echocardiograph

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More about Echocardiography: Purpose Precautions Preparation Aftercare Risks Normal results Abnormal results Resources

Definition

Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart's valves and chambers as well as the flow of blood through the heart. Echocardiography may show such abnormalities as poorly functioning heart valves or damage to the heart tissue from a past heart attack.

Description

Echocardiography creates an image of the heart using ultra-high-frequency sound waves—sound waves that are too high in frequency to be heard by the human ear. The technique is very similar to ultrasound scanning commonly used to visualize the fetus during pregnancy.

An echocardiography examination generally lasts between 15–30 minutes. The patient lies bare-chested on an examination table. A special gel is spread over the chest to help the transducer make good contact and slide smoothly over the skin. The transducer, a small hand-held device at the end of a flexible cable, is placed against the chest. Essentially a modified microphone, the transducer directs ultrasound waves into the chest. Some of the waves get echoed (or reflected) back to the transducer. Since different tissues and blood all reflect ultrasound waves differently, these sound waves can be translated into a meaningful image of the heart, which can be displayed on a monitor or recorded on paper or tape. The patient does not feel the sound waves, and the entire procedure is painless. In fact, there are no known side effects.

Occasionally, variations of the echocardiography test are used. For example, Doppler echocardiography employs a special microphone that allows technicians to measure and analyze the direction and speed of blood flow through blood vessels and heart valves. This makes it especially useful for detecting and evaluating regurgitation through the heart valves. By assessing the speed of blood flow at different locations around an obstruction, it can also help to precisely locate the obstruction.

An exercise echocardiogram is an echocardiogram performed during exercise, when the heart muscle must work harder to supply blood to the body. This allows doctors to detect heart problems that might not be evident when the body is at rest and needs less blood. For patients who are unable to exercise, certain drugs can be used to mimic the effects of exercise by dilating the blood vessels and making the heart beat faster.

— Robert Scott Dinsmoor

Definition

Echocardiography is a diagnostic test that uses ultrasound waves to produce an image of the heart muscle and the heart's valves.

Purpose

Echocardiography is used to diagnose certain cardiovascular diseases, and is one of the most widely used diagnostic tests for heart disease. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart's valves and chambers, as well as the flow of blood through the heart. Echocardiography may show abnormalities such as a poorly functioning heart valve or damage to the heart tissue from a heart attack. Echocardiography is especially useful for assessing disorders of the heart valves. It not only allows doctors to evaluate the heart valves, but can also detect abnormalities in the pattern of blood flow. For example, echocardiography can show the backward flow of blood through heart valves that are partially open (that should be fully closed). This backward flow of blood through a valve is known as regurgitation. By assessing the motion of the heart wall, echocardiography can help detect the presence, and assess the severity, of coronary artery disease, as well as help determine whether chest pain is related to heart disease. Additionally, echocardiography can help detect hypertrophic cardiomyopathy, in which the walls of the heart thicken in an attempt to compensate for heart muscle weakness.

Echocardiography is also used to evaluate heart murmurs (abnormal heart sounds), determine the causes of congestive heart failure, assess enlarged hearts or hearts with septal defects (holes between pumping chambers), and monitor the heart in patients with diseases that may affect heart function (e.g., lupus, lung diseases). The biggest advantage to echocardiography is that it is noninvasive (it does not involve breaking the skin or entering body cavities) and has no known risks or side effects. Echocardiography is often used in conjunction with other diagnostic tests for the heart such as electrocardiography.

Echocardiography is usually performed in the cardiology department at a hospital, but may also be performed in a cardiologist's office or an outpatient imaging center. Because the ultrasound scanners used to perform echocardiography are portable (handheld) or mobile, echocardiography can be performed in the hospital's emergency department or at the bedside of patients who cannot be transported to the cardiology department.

Description

Echocardiography creates an image of the heart using ultra-high-frequency sound waves—sound waves that are too high in frequency to be heard by the human ear. The technique is very similar to ultrasound scanning commonly used to visualize the fetus during pregnancy.

An echocardiography examination generally lasts between 15–30 minutes. The patient lies bare-chested on an examination table. A special gel is spread over the chest to help the transducer make good contact and slide smoothly over the skin. The transducer, also called a probe, is a small handheld device at the end of a flexible cable. The transducer, essentially a modified microphone, is placed against the chest and directs ultrasound waves into the chest. Some of the waves get echoed (or reflected) back to the transducer. Since different tissues and blood reflect ultrasound waves differently, these sound waves can be translated into a meaningful image of the heart that can be displayed on a monitor or recorded on paper or tape. The patient does not feel the sound waves, and the entire procedure is painless.

Occasionally, variations of the echocardiography test are used. For example, Doppler echocardiography employs a special microphone that allows technicians to measure and analyze the direction and speed of blood flow through blood vessels and heart valves. This makes it especially useful for detecting and evaluating regurgitation through the heart valves. By assessing the speed of blood flow at different locations around an obstruction, it can also help to precisely locate the obstruction.

An exercise echocardiogram, or stress echo, is an echocardiogram performed during exercise, when the heart muscle must work harder to supply blood to the body. This allows doctors to detect heart problems that might not be evident when the body is at rest and needs less blood. For patients who are unable to exercise, certain drugs can be used to mimic the effects of exercise by dilating the blood vessels and making the heart beat faster.

During the examination the sonographer can take measurements and, using the ultrasound scanner's computer, make calculations, including measuring blood flow speed. Most ultrasound scanners are equipped with videotape recorders or digital imaging/archiving devices to record the real-time examination, and with medical image printers to print out hard copies of still images.

Preparation

The patient removes any clothing and jewelry above the chest.

Aftercare

No special measures need to be taken following echocardiography.

Risks

There are no known complications associated with the use of echocardiography. There is a slight risk of having a heart attack during an exercise echocardiogram, due to the stress put on the heart during the test, mostly for patients with a history of heart attack or other risk factors.

Normal Results

A normal echocardiogram shows a normal heart structure and the normal flow of blood through the heart chambers and heart valves. However, a normal echocardiogram does not rule out the possibility of heart disease.

An echocardiogram may show a number of abnormalities in the structure and function of the heart, including:

• thickening of the wall of the heart muscle (especially the left ventricle)
• abnormal motion of the heart muscle
• blood leaking backward through the heart valves (regurgitation)
• decreased blood flow through a heart valve (stenosis)

Resources

Books

The Patient's Book of Medical Tests. Boston, New York City: Houghton Mifflin Company, 1997.

Periodicals

Kosoff, George. "Basic Physics and Imaging Characteristics of Ultrasound." World Journal of Surgery 24 (February 2000): 134–142.

Lee, Thomas H., and Charles A. Boucher. "Noninvasive Tests in Patients with Stable Coronary Artery Disease." New England Journal of Medicine 344, no. 24 (June 14, 2001): 1840–6.

Organizations

American College of Cardiology. Heart House. 9111 Old Georgetown Road, Bethesda, MD 20814-1699. (800) 253-4636. http://www.acc.org.

American Heart Association National Center. 7272 Greenville Avenue, Dallas, TX 75231. (800) AHA-USA1. http://www.americanheart.org.

American Institute of Ultrasound in Medicine. 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707-5906. (301) 498-4100. http://www.aium.org.

American Registry of Diagnostic Medical Sonographers. 600 Jefferson Plaza, Suite 360, Rockville, MD 20852-1150. (800) 541-9754. http://www.ardms.org.

American Society of Echocardiography. 1500 Sunday Drive, Suite 102, Raleigh, NC 27607. (919) 787-5181. http://asecho.org.

Other

Barasch, Eddy. "Why Doctors Use Echocardiography." http://www.thedoctorwillseeyounow.com/articles/heart/echo card_3/.

— Jennifer E. Sisk, MA Lee Shratter, MD

A diagnostic procedure that uses ultrasound at a frequency of 2.5–10 mHz to provide an image of the heart. The principle is that the interface between tissues of different acoustical impedance causes the ultrasound to be reflected to the transducer which spends a fraction of each second receiving these echoes. There are many interfaces between blood and the various structures in the heart that contact blood, such as the heart walls, valves, and great vessels. Also, the surface of the heart reflects ultrasound because it is surrounded by the lungs, which are filled with air. See also Ultrasonics.

An ultrasound image of the heart is generated on a video monitor (see illustration). The image is generated by moving the ultrasound beam mechanically or electronically repeatedly through an arc. The transducer is usually applied to the anterior chest by using a coupling gel devoid of air. This procedure is referred to as transthoracic echocardiography. Small transducers can also be attached to probes placed in the esophagus behind the heart—a procedure known as transesophageal echocardiography; and during heart surgery the transducer can be placed directly on the heart—a procedure known as epicardial echocardiography. The closer the transducer is to the heart, the higher the resolution of the resulting images.

Two-dimensional echocardiogram from a position near the apex of the ventricles. The left ventricle is on the right, separated from the left atrium below by the mitral valve. The right ventricle is on the left, and the right atrium is below it with the tricuspid valve in between.

Two-dimensional echocardiography is completely harmless and provides such excellent images of the heart that it has largely replaced other more risky imaging techniques and those that require radiation exposure. It is unequaled for determining the anatomy and function of heart valves, detecting abnormal amounts of pericardial fluid, and defining the complex anatomy of congenital heart defects. Thus, two-dimensional echocardiography is frequently employed to evaluate suspected or overt heart disease.

Echocardiography can also be used to assess blood flow in the heart by employing the Doppler principle. Three basic types of Doppler echocardiographic systems are available on most ultrasound machines: continuous wave, pulsed, and color flow. In a continuous-wave (CW) Doppler system, sound is continuously transmitted and received. The advantage of continuous-wave Doppler is that the very high velocities of severe structural heart defects are accurately quantitated. Pulsed Doppler avoids the range ambiguity of the continuous-wave Doppler by being able to range-gate the returning echoes so that only certain areas in the sound beam are sampled. However, pulsed Doppler cannot resolve very high velocities. Pulsed and continuous-wave Doppler are useful for detecting and localizing increased velocities associated with obstructions to flow. In the third system, color-flow Doppler, small sample volumes (0.04–0.08 in. or 1–2 mm) throughout the two-dimensional echocardiographic image are sampled for velocity, and only velocities fast enough to result from blood movement are displayed, superimposed on the two-dimensional echocardiographic image and color-encoded. Color Doppler is excellent for displaying abnormal flow due to valve leakage or other structural defects. See also Doppler effect.

The complete echocardiographic examination also includes selective sampling along certain radians in the arced two-dimensional image, and displaying of the movement of the structures crossed by the radian over time in an analog fashion. This format is called time-motion echocardiography or M-mode echocardiography. It is adjunctive to two-dimensional and color-flow Doppler echocardiography for answering specific questions about heart structural dimensions and function. See also Heart disorders.

Recording of the position and motion of the heart walls or internal structures of the heart and neighboring tissue by the echo obtained from beams of ultrasonic waves directed through the chest wall.
Echocardiography is based on the same principle as the oceanographic technique of depth-sounding; that is, it utilizes ultrasound to delineate anatomical structures by recording on a graph the echoes from the heart structures. It is particularly useful in demonstrating, without danger to the patient, valvular and other structural deformities of the heart which formerly required cardiac catheterization or some other elaborate procedure for accurate diagnosis. See also ultrasonography.

• contrast e. — microbubbles in liquid are used as a vascular contrast medium. When injected intravenously in a selected or non-selected location, these can be tracked to demonstrate abnormalities of blood flow.
• transesophageal e. — the ultrasound probe is mounted on a flexible endoscope and is positioned in the esophagus over the base of the heart, thus enabling unique viewing projections of structures in this area.

Not to be confused with electrocardiography.

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File:'Echocardiogram' 4chambers.jpg

An echocardiogram. Image shows that the human heart has four chambers. Apical view - left side of the heart to the right. Anatomically correct image - heart's apex at bottom. The trace in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the image was captured.

An abnormal echocardiogram. Image shows a mid-muscular ventricular septal defect. The trace in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colors are used to represent the velocity and direction of blood flow.

Sonographer doing pediatric echocardiography

Echocardiogram in the parasternal long-axis view, showing a measurement of the heart's left ventricle

Ventricular septal defect

An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging.

In addition to creating two-dimensional pictures of the cardiovascular system, an echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave Doppler ultrasound. This allows assessment of cardiac valve areas and function, any abnormal communications between the left and right side of the heart, any leaking of blood through the valves (valvular regurgitation), and calculation of the cardiac output as well as the ejection fraction.

Echocardiography was an early medical application of ultrasound. Echocardiography was also the first application of intravenous contrast-enhanced ultrasound. This technique injects gas-filled microbubbles into the venous system to improve tissue and blood delineation. Contrast is also currently being evaluated for its effectiveness in evaluating myocardial perfusion. It can also be used with Doppler ultrasound to improve flow-related measurements (see Doppler echocardiography).

Echocardiography is either performed by cardiac sonographers or doctors trained in cardiology.

Contents 1 Purpose 2 Transthoracic echocardiogram 3 Transoesophageal echocardiogram 4 3-dimensional echocardiography 5 Accreditation 6 See also 7 References 8 External links

Purpose

Echocardiography is used to diagnose cardiovascular diseases. In fact, it is one of the most widely used diagnostic tests for heart disease. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity and the location and extent of any damage to its tissues. It is especially useful for assessing diseases of the heart valves. It not only allows doctors to evaluate the heart valves, but it can detect abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation. By assessing the motion of the heart wall, echocardiography can help detect the presence and assess the severity of coronary artery disease, as well as help determine whether any chest pain is related to heart disease. Echocardiography can also help detect hypertrophic cardiomyopathy. The biggest advantage to echocardiography is that it is noninvasive (doesn't involve breaking the skin or entering body cavities) and has no known risks or side effects.

Transthoracic echocardiogram

Main article: Transthoracic echocardiogram

A standard echocardiogram is also known as a transthoracic echocardiogram (TTE), or cardiac ultrasound. In this case, the echocardiography transducer (or probe) is placed on the chest wall (or thorax) of the subject, and images are taken through the chest wall. This is a non-invasive, highly accurate and quick assessment of the overall health of the heart.

Transoesophageal echocardiogram

Main article: Transoesophageal echocardiogram

This is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's oesophagus. This allows image and Doppler evaluation which can be recorded. This is known as a transoesophageal echocardiogram, or TOE (TEE in the United States).

3-dimensional echocardiography

3D echocardiogram of a heart viewed from the apex

3-D echocardiography is now possible, using an ultrasound probe with an array of transducers and an appropriate processing system. This enables detailed anatomical assessment of cardiac pathology, particularly valvular defects,^[1] and cardiomyopathies.^[2] The ability to slice the virtual heart in infinite planes in an anatomically appropriate manner and to reconstruct 3-dimensional images of anatomic structures make 3D echocardiography unique for the understanding of the congenitally malformed heart.^[3]

Accreditation

• United States: The "Intersocietal Commission for the Accreditation of Echocardiography Laboratories" (ICAEL) sets standards for the echo labs, cardiologists and technologists in the US to comply to. Once all requirements have been met, the lab will receive ICAEL certification. A lab that has received the certification may also receive higher reimbursement from insurance companies such as Medicare and United Healthcare. http://www.icael.org/icael/index.htm

• UK: In the UK, accreditation is done by the British Society of Echocardiography. Accredited technologists or other professionals from the echocardiography field will have completed a logbook and passed an exam.

• Europe: At a European level,individual and laboratory accreditation is provided by the European Association of Echocardiography (EAE). Three subspecialties for individual accreditation: Adult Transthoracic Echocardiography (TTE), Adult Transesophageal Echocardiography (TEE) and Congenital Heart Disease Echocardiography (CHD).

See also

• Angiogram
• Aortic valve area calculation
• Electrocardiogram
• Fetal echocardiography

References

1. ^ Poh KK, Levine RA, Solis J, Shen L, Flaherty M, Kang YJ, Guerrero JL, Hung J. (2008). "Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography". Eur Heart J 29: 2526. doi:10.1093/eurheartj/ehn022. PMID 18263866. 
2. ^ Goland S, Czer LS, Luthringer D, Siegel RJ. (2008). "A case of arrhythmogenic right ventricular cardiomyopathy". Can J Cardiol 24 (1): 61–2. PMID 18209772. 
3. ^ Impact of Multiplanar Review of Three-Dimensional Echocardiographic Data on Management of Congenital Heart Disease. Ann. Thorac. Surg., September 2008; 86: 875 - 881)

External links

• Mitral Valve Prolapse
• American Society of Echocardiography
• British Society of Echocardiography
• International Society of Cardiovascular Ultrasound
• European Association of Echocardiography
• 3D Echo Box: Interpretation of 3 Dimensional Echocardiography images and derive information online
• VIRTUAL TEE - online self-study and teaching resource
• Echobasics - free online echocardiography tutorial
• Algorithms and System for Digital Echocardiogram Video Indexing and Su

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Dansk (Danish)
n. - ekkokardiografi

Français (French)
n. - (Méd) échocardiographie, cardiographie vasculaire

Deutsch (German)
n. - (Med.) Echokardiographie, (die Benutzung von Ultraschall zur Untersuchung der Herzaktivität)

Ελληνική (Greek)
n. - ηχοκαρδιογράφημα

Italiano (Italian)
ecocardiografia

Português (Portuguese)
n. - ecocardiografia (f) (Med.)

Русский (Russian)
эхокардиография

Español (Spanish)
n. - ecocardiografía

Svenska (Swedish)
n. - ekokardiografi

中文（简体）(Chinese (Simplified))
回声心力记录器, 超音波心脏检查

中文（繁體）(Chinese (Traditional))
n. - 回聲心力記錄器, 超音波心臟檢查

한국어 (Korean)
n. - 초음파 심장 검사기

日本語 (Japanese)
n. - 超音波心臓検査

עברית (Hebrew)
n. - ‮שימוש בגלים על-קוליים לבדיקת פעולת הלב, אקוקרדיוגרפיה, בדיקת אולטרסאונד ללב, בדיקת אקו‬

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