Echocardiogram
Testing For Heart Disease With Ultrasound

Heart Testing Echo Pictures

Heart Echo Ultrasound

Echocardiogram

Contents

What Is An Echocardiogram?
What Does It Test?
How Is The Test Done?
Is It Safe?
When Will I Receive The Results?
What Is A Stress Echocardiogram?
What Is A Contrast Echocardiogram?
What Is A Transesophageal Echocardiogram?
How Much Does An Echocardiogram Cost?



Other Related Articles:

Heart Disease in Women
Heart Disease Testing

What Is An Echocardiogram?

An echocardiogram is also referred to as an echo or echocardiography. Echocardiography uses ultrasound high-frequency sound waves to produce detailed images of the heart. There are different types of echocardiograms which are used to test various aspects of the heart including it's size, shape, contractions and how blood flows through it and the arteries. The most important function of the echo is to confirm the diagnosis of heart disease after a physical examination. More than 5 million echos are completed every year in the USA. It is the same technology that is used in pregnancy ultrasound scans for checking fetus development. The sound waves enter the body through a handheld device called a transducer. They bounce off internal structures and fluids in the heart and return echoes back through the transducer. The echoes are then converted into images on a computer screen. While very few diseases are diagnosed solely by echocardiographic criteria (a heart catheterization or specifically coronary angiography is still necessary), it is an important tool in the diagnosis of most types of heart disease.

What Does It Test?

Measuring Blood Turbulence
Echocardiography is commonly used to monitor the severity of heart valve problems which cause turbulent blood flow in the heart. The changes can be seen by the speed of blood passing through the valves. It does not however allow a doctor or technician to directly visualize the arteries of the heart.


Appearance of Heart
The test will indicate how the chambers or wall of the heart have been altered by previous heart attacks, heart failure or hypertension. It is in fact one of the main tests for the diagnosis of heart failure. The size of the heart, including the thickness of the wall and volume of the cavity will be captured by image and investigated. Thickness or stiffness of the heart wall can indicate long standing high blood pressure. Any enlargement of the left or right ventricle may be an indication of previous heart failure. Doctors will compare the images with previous ones taken in the past. Images taken on an annual basis can gauge the patient's response to treatment.


Pumping Function
The test can assess the strength of the heart's pumping action, also known as ejection fraction. A normal ejection fraction is about 55 to 65 percent. This means that more than 55 percent of your blood is squeezed out of the left ventricle (the main pumping chamber) in a single heart beat. A figure below 45 percent suggests a weakened heart which could be an indication of cardiomyopathy while figures below 35 percent represent a serious decrease, possibly the result of a previous heart attack. The test can be particularly meaningful for those with genetic heart conditions that can pose serious risk of sudden death. One example is hypertrophic cardiomyopathy which is an abnormal thickening of the heart muscle which sometimes causes sudden death in young athletes.

Valve Function
An echo can check the condition of the heart's four valves, their structure, thickness and movement. This can help determine if there is any scarring resulting from rheumatic fever or infection. It may also be used to check the function of artificial heart valves which were implanted in previous surgery. The use of a Doppler mode can check in real time how blood flows through the valves. If flow slows down at one point, this could be an indication of a block. If flow reverses it can indicate a leaky valve known as mitral valve. If mitral valve is diagnosed, the patient will be advised to take antibiotics prior to any dental or non-sterile surgical procedure to prevent a rare complication of infection of the valve.

Volume of Blood
The test can also provide information about the volume of blood circulating the body. Reduced blood flow may be an indication of poor heart function, but it can also be the result of using diuretics (which help the body excrete urine). It can also occur with dehydration and blood loss.

How Is The Test Done?

Echocardiograms can be performed in a doctor’s office or hospital. No special preparation is needed for a resting echo, other types are mentioned further below. The patient removes their clothes and is given a gown to wear (or women will be covered with a sheet for privacy if they just take their top off). She then lies on an examination table and sticky patches called electrodes are attached to her chest and shoulders. These will help to record the heart's electrical impulses or electrocardiogram (EKG or ECG) during the echocardiogram. The set up procedure is the same as for an electrocardiogram. Next the technician will apply a colorless gel to the chest to help with the transmission. He will then move the transducer over the heart area while images are recorded on a nearby screen. You may be asked to lie in several different positions and to breath slowly or to hold your breath. The whole procedure takes about 40 minutes. The images are recorded on tape and then reviewed by a physician before completion of the final report.

Is It Safe?

It is extremely safe, there are no known risks. However image quality may be limited in obese patients and those with obstructive lung disease.

What Are The Risks? Risk factors for heart disease.

When Will I Receive The Results?

If the doctor is present during the test you may receive your results before leaving his office. However more commonly a doctor is not present and you will have to wait several days for the full results. If the test does not reveal any issues you may get your results by phone. A physician may call you directly if they discover any unexpected findings.

What Is A Stress Echocardiogram?

If a doctor suspects a patient is showing symptoms of coronary heart disease they will sometimes order a stress echocardiogram. Comparing the images of a rested heart (the regular echo) next to stressed images can be informative. A stressed image can show abnormalities in areas of the heart that do not (but should) move when the heart is made to work harder. Stress echocardiography is usually carried out using exercise as the stress – the patient will be required to use a treadmill or stationary bike - this is known as an exercise stress test. The main advantage of a stress echo over a stress ECG is that the echo can better highlight areas of the heart not receiving adequate blood supply. Once the patient has reached a certain target heart rate on the exercise machine they are immediately moved to the examination table where the echocardiogram begins. The same procedure is applied - gel is applied to the chest area and a transducer is used to take images. The entire expanded test takes about an hour and a half.

In some instances 'stress' may not be induced by exercise, but chemically induced with the use of dobutamine which makes the heart pump faster. A dobutamine echocardiogram may be used to check for blockages in the valves of the heart, specifically for evaluating aortic valve disease. The dobutamine is injected directly into the arm and takes a few minutes to take effect. Once it starts working, an echo is performed as normal. The results of the test will help doctors determine if valve surgery or other treatments such as heart bypass surgery may help the heart function better.

Heart Facts, see: American Heart Disease Facts and UK Heart Disease Facts

What Is A Contrast Echocardiogram?

This is an echocardiogram which involves the use of a contrast agent to help doctors evaluate blood flow and the heart cavity. The most common type of contrast echo is referred to as a bubble echocardiogram or bubble study. It is often used to evaluate patients who have had a stroke (see stroke in women) and checks communications between the left and right side of the heart. Microbubbles derived from agitated saline are injected into the blood stream. If they find their way to the left atrium and ventricle it can indicate a problem. Bubble studies are considered safe.

The second type of contrast echocardiogram uses different contrast agents - most commonly microbubbles which are encapsulated in a shell of carbohydrate, protein or lipid. This test may be performed on people whose images from a regular echocardiogram are poor, possibly because the patient is obese or has emphysema. The risks associated with this type of test are debatable as it has caused a handful of deaths. The FDA requires patients be warned before contrast agents are used. It suggests that it should not be used on patients with serious heart arrhythmia, those with a shunt or who have had a heart attack or heart failure exacerbations. As with all tests, doctors will weigh the risks and benefits. Most physicians feel that contrast echocardiograms can be performed, when required, quite safely.

What Is A Transesophageal Echocardiogram?

Although a standard echocardiogram is good for seeing structures near the surface of the chest wall, a transesophageal echocardiogram can go deeper. The test is similar to a routine echo except that the ultrasound probe is inserted into the esophagus using an endoscopic probe. The patient will need to be sedated but the procedure is very safe. It is most commonly carried out to assess the mitral valves and to check for signs of infections in the valves and blood clots.

How Much Does An Echocardiogram Cost?

The average price of a standard echocardiogram is $1,400 and this rises to $3,300 for a transesophageal echocardiogram. The cost is usually covered by insurance, although there may be an out of pocket expense of up to $200.

Other Types of Heart Tests

Holter Monitor (24 Hour Test)
Event Monitor
Chemical Stress Test
Nuclear Stress Test
Calcium Score Test

  Related Articles on Echocardiograms

For more Heart Problems, see the following:

Heart Disease in Pregnancy

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