What is echocardiography?

Echocardiography often called heart echo or sip echo is one of the most critical routine examinations at heart. This ultrasound examination can provide information about various heart diseases. There are several variants of the heroes, some of which can be combined.

During the examination, the doctor holds an ultrasound head to the chest from the outside. An ultrasound probe at the tip of an endoscope can also be inserted over the esophagus down to heart level. The devices emit sound waves that are reflected in different degrees by the various tissues of the heart and by the blood-filled ventricles. The echo of these sound waves creates a moving black and white picture on a monitor.

The ultrasound image generated in this way shows the structure of the heart and makes it possible, for example, to assess the size of the heart chambers, the function of the heart valves or the thickness of the heart muscle. Besides, the heart can be observed in real time at work and determine the direction of flow of various bloodstreams or the pumping power of the spirit.

What types of echocardiography are there?

Echocardiography from the outside through the thorax (TTE)

In the most common cardiac echo, transthoracic echocardiography (TTE), the ultrasound head is placed on the outside of the anterior chest wall. The TTE is a simple, fast and inexpensive process. It already provides much information about the cavities of the heart, the heart valves, the heart muscle and the performance of the heart. Also, the following examinations are possible:

3D imaging of the breast: Using a particular ultrasound probe, a three-dimensional spatial representation of the heart is also possible. It is mainly used to assess the heart valves and heart failure.
Doppler and color Doppler echocardiography: A Doppler echocardiography makes the blood flow visible, a color Doppler echocardiography shows the direction of blood flow in different colors. Sound waves of a particular frequency are used. The flow rate of the blood can also be measured. This makes, for example, small valve defects or holes visible in the cardiac septum.

Stress echocardiography: A heart echo is possible even under stress. In this “stress echo” cardiac output is increased by physical exertion on the bicycle ergometer or by individual drugs. The drugs increase the oxygen demand of the heart and are injected into the arm vein. Under stress, signs of disturbed blood flow to the coronary arteries become apparent, for example, movement disorders of the heart wall.
Sometimes a contrast agent is injected into a vein and observed as it spreads under stress in the heart. Areas that are not well supplied with blood stain less strongly with the contrast medium.

Echocardiography of the esophagus (TEE)

In transesophageal echocardiography (TEE), the ultrasound head is at the tip of a long, flexible tube that is gently inserted through the mouth into the esophagus, similar to a gastroscopy. Since the throat is located close behind the heart, this examination can provide more accurate images than external echocardiography.

Above all, the atria and the heart valves can be examined very well with the TEE. It is therefore used in atrial fibrillation to detect blood clots in the atria, or suspected bacterial infection of the heart valves (endocarditis). Also, sagging of the thoracic aorta (an aortic aneurysm) and congenital heart defects are more evident with a TEE than with a TTE.

What is being investigated with echocardiography?

For example, the ultrasound image of the heart transmits information.

  • Changes in the heart valves,
  • congenital heart defects such as a hole in the heart septum,
  • Myocardial diseases (for example with thickened heart wall and enlarged heart chambers),
  • Pericardial diseases (pericardial diseases),
  • Circulatory or pumping disorders in the heart,
  • Changes in the center that may indicate a pulmonary embolism, a tumor or a possible aneurysm on the aorta, the main artery.
  • In people with coronary heart disease (CHD) or after a heart attack, a cardiac echo can also help identify damaged areas of the heart. Echocardiography may also be useful if an electrocardiogram (ECG) has revealed abnormalities.

Although heart ultrasound does not map the coronary arteries – this would require cardiac catheterization or computed tomography (CT) of the heart – but it can indirectly provide information on their blood flow. If, for example, certain areas of the center appear to be less mobile in ultrasound than usual, this may indicate poor perfusion of the coronary arteries.

How do you prepare for the investigation?

For the standard echocardiography from the outside usually, no preparation is necessary.

When the transducer is inserted through the esophagus (TEE), do not eat for at least four hours before the exam. Eating and drinking are not allowed until one or two hours later.

How is the examination performed?

For external echocardiography (TTE), the upper body must be free. As a rule, one lies in a slight lateral position, sometimes with a slightly raised upper body. Especially old and frail people or those with shortness of breath sometimes do not like the lateral examination. They can be examined in the supine position, but the image quality is a bit worse then.

As always with the ultrasound, the doctor applies a contact gel to the skin. With light pressure, the probe is then passed over the thorax. The images on the monitor can be immediately saved and evaluated.

In TEE, a long, flexible tube is gently inserted through the mouth into the esophagus. It helps to swallow actively; That is why the study is also referred to as consuming. To avoid gagging, a local anesthetic is sprayed into the throat. Sometimes a light sedative is given. Then you are not allowed to drive your car, bike or bike on that day.

Does the investigation have any risks?

If there is an external investigation, there are no risks. Radiation exposure is not associated with ultrasound.

During the swallowing echo (TEE), it can lead to gag reflexes and strong salivation. An injury to the esophagus is very rare.

If echocardiography uses local anesthetics, tranquilizers or contrast agents, side effects such as allergic reactions or respiratory problems are possible. Contrast agents can cause short-term headaches, nausea, anxiety or vision and hearing issues.

The risks of exercise echocardiography are similar to those of a stress ECG. For example, cardiac arrhythmias may occur, blood pressure may rise or fall sharply, or the supply of heart muscle oxygen may be reduced. It must, therefore, be clarified before the investigation whether there is an increased risk of such problems. Also, the examination takes place in a room that is equipped so that the doctor can immediately respond to complications.


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