SPECIAL DIAGNOSTIC PROCEDURE
5 Echocardiogram | July 1, 2022
ECHOCARDIOGRAM
• Otherwise known as the echo test which is
considered as a scan used to look for the heart and
at the same time the nearby blood vessels.
• Echoes are actually picked up by the probe and turn
into a moving image in the monitor while the scan is
being carried up.
• Echocardiogram is not the same as ECG, which is
used to check for hearts rhythm and electrical activity.
• The advantage of the echo test is that the anatomical
features of the heart is actually checked and the
cardiologist will be able to analyze how the blood
flows through them and assessing the heart
chambers as well.
• It is part of the series of cardiac testing and the
cardiologist is the one to decide if the test is needed.
• It's a type of ultrasound scan, which means a small
probe is used to send out high-frequency sound
waves that create echoes when they bounce off
different parts of the body
• Cardiac sonographers, also known as
echocardiographers-operate ultrasound equipment
that provides moving 2-D or 3-D images of the heart
and its chambers. This test they perform is called an
echocardiogram.
• They are healthcare professionals who are
specifically trained in the imaging technology. They
would actually help the physicians diagnose heart
problems to certain patients.
Common Responsibilities and Duties of a Cardiac
Sonographer include:
• Performing echocardiogram tests.
In order to obtain important data about the patient.
• Looking at blood flow, valve function, and chamber
size.
• Accurately recording patient's data and test results
• Helping with administrative duties such as scheduling
appointments or cleaning
Importance
An echocardiogram can help detect:
• damage from a heart attack
wherein the supply of blood to the heart is suddenly
blocked.
• heart failure
the heart fails to pump enough blood around the body
at the right pressure
• congenital heart disease
birth defects that affect the normal activities of the
heart
• problems with the heart valves
that would control the flow of the blood within the
heart
• cardiomyopathy
thickening of the heart walls or enlargement of the
heart
• endocarditis
Types
Transthoracic Echocardiogram
• The probe is attached by a cable to a nearby machine
that will display and record the images produced.
• Most common of all the types, here the probe is
actually moved across the chest.
Transesophageal Echocardiogram
• More-detailed images are captured
• This is done whenever there is a difficulty to get a
clear picture of the heart with a standard
echocardiogram.
• The doctor is the one who actually recommends for
this.
• In this procedure, the throat is numb and a flexible
tube containing the transducer is guided down to the
throat into the tube connecting the mouth to the
stomach.
• The transducer is the one that records the
soundwaves or echoes from the heart.
• It is a quite invasive, and it is optional and an
alternative to transthoracic.
Stress Echocardiogram
• An echocardiogram carried out during or just after a
period of exercise
• this is part of the process of cardiac stress test
particularly those involving arteries that would supply
the heart muscles in cases where coronary arteries
wherein problems occur only during physical
activities.
The type of echo test that the patient will have depend on
the heart condition being assessed and of course how
images need to be detailed. The doctor decides for the
proper procedure with regards to the patient’s needs.
Risk
• A standard echocardiogram is a simple, painless,
safe procedure.
• There is no radiation during echo test.
• There could be associated risk with the less common
types of echo test such as the transesophageal where
the patient may feel uncomfortable, the throat may
feel sore few hours after the procedure.
• In stress echocardiogram, the patient may feel sick or
dizzy following exercise, and may also experience
chest pain.
Preparation
• No special preparations are necessary for a standard
transthoracic echocardiogram.
• In trans esophageal, the patient needs to fast
ECHOCARDIOGRAPHY
• Echocardiography utilizes ultrasound to produce
images of the heart and vascular structures and to
provide information about the direction and velocity of
blood flow within these structures.
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• Ultrasound refers to sound waves with a frequency
well beyond the range of human hearing.
• Echocardiography utilizes properties of soundwaves
interaction with human tissue, the soundwaves are
sent through a device called transducer and are
reflected of structures if the heart.
• These echoes are converted into pictures of the heart
that can be seen in a video monitor.
There are 5 basic components of an ultrasound scanner
that are required for generation, display and storage of an
ultrasound image.
1. Pulse generator - applies high amplitude voltage to
energize the crystals
2. Transducer - converts electrical energy to
mechanical (ultrasound) energy and vice versa
3. Receiver - detects and amplifies weak signals
4. Display - displays ultrasound signals in a variety of
modes
5. Memory - stores video display
• Ultrasound gel is applied to the transducer to allow
transmission of soundwaves from the transducer to
the scheme.
• The transducer transform echo which is the
mechanical energy into an electrical signal which is
processed and displayed as an image on the screen.
• The conversion of the sound to electrical energy is
called the piezoelectric effect.
Importance:
• Assess the overall function of the heart.
• Determine the presence of many types of heart
diseases.
Such as valve diseases, myocardial diseases,
pericardial, infective endocarditis and congenital
heart diseases.
• Follow the progress of valve disease over time
• Evaluate the effectiveness of the medical or surgical
treatments
Indications
Abnormal findings in echocardiogram may provide
information about:
• Changes in the heart size
Weakened or damaged heart valves, high blood
pressure or other diseases can cause the chambers
of the heart to enlarge or the walls of the heart to be
abnormally thickened
• Pumping strength
The measurements obtained from echocardiogram
includes the percentage of blood that’s pumped out of
a failed ventricle with each heartbeat and also the
volume of the blood pumped by the heart in 1 minute
which is the cardiac output. The heart that is not
pumping enough blood to meet the body’s needs can
lead to symptoms of heart failure.
• Damage to the heart muscle
Echocardiogram would help the doctor determine
whether all parts of the heart wall are contributing
normally to the heart’s pumping activity, areas of the
heart that move quickly may have been damaged
during a heart attack or is receiving too little oxygen.
• Valve problems
The test can help determine if the heart valves open
wide enough for adequate blood flow or close fully to
prevent blood leakage.
• Heart defects
It may also show problem with the heart chambers,
abnormal connections between the heart and the
major blood vessels and complex heart beat that are
already present at birth.
Risk/ Contraindications
• No risks are involved in a standard transthoracic
echocardiogram
The patient may feel some discomfort from the
transducer being held very firmly against the chest.
The firmness is necessary to produce the best images
of the heart.
• In a transesophageal echocardiogram, the patient’s
throat may sore for a few hours after the procedure.
Rarely the tube may scrape the inside of the throat,
the oxygen level will be monitored during the
examination to check for any breathing problems
caused by sedation medication.
Examination Protocol
Preparations:
• No special preparations are necessary for a standard
transthoracic echocardiogram.
The patient can eat, drink, and take medications as
they normally would.
• In transesophageal echocardiogram, the patient will
be asked not to eat for several hours beforehand.
During the Procedure
Transthoracic Echocardiogram:
Rules of the echo technician who will be performing the
procedure:
• First is to ask the patient to lay on an examination
table or bed.
• Next, the technician will attach sticky patches
(electrodes) to the patient’s body. To help detect and
conduct the heart’s electrical currents.
• The technician will also
apply a gel to the
transducer that
improves the conduction
of sound waves.
• The technician will move
the transducer back and
forth over the chest to
record images of
soundwave echoes from
the heart.
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 • The patient may hear a pulsing sound which is the 4. 2-D (two-dimensional) Echocardiography
ultrasound recording the blood flowing through the • This technique is used to "see" the actual motion of
heart. the heart structures.
• The patient may also be asked to breath in a certain • A 2D echo view appear as cone shaped on the
way or to roll onto the left side. monitor and the real time motions of the heart
Echo Techniques structures can be observe, this enables the doctor to
An echocardiogram may use several special types of see the various heart structures at work and evaluate
echocardiography. them.
1. M(motion)-mode Echocardiography
• This is the simplest type of echocardiography that
produces an image that is similar to a tracing rather
than an actual picture of heart structures.
• It is useful for measuring or viewing heart structures,
such as the heart's pumping chambers, the size of the
heart itself, and the thickness of the heart walls.

5. 3-D (three-dimensional) Echocardiography

• It captures three-dimensional views of the heart
structures with greater detail than 2-D echo.
• The live or real time images allows for a more
accurate assessment of the heart function by using
measurements taken while the heart is beating.
• 3-D echo shows enhanced views of the heart's
anatomy and can be used to determine appropriate
plan of treatment for a person with heart disease.
2. Doppler Echocardiography
• It is used to measure and assess the flow of blood
through the heart's chambers and valves.
• The amount of blood pumped out with each beat is an
indication of heart’s functioning.
• It can also detect abnormal blood flow within the heart
which can indicate a problem with one or more of the
heart’s 4 valves or with the heart’s walls.

Types:
1. Transthoracic Echocardiogram
• standard echocardiogram
3. Color Doppler • a painless test similar to x-ray but without the
• It is an enhanced form of doppler echocardiography radiation.
• The different colors are used to designate the • A hand-held device called a transducer is placed
direction of blood flow, this simplifies interpretation of on the chest and transmits high frequency sound
the doppler technique. waves (ultrasound) and these sound waves bound
off the heart structure producing images and
sounds to detect heart damage and disease.

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Standard positions on the chest wall are used for 4. Intravascular Ultrasound
placement of the transducer called “echo windows” • A form of echocardiography performed during
cardiac catheterization.
• During this procedure, the transducer is threaded
into the hart vessels via a femoral catheter.
• It is used to provide detailed information about the
atherosclerosis inside the blood vessels.
5. Fetal Echocardiography
• It is used to diagnose cardiac conditions in the fetal
stage.
• Cardiac defects are among the most common birth
defects, their diagnosis is important in the fetal stage
as it might help provide an opportunity to plan and
2. Transesophageal Echocardiogram (TEE) manage the baby as the baby is born.
• This test requires that the transducer be inserted
down the throat into the esophagus.
• The esophagus is located close to the heart,
therefore, clear images of the heart structures can
be obtained without the interference of the lungs
and the chest.
• TEE provides superior image quality, particularly
for posterior cardiac structures which are nearer to
the esophagus and less well visualized on
transthoracic echocardiography.

3. Stress Echocardiogram
• It is performed while the person exercises on a
treadmill or stationary bicycle.
• To visualize the motion of the heart's walls and
pumping action when the heart is stressed.
• It may reveal a lack of blood flow that is not always
apparent on other heart test.
• The echocardiogram is performed just prior and just
after the exercise.

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