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An introduction to Echocardiography

An echocardiogram, or echo-test, is an ultrasound scan that is used to look at the heart and surrounding blood vessels. During the scan, a hand-held wand sends out high-frequency sound waves that create echoes when they bounce off different parts of the body. The echoes are picked up by the probe and turned into a moving image that is displayed on a monitor.

Although the names sound similar, an echocardiogram is not to be confused with an electrocardiogram (ECG), which is a common test used to check your heart’s rhythm and electrical activity.

Why choose to have an Echocardiography test

With heart disease being the leading cause of death in the United States it’s important to stay on top of your heart health.  If you have been experiencing signs or symptoms of heart problems, your cardiologist or family physician may order an echocardiogram test.  An echocardiogram (from the word “echo” meaning sound) is a painless ultrasound test that uses sound waves to create pictures of your heart’s valves and chambers.  The results from an echocardiography allow your doctor to see how the heart is beating and pumping blood. This information can be used to confirm a diagnosis, determine the status of an existing problem, or help guide treatment options.

Different types of Echocardiography tests

There are several different ways an echocardiogram can be carried out, however, most patients will have what is known as a transthoracic echocardiogram (TTE). This is a non-invasive procedure that takes place entirely outside your body. 

A second type of test is the transesophageal echocardiogram (TEE) which involves a thin tube, called a probe, being passed down your throat into your esophagus. This type of test gives a much clearer picture of the heart than a regular ultrasound. 

Echocardiogram, Doppler ultrasound and color Doppler are often combined to assess blood flow across the patient’s heart valves.

Your doctor will determine the appropriate test for your condition.

How is an Echocardiography performed?

The procedure is carried out by positioning the patient flat on the table where the technician (sonographer) puts small metal disks called electrodes, on the patient’s chest. The disks are attached to wires that are linked to an electrocardiograph machine. An electrocardiogram (ECG or EKG) tracks the heartbeat during the test. To better observe the video monitor, the room is kept dark throughout the procedure.

If you are undergoing a transesophageal echocardiogram (TEE) you will receive a mild sedative to help you relax during the test and your throat will be sprayed with a local anesthetic to make it “numb” and reduce your gag reflex.

In the case of a transthoracic echocardiogram, the patient’s chest is applied with gel for sound waves to pass easily. The probe (transducer) is then passed across the chest to generate sound waves that bounce off the heart and “echo” back to the probe. The sound waves are converted into pictures and shown on a video monitor. These are then recorded for the doctor. The process takes about 40 minutes to one hour. 

Echocardiography test details (before/during/after)

Prior to the test please follow any instructions given by your healthcare provider. If undergoing a transesophageal echocardiogram (TEE), you may be asked to stop eating or drinking after midnight the day of the test.  On the day of the test, wear comfortable clothing that is easy to remove.

During the test, you will meet the ultrasound technologist (sonographer) who will carry out the test. You will be given a gown to wear to cover yourself during the exam. The sonographer will position you on a table, on either your back or left side.  Small electrodes will be placed on your chest to monitor your heart rate and a cool gel will be applied to your chest area.

If your doctor ordered an echocardiography with contrast the sonographer will inject a saline solution or dye into your veins, which makes the heart look more defined on the echocardiogram.

You may be asked to change positions during the test and hold your breath for a few seconds.

After the test, the pictures will be sent to your doctor or a cardiologist for review.  Most patients can return to their normal activities right away. People having a transesophageal echocardiogram (TEE) may need to rest for a few hours after the procedure as they may experience a sore throat initially, but it usually gets better within a few hours to a day. People who received a sedative before the exam should not drive for a few hours after the test is completed.

Results and follow-up (if applicable)

After the test, the sonographer sends the echocardiographic images to the doctor who ordered the test. The doctor will appraise the images and look for symptoms of heart problems such as:

  • Injured heart muscle tissue
  • Thick or thin ventricle walls
  • Irregular chamber size
  • Poorly functioning valves
  • Reduced pumping strength
  • Masses in the heart, like blood clots or tumors

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