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What is an Echocardiogram or Heart Echo?

Echocardiogram (echo) is an imaging technique performed for suspected problems with the valves or chambers of the heart. It can immediately and safely determine whether the cause of some common complaints like shortness of breath is heart-related or not.

A Sonographer or Cardiologist uses a device known as a “transducer” over the chest to record pictures of the heart through ultrasound waves. This process is entirely painless and non-invasive and does not require harmful X-rays (radiation).

Echocardiogram Machine

Why an echocardiogram is done?

There are many reasons that one might require an echocardiogram (heart echo). Some patients may need serial echocardiograms to check the progress of their disease. This is especially true in people with heart failure or heart valve diseases. Others may require an echocardiogram only once, to rectify the presence or absence of any specific disease. Here I have provided a list of diseases where an echocardiogram is required. As much as I have tried to provide a complete list, there may be other indications that are not listed here.

To investigate the cause of an abnormal sound heard while listening to the heart (called heart murmur).

Looking for the cause of chest pain, shortness of breath, irregular heartbeats, swollen legs, or an enlarged heart.

High Blood Pressure (Hypertension) to check the effects of hypertension on the heart muscle, like diastolic heart failure.

Checking the heart valves (native or artificial) and their function. Echo is the perfect test to check for valvular stenosis (incomplete opening of the valve) or Regurgitation (leaking of the valve due to the valve not closing tightly).

Measure the size and shape of the heart’s chambers.

Check the ability of the heart to pump blood (cardiac function). An echocardiogram can show how much blood your heart can pump during each heartbeat, called ejection fraction. Ejection fraction is usually low in heart failure.

Echocardiogram can detect diseases that affect the heart muscle and its function, such as Hypertrophic Cardiomyopathy or Dilated Cardiomyopathy. These diseases can run in families, and screening is recommended for the first-degree relatives of the patient.

Heart echo test can detect blood clots and tumours inside the heart. 

Echo is used widely to detect congenital heart defects or the effectiveness of previous cardiac surgery.

Heart echo can reveal how someone’s heart has been affected by a heart attack. This can be diagnosed when one part of the heart doesn’t work as well as the other segments, called “regional wall motion abnormality“.

Echo is widely used to Identify the cause of heart failure.

Echocardiogram can easily detect fluid collection around the heart (pericardial effusion). It can sometimes help diagnose the inflammation of the sac around the heart (pericarditis).

Echocardiogram is used during a stress test to detect regional wall motion abnormalities. This test is called Stress Echocardiogram.

Patients who suffer from an acute stroke require an echocardiogram to rule out some cardiac causes (about 15-20% of strokes can have cardiac causes).

Why do I need an echocardiogram before or during chemotherapy?

There has been a remarkable advance in chemotherapeutic agents during the past 2 decades. One of the life-threatening side effects of these agents is heart failure, called “chemotherapy-induced cardiomyopathy“. These days it is common practice to check the cardiac function before initiation of chemotherapy and periodically during the therapy. This is more common with some specific types of cancers like breast cancer.

An example of an echocardiogram (Heart Echo) picture (Loop). We can see all four heart chambers, including the left and right ventricles and atria

How often do I need to repeat Echocardiogram?

It depends on the findings in your initial test. If the initial echocardiogram was normal, there is no need to repeat it unless there are new complaints.
Heart Failure and Heart Valve Disease are the two most common diseases requiring more frequent Echocardiograms. Depending on the severity of the disease, an echocardiogram might need to be repeated more frequently. For example, Aortic Valve Stenosis (AS) should usually be followed every 6-12 months if the stenosis is severe; otherwise, 3-5 years is the rule for mild disease. Other valve pathologies usually follow the same rule depending on the severity of the disease. This is a rough guide; every patient should be assessed based on their merits and cardiologist assessment.

Is Echocardiogram safe and how long does it take to complete the test?

To do an echocardiogram, we use ultrasound waves, not X-rays. Ultrasound waves are safe and have not been associated with any harm in humans.
 
An echocardiogram usually takes 30 minutes to be completed by the sonographer. The pictures and a preliminary report are then sent to the Cardiologist for the final report to be prepared.

A typical scenario depicting the role of echocardiogram:

A 50-year-old man with a strong family history of heart attacks presents to his doctor for a “cardiac assessment”. His doctor calculates his risk based on his traditional risk, which comes back as low to intermediate risk. He also checks his Coronary Calcium Score (CAC score) to further stratify his risk. During the routine physical exam, the doctor notices an abnormal sound and suspects valvular heart disease. To further investigate his finding, he orders an Echocardiogram. The echo shows a problem with the mitral valve, called Mitral Valve Prolapse, causing moderate mitral regurgitation.

Here we can see the importance of an echocardiogram in this scenario and how readily it can detect serious, life-threatening cardiac conditions safely and immediately.