acoustic coding of blood flow volume and velocity. Once your assessment is complete, the jelly will be wiped off your skin and you can get dressed. The procedure takes approximately 20-30 minutes.

After the procedure

The echo report will be discussed with you during the initial appointment and depending on the result, an appropriate action will be taken. You will be able to resume your normal activities; there is no special care following echocardiogram.


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