Dr Reza Moazzeni | Cardiologist Sydney (Westmead)
Echocardiogram (Echo): Why you may need one and what to expect
If you are curious about transthoracic echocardiogram (“Echo” ) and its importance, you have come to the right place. This guide will give you a basic understanding of echocardiography and its role in maintaining a healthy heart and diagnosing and monitoring heart disease. To help you understand the procedure, we have included a brief video at the end of the post. Stay informed with this short guide to echocardiography.
Table of Contents
What is an Echocardiogram
Echocardiogram, commonly referred to as Echo, is a medical test that examines the heart’s valves and chambers for potential issues. During the test, a Sonographer or Cardiologist will use a transducer to capture ultrasound images of the heart by placing it on the chest. The procedure is non-invasive, painless, and ultrasound-based, and it does not expose the patient to harmful X-ray radiation. It provides real-time visuals of the heart’s structure, valves, and blood flow patterns, enabling early diagnosis and prompt treatment of various heart conditions. It is a safe and quick way to determine if common symptoms, such as shortness of breath, are heart-related.
What are some of the main indications for an echocardiogram?
There are several indications for performing an echocardiogram, which can aid in diagnosing, monitoring, and evaluating the effectiveness of treatments for a range of heart conditions. Some common indications for echocardiograms include:
Echocardiogram and Heart Murmurs:Â
A heart murmur is an abnormal sound heard during a heartbeat, usually detected through a stethoscope. Echocardiograms can help identify the cause of a murmur, such as a malfunctioning heart valve or a congenital heart defect, by providing detailed images of the heart’s structure and blood flow.
Chest Pain or Shortness of Breath:Â
Echocardiograms can be used to investigate the cause of chest pain or shortness of breath, which may be related to coronary artery disease, heart valve problems, or other heart conditions. By visualizing the heart’s function and blood flow, physicians can determine if these symptoms are due to a heart-related issue. Echo is also a component of the test, Stress Echocardiogram, that is performed to investigate chest pain and dyspnea on exertion.
Arrhythmias:Â
Arrhythmias are irregular heartbeats resulting from various heart conditions or abnormalities, such as Atrial Fibrillation (AF). An echocardiogram can help identify structural or functional issues contributing to an arrhythmia, such as a damaged heart muscle or valve disorder.
Echocardiogram role in Cardiomyopathies:Â
Cardiomyopathies are diseases of the heart muscle that can affect the heart’s ability to pump blood effectively. Echocardiograms can evaluate the size, shape, and function of the heart muscle, helping physicians diagnose and monitor cardiomyopathies and their potential complications.
Valvular Heart Diseases:Â
Valvular heart diseases involve dysfunction or damage to one or more of the heart valves. Echocardiograms can assess the structure and function of the heart valves, revealing issues such as valve narrowing (stenosis) or leaking (regurgitation). This information is crucial for determining the severity of the condition and guiding treatment decisions.
Congenital Heart Defects:Â
Congenital heart defects are heart abnormalities present at birth. Echocardiograms can detect these defects, such as holes between heart chambers or abnormal connections between blood vessels, by providing detailed images of the heart’s anatomy and blood flow patterns.
Monitoring Heart Function and Treatment Progress:Â
Echocardiograms are often used to monitor heart function in patients with existing heart conditions, as well as to evaluate the effectiveness of treatments, such as medications, heart procedures, or surgeries. Regular echocardiograms can help physicians track the progress of a condition and adjust treatment plans as needed.
The role of Echocardiogram in stroke evaluation and management
Transthoracic Echocardiogram plays an essential role in the evaluation and management of stroke. A stroke occurs when the blood supply to part of the brain is interrupted or reduced, usually due to a blocked or ruptured blood vessel. Echocardiogram can help identify potential cardiac sources of a stroke, such as:
Finding Cardiac Emboli with Echocardiogram:
A cardiac embolus is a blood clot that forms in the heart and then travels to the brain, causing a stroke. Echocardiograms can detect the presence of blood clots within the heart chambers, particularly in patients with atrial fibrillation (an irregular and rapid heart rate), which increases the risk of clot formation.
Patent Foramen Ovale (PFO):Â
A PFO is a small hole between the heart’s atria (upper chambers) that is present at birth but usually closes shortly after. In some individuals, this hole remains open, creating a potential pathway for blood clots to bypass the lungs and travel to the brain, increasing the risk of stroke. Echocardiograms, particularly Transesophageal Echocardiogram (TEE), can identify a PFO and help determine if it is a potential cause of the stroke.
Valvular Heart Disease:Â
Valvular heart diseases, such as aortic stenosis or mitral valve disease, can sometimes lead to blood clots, increasing the risk of stroke. An echocardiogram can evaluate the structure and function of the heart valves and determine if they are a potential source of emboli.
Left Ventricular Dysfunction:Â
A weakened or damaged left ventricle may lead to blood stasis (slow or sluggish blood flow) within the heart, increasing the risk of clot formation and subsequent stroke. Echocardiograms can assess left ventricular function and help identify patients at higher risk of stroke.
Infective Endocarditis:Â
Infective endocarditis is an infection of the heart valves or inner lining of the heart. This condition can cause the formation of vegetations (clumps of bacteria and blood cells) on the heart valves, which can break off and travel to the brain, causing a stroke. Echocardiograms, particularly TEE, can detect the presence of vegetations and help guide treatment decisions.
The role of an Echocardiogram in chemotherapy
Transthoracic Echocardiogram has become a crucial tool in monitoring patients undergoing chemotherapy for several reasons. Some chemotherapy drugs, particularly a class of medications called anthracyclines, are known to be cardiotoxic and may cause damage to the heart muscle (Chemotherapy-induced Cardiomyopathy). This can decrease the heart’s ability to pump blood effectively, leading to heart failure or other cardiac complications. Echo can be used to monitor heart function in patients receiving chemotherapy for the following purposes:
Baseline Evaluation:Â
An echocardiogram can provide a baseline assessment of the patient’s heart function before starting chemotherapy, particularly with cardiotoxic drugs. This evaluation helps us determine if the patient’s heart is healthy enough to tolerate the chemotherapy regimen and is a reference point for future echocardiograms.
Monitoring Cardiac Function:Â
During chemotherapy treatment, regular echocardiograms may be performed to monitor the patient’s cardiac function, particularly the left ventricular ejection fraction (LVEF). LVEF is a measure of the percentage of blood that is pumped out of the left ventricle with each heartbeat. A decrease in LVEF can indicate that the heart muscle is being adversely affected by the chemotherapy drugs.
Echocardiogram role in Early Detection of Cardiotoxicity:Â
Echocardiograms can help detect signs of cardiotoxicity early, allowing for timely intervention and potential changes in the chemotherapy regimen to minimize further damage to the heart. If significant cardiotoxicity is detected, physicians may consider adjusting the dosage, altering the chemotherapy drug, or introducing medications to help protect the heart.
Long-term Follow-up:Â
After completing chemotherapy, it is essential to continue monitoring the patient’s heart function, as cardiotoxic effects may be delayed or persist even after the treatment has ended. Regular echocardiograms can help track heart function over time and ensure appropriate management of long-term cardiac complications.
In summary, echocardiograms are crucial in assessing and monitoring heart function in chemotherapy patients. By detecting and addressing cardiac complications early, we can help mitigate the potential risks associated with cardiotoxic chemotherapy drugs and ensure the best possible outcomes.
How frequently would you need an Echocardiogram?
The frequency at which you should undergo an echocardiogram depends on various factors, including your specific heart condition, risk factors, symptoms, and your doctor’s recommendations. Some general guidelines for echocardiogram frequency are as follows:
Healthy Individuals:Â
Routine echocardiograms are usually unnecessary for individuals without any known heart conditions or risk factors. However, if new symptoms or concerns appear, such as chest pain, shortness of breath, or a heart murmur, your doctor may recommend an echocardiogram to investigate the cause.
Monitoring Existing Heart Conditions:Â
For patients with known heart conditions, such as heart valve disease, cardiomyopathy, or congenital heart defects, the frequency of echocardiograms will depend on the severity and stability of the condition. You may require regular echocardiograms every 6 to 12 months or more frequently if the situation warrants closer monitoring.
After Heart Surgery or Intervention:Â
Following heart surgery or a procedure such as a valve replacement, valve repair, or stent placement, you may require frequent echocardiograms to monitor your recovery and ensure that the intervention was successful. The frequency may decrease over time as your condition stabilizes.
Chemotherapy Patients:Â
In patients receiving cardiotoxic chemotherapy drugs, echocardiograms may be performed before starting treatment, during treatment, and after completing therapy to monitor for potential cardiac complications. The frequency depends on the specific chemotherapy regimen, the patient’s risk factors, and the physician’s recommendations.
What is involved in the Echocardiogram procedure and how long it takes to complete?
The echocardiogram procedure is non-invasive, painless, and relatively quick. Here are the main steps involved in the process:
Patient Preparation:
Before the echocardiogram, you may be asked to remove clothing from your upper body and wear a gown. You will lie down on an examination table, and small electrodes will be placed on your chest to monitor your heart rate during the procedure.
Application of Ultrasound Gel:
The sonographer or technician will apply a water-based gel to your chest. The gel helps conduct the ultrasound waves and ensures optimal contact between the transducer and your skin.
Image Acquisition:
The sonographer will place the handheld transducer (a device that emits and receives ultrasound waves) on your chest and move it over different areas to obtain images of your heart from various angles. You may be asked to change positions or hold your breath briefly during the procedure to capture the best images. During the test, the transducer sends high-frequency sound waves into your body. These waves bounce off your heart and return to the transducer, which converts the sound waves into electrical signals. These signals are processed by a computer and displayed as real-time images on a screen, allowing the sonographer or cardiologist to assess the heart’s structure and function.
Duration and Potential Discomfort:
The echocardiogram typically takes 30 minutes to complete. Although the procedure is generally painless, you may experience slight discomfort from the transducer’s pressure on your chest, particularly over bony areas such as the ribs. The gel may also feel cold when initially applied.
Post-Procedure:
After the echocardiogram, the sonographer will remove the electrodes and gel from your chest, and you can get dressed. You can typically resume your normal activities immediately following the procedure.
A typical scenario depicting the role of echocardiogram
A 50-year-old man with a family history of heart attacks visits his doctor for a heart checkup. His doctor evaluates his risk and finds it to be low to intermediate. They also check his Coronary Calcium Score (CAC score) for more details on his risk level. During a routine exam, the doctor hears an unusual heart sound and thinks it might be a serious heart valve issue. To learn more, the doctor orders an echocardiogram. The test shows a significant narrowing of the aortic valve, known as aortic stenosis or AS. This case highlights how important echocardiograms are for quickly and safely detecting serious heart problems.
Conclusion
In summary, an echocardiogram is a crucial diagnostic modality in cardiology, enabling physicians to evaluate cardiac structure and function through a non-invasive and well-tolerated approach. This imaging technique is primarily reserved for individuals presenting with symptoms suggestive of heart problems and is not a routine screening test for the general population. With its broad range of indications, echocardiography plays a vital role in detecting heart abnormalities, monitoring the progression of heart diseases, and informing evidence-based clinical decisions. This brief and safe procedure offers critical information about a patient’s cardiovascular status.
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