Echocardiography (cardiac ultrasound) is a method of examination using high-frequency sound waves to capture images of the structure of the heart's organs. Echocardiography is usually assisted by Doppler technology where this technology can help measure the speed and direction of blood flow.
Echocardiography is used to check for abnormalities in the structure of the heart, blood vessels, blood flow, and the ability of the heart muscle to pump blood. This imaging method is often used to detect the potential for heart disease so that appropriate treatment can be decided, and it is also used to evaluate treatment.
The following are some types of echocardiography that are generally recommended:
- Transthoracic echocardiogram (TTE). No different from ultrasound in general, TTE uses a probe electrode sensor that is affixed and moved above the patient's chest, with results that are immediately visible on the monitor. This test is often an option for examining the structure and function of the heart, as well as for detecting if there is a heart disease or abnormality.
- Transesophageal echocardiogram (TEE). This test uses an endoscopic device that is inserted through the mouth into the esophagus (esophagus) to capture detailed images of the heart's structure, without obstruction of the chest and lungs. TEE is generally recommended when TTE waves cannot capture images clearly, especially when patients are undergoing heart surgery.
In addition, there is also a stress echocardiogram that is performed to check the strength of heart function and blood flow during activities or when the heart is stimulated. In addition to stimulation, patients can be injected with a dye (contrast) to see a clearer picture of the heart.
Echocardiographic Indications
The following are indications that physicians consider in choosing the type of echocardiography:
Transthoracic echocardiogram (TTE)
- Heart rhythm disorders.
- Heart valve disease.
- Heart damage after a heart attack.
- Congenital heart disease.
- Heart pump disorders.
- Look for blood clots in the heart that might be the cause of a stroke.
- Pericarditis, which is inflammation of the membrane lining the heart (pericardium).
- Pericardial effusion, which is the accumulation of fluid in the pockets around the heart.
- Infection in or around the heart valves.
- Heart muscle abnormalities.
- Pulmonary hypertension.
Transesophageal echocardiogram (TEE)
- The results of TTE are not clear, usually because of the structure of the chest, lungs, or fat covering (in obese people).
- Requires more detailed imaging, for example before performing heart surgery.
Stress echocardiogram
- Heart rhythm disorders and blood pressure disorders when exercising or when experiencing physical pressure.
- Suspected of having coronary heart disease that has the potential to cause a heart attack.
- Check the supply of oxygen to the heart muscle during activity.
- Seeing the limits of the heart's ability to benefit the cardiac rehabilitation program.
- Evaluate the success of treatment and medical measures, such as antiangina drugs, antiarrhythmic drugs, bypass surgery, and ring fitting.
Echocardiography Warning
Echocardiographic imaging is classified as safe, including for the fetus, because it does not use radiation. Although echocardiography is safe, sound waves are unable to penetrate thick chest walls (in obese patients) or if the chest wall is dominated by ribs (usually in very thin patients). Your doctor may recommend other tests.
Tell your doctor if you have an allergy to certain medications, medications that are routinely taken, or use pacemakers. For patients who are specifically about to take a TEE test, tell the doctor if there is a disorder in the esophagus, such as dysphagia, hiatus hernia, or esophageal cancer. For people with arrhythmias or coronary heart disease, be careful when doing a stress echocardiogram.
Before echocardiography
Preparations before echocardiography will be adjusted to the type of test to be performed. Generally, patients are allowed to eat and drink as usual before TTE.
If you are taking certain medications, ask your doctor if there is anything that needs to be stopped before TTE is done. Some examples of drugs that are generally avoided for 24 hours before TTE are beta-inhibiting drugs (eg bisoprolol), isosorbide dinitrate, isosorbide mononitrate, and nitroglycerin. Patients who are taking diabetes medications or are on insulin treatment also need to inform their doctor. Patients are advised to bring inhaler when in use.
For TEE, patients will be asked to fast a few hours before the procedure, to avoid nausea, vomiting, and entry of stomach contents into the lungs. The doctor will inject sedative medicine as a sedative and spray the local anesthetic into the throat, so that the patient does not feel pain when an endoscope is inserted. The patient will be asked to remove the dentures, if any, before the procedure.
To prepare for a stress echocardiogram, the patient needs to fast for 4 hours (water is still permitted) before the procedure. In addition, avoid smoking and consumption of drugs, food, or drinks that contain caffeine such as chocolate, colas, coffee, and tea, 24 hours before the action. On the day of the examination, patients will be asked to wear comfortable clothes and shoes for exercise.
If needed, the doctor will inject the contrast before echocardiography is done, so that the resulting blood flow picture becomes clearer.
Echocardiography Procedure
Each type of echocardiography has a different procedure technique.
Transthoracic echocardiogram (TTE)
The patient will be asked to lie down on the bed and open the chest to be installed electrodes at several points.
The cardiologist will apply a lubricating gel around the chest and move the probe that is connected to the monitor. Sound waves from the electrodes and probes will be recorded and seen on a monitor that is placed not far from the patient's position.
The patient may hear noise during the scan. This is normal because the probe will catch the sound of blood flow.
The patient can be asked to take a deep breath and hold his breath, or turn to the left while the doctor presses the probe on the chest area to capture the image clearly. This can cause discomfort for a while.
Transesophageal echocardiogram (TEE)
After the patient lies down and is given a sedative injection and local anesthetic spray, the doctor will insert an endoscopy device by mouth, and push it towards the esophagus. Blood pressure gauges and oxygen levels will continue to be installed to monitor the patient's condition during the procedure.
After getting the right position, the doctor will record images of the heart, including the heart valves, in more detail through sound wave technology.
Stress echocardiogram
The doctor will do a TTE at first, then the patient will be asked to move, either using a treadmill or a static bicycle that has been provided, for 6-10 minutes or according to the conditions. If the patient is unable to exercise, the doctor will give a heart-triggering injection (dobutamine) so that the heart can pump like it is exercising. Dobutamine can cause patients to feel warm or dizzy.
When the patient is exercising, the doctor will continue to ask the patient's condition to make sure there are no side effects. Notify the doctor immediately if you feel discomfort in the chest, arms or jaw, as well as symptoms such as dizziness or shortness of breath.
Once it is sufficient, the intensity of exercise will be reduced so that the patient's heart rate returns to normal. The doctor will then compare the patient's heart condition when exercising or being stimulated, with the initial imaging results.
Echocardiography generally takes 15 minutes to 1 hour, depending on the type of test performed and the patient's condition.
After echocardiography
In general, patients are allowed to go home and do activities after echocardiography. But for those who are given sedative injections, patients are not allowed to drive a vehicle, operate heavy equipment, or consume alcohol for 24 hours. It is recommended to contact family or relatives to accompany and take you home. For patients who are undergoing hospitalization, will be delivered back to the treatment room.
Usually, patients will get a scan directly. If in-depth analysis is still needed, the results will be sent to the referring doctor within a few days. Generally, the results reported include heart size, heart's ability to pump blood, damage to the heart muscle, valve abnormalities, and blood vessel disorders. If needed, the doctor will recommend further tests, such as a CT scan or catheterisasai (coronary angiography).
The doctor will advise patients to switch to a healthy lifestyle, such as stopping smoking, eating foods with balanced nutrition, reducing salt intake, exercising, maintaining ideal body weight, and treating diseases related to heart health, such as hypertension, high cholesterol, and diabetes.
Echocardiographic Side Effects
In general, echocardiography is safe. However, patients can experience some side effects after undergoing this examination, such as:
- Pain and discomfort after the electrodes are removed from the chest.
- Discomfort, irritation and sore throat for several hours after doing a transesophageal echocardiogram (TEE).
- Feeling nauseous, dizzy, or chest pain after a stress echocardiogram.
- Mild allergic reactions, such as hives, after receiving a contrast injection.
Although rare, the potential for severe side effects can also occur. Among these are palpitations, fainting or heart attack during a stress echocardiogram, as well as severe allergic reactions after receiving contrast injections or applying a lubricating gel. This risk can be reduced by monitoring carried out by the doctor at the time of the action. Echocardiography will immediately be stopped if side effects occur.
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