Echocardiogram insight

The term “echo” is most likely a familiar one, but unlike its everyday definition, this one is used in reference to an echocardiogram. An echocardiogram is a noninvasive procedure in which a sonographer uses Doppler ultrasound to observe the entirety of the heart in an effort to gain insight into one’s cardio health. There are a number of reasons why a physician may order an echo, and a number different types and ways in which they can be conducted. But just how exactly does an echocardiogram work? Are there any risks or potential complications? How is one performed? All questions will be answered as we dive deeper into the anatomy of the echo.

The History:

Echocardiograms, in the grand scheme of medicine, are relatively new coming in at only about 70 years old. Inde Edler, considered to be the “Father of Echocardiography,” created the first medical echocardiogram back in 1953 after being inspired by a French physician’s suggestion of using RADAR and SONAR to view human organs. After many years of trial and error with his cohorts, the delicate adaptation of high-frequency sound waves used to view inside the body suddenly changed not only the face of medicine but how procedures were done. Since then several different types of echocardiograms have been developed by pioneering scientists in order to serve more specific purposes, and view the heart with varying techniques.

Types of Echos:

The most common types of echos are Transthoracic and Transesophageal. The Transthoracic, being the more regularly performed, is similar to that of an ultrasound given to a pregnant woman; the transducer, or ultrasound wand, will be pressed and dragged along multiple sections of the chest in order to view the heart at different angles, all while the patient lays comfortably on the exam table. Comparatively the Transesophageal echo works the same way with the exception of being performed inside the body via the esophagus; the transducer will be inserted through the mouth in order to get closer to the heart to take clearer images. Slightly less common echocardiograms are two types of “stress tests” where the patient will either exercise vigorously or be given dobutamine to simulate the same amount of exercise, and then monitored, and the more invasive intravascular ultrasound in which a transducer is inverted via a catheter in the groin area and fed up into the arteries to view blockages. For the sake of brevity we will only be covering Transesophageal and Transthoracic echocardiograms in this article.

About Sonographers:

When getting an echo done, a sonographer will conduct the exam, then a cardiologist will read the results and convey their findings to the primary doctor. In order to perform the procedure, sonographers must first obtain an undergraduate degree, follow up with a Medical Ultrasound degree or sonography training, and be well practiced in patient care, biology, physics, technology, and health. While sonographers may not be full fledged doctors, their expertise at performing their job is quite impressive. The ability to properly capture and read the heart is difficult, and it is important that this job is done correctly in order to have a proper outcome. So what exactly does a proper echo look like?

The Anatomy and What it’s For:

In order to fully understand what an echocardiogram does and what it is for, we first need to look at the anatomy of the heart. The heart is a muscle comprised of four chambers (the atrium and ventricles), valves and other blood vessels. During an echo, each section of the heart is examined while images are captured and shown on a monitor in varying colors. Each color indicates varying levels of blood flow and will help pinpoint problem areas. Through the use of Doppler signals through the transducer, sound waves are bounced off of the heart and are echoed back to the probe, earning the procedure its fitting name. These images are used to view both of the upper chambers of the heart (atrium), the two lower chambers (ventricles), the aorta, arteries, and viens, the thickness of the muscle, the function and strength of the pumping, whether blood is leaking backwards into the flow, the overall size of the heart and its segments, see abnormal holes, view the outer lining (pericardium), monitor birth defects, and determine whether there are any growths, tumors, or blood clots. An echo is a great way to cover heart health and an incredibly noninvasive way to do it. Since echocardiograms use sound waves and not radiation, there are zero risks and have never been any complications; it is most likely the safest medical exam or procedure one could ever get.

Prep & Procedure:

Now let’s talk a little about what happens during an echo. The preparation for an echo depends on the type. For a Transthoracic echocardiogram, there is almost no preparation; all medication can be taken regularly, normal food and drinks can be consumed at any time, and there is no restriction on exercise before or after the procedure. There are only a couple differences for the Transesophageal echo; six hours before the procedure all food and drink intake must stop and any problems with the esophagus including hiatal hernias, problems swallowing, and cancer, must be conveyed to the doctor beforehand. In both cases small, sticky disks called electrodes will be stuck to specific sections of the chest and will be connected to wires that feed into an echocardiography monitor, which will track electrical activity; this is also called an EKG or ECG. During a Transthoracic echo, the sonographer will then have the patient open their medical gown from the waist up and gel will be applied liberally on the areas of the chest being monitored; the transducer will be pressed firmly to the chest and the patient may be asked to change laying positions in order to capture better images. A repetitive “swooshing” sound will be audible from the machine as the sonographer watches your heart beat and the chambers open and close.

Similarly, the Transesophageal echo maintains the same essence, but is performed a bit differently. We mentioned before that the transducer is inserted orally into the esophagus rather than used on the chest, but before doing so an IV will be inserted to administer medication and fluids, a blood pressure cuff will be put on, and an oximeter will be places on the finger to monitor vitals. The patient will then be given a mild sedative to both ease nerves and allow the procedure to progress smoothly. The probe isn’t large enough to inhibit normal breathing and the sonographer may instruct the patient to swallow to help the transducer maneuver down the throat to the esophagus. After the images are taken, which can’t be felt, the probe will be taken out and the procedure is finished.

What Happens After:

After an echocardiogram, the results will be sent to a cardiologist, who will read the images and come to a determination. The cardiologist’s determination will then be sent off to the patient’s

doctor to be conveyed, and an additional “stress test” may be conducted. In the unfortunate event that an echo comes back abnormal, some possible frequent diagnoses include atrial fibrillation, cardiovascular disease, heart valve disease, thickening of heart walls, pericardial effusion, mitral valve prolapse, and more. In rare cases the diagnosis may be severe but many heart problems are treatable. No matter what the diagnosis, the next step will be at the discretion of both the doctor and patient in conjunction, and followed through with care.

Echocardiograms are often ordered when a patient is exhibiting symptoms of heart disease, shortness of breath, chest discomfort, leg swelling, and heart murmurs. If you’re thinking about getting an echo or are worried, talk to your doctor about all of your concerns or symptoms and the best course of action. It is likely he or she will do a physical exam first and listen to your heart before ordering blood work or referring you to cardiology. If/when your echo takes place, glance at the monitor and watch the amazing sight of your valves opening and closing, it may just make you appreciate your heart health in a new way.

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