OakOcardiography (ultrasound of the heart) is a method of examining which usehigh frequency sound wavesto capture imagesan heart structure.Ecocardiography is usually assisted with Doppler technology which can measure the speed and direction of blood flow.
Echocardiography aims 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 can be used to detect heart disease, determine appropriate treatment, and evaluate the treatment given.
Types of Echocardiography
Echocardiography is divided into several types, namely:
1. Transthoracic echocardiogram (TTE)
Not different from ultrasound in general, TTE uses an electrode sensor, or also known as transducer, which is attached and moved over the patient's chest, with the results immediately visible on the monitor.
This type of echocardiography is often an option to check for abnormalities in the heart, both from the structure and function of the heart.
2. Transesophageal echocardiogram (TEE)
TEE uses an endoscope that is inserted through the mouth into the esophagus (oesophagus) to capture detailed images of the heart's structure, without being obstructed by images of the chest and lungs.
TEE is generally recommended when the TTE waveform cannot capture images clearly, especially when the patient is about to undergo cardiac surgery.
3. Stress echocardiogram
Sstress echocardiogram done to check the strength of heart function and blood flow when the patient is active or when the heart is stimulated by giving special drugs that make the heart work like you are exercising.
4. Intravascular ultrasound
Intravascular ultrasound can be used to help doctors identify blockages in the blood vessels in more detail. In the process, the doctor will enter transducer into the blood vessels of the heart with the help of a catheter (a long and small tube) through a small incision made in the groin.
5. Fetal echocardiography
Fetal echocardiography is useful for detecting cardiac abnormalities in the fetus. This type of echocardiography is performed on pregnant women with a gestational age of 18–22 weeks. This examination is safe for the fetus because it does not use radiation, as in X-ray procedures.
IndicationEchocardiography
The type of echocardiography performed by a doctor can be different for each patient. The following are indications of each type of echocardiography:
Transthoracic echocardiogram (TTE)
Doctors can use a TTE-type echocardiography to detect, see the severity, and help treat some of the following conditions:
- Heart murmur
- heart valve disease
- Heart damage from a heart attack
- Blockage of a blood vessel from a stroke or transient ischemic attack (TIA)
- Congenital heart disease
- Impaired heart pump due to heart failure
- Pericarditis
- Pericardial effusion, which is an accumulation of fluid in the sac around the heart
- Infections in or around the heart valves
- Heart muscle disorders, such as cardiomyopathy
- Pulmonary hypertension
Transesophageal echocardiogram (TEE)
TEE-type echocardiography is usually used by doctors if:
- 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
Here are some of the goals it does stress echocardiogram:
- Detecting heart problems that arise during exercise or strenuous physical activity
- Detect coronary heart disease or structural damage to the heart due to myocardial infarction (heart attack)
- Checking the supply of oxygen to the heart muscle during activity
- Seeing the limits of the heart's ability for the benefit of cardiac rehabilitation programs
- Evaluating the success of treatment and medical actions, such as administering antianginal drugs, antiarrhythmic drugs, surgery bypass, and ring mounting
intravascular ultrasound & Fetal echocardiography
Doctors generally use intravascular ultrasound to see blockages in the blood vessels in more detail. Meanwhile, fetal echocardiography is performed to detect heart problems in the fetus, either due to heredity or lifestyle and maternal health conditions.
WarningEchocardiography
Echocardiographic imaging is safe, including for the fetus, because it does not use radiation. Although safe, there are several things that must be known before undergoing echocardiography, namely:
- Tell your doctor if you have any allergies to certain medications.
- Tell your doctor about any medicines, supplements, or herbal products you have or are currently using, especially beta-blocking drugs (eg bisoprolol), isosorbide dinitrate, isosorbide mononitrate, and nitroglycerin.
- Tell your doctor if you have any implants in your body, such as a pacemaker.
- Tell your doctor if you are taking any medication.
- For patients who are specifically going to have a TEE test, tell the doctor if there is a problem in the esophagus, such as dysphagia, hiatal hernia, or esophageal cancer.
- Tell your doctor about your condition or illness. In rare cases, examination stress echocardiogram can cause a heart attack.
It should be noted that sound waves on echocardiography are not able to penetrate a thick chest wall (in obese patients) or when the chest wall is dominated by the ribs (usually in very thin patients). In this case, your doctor may recommend other tests.
BeforeEchocardiography
Preparation before echocardiography depends on the type of test to be performed. Generally, the patient is allowed to eat and drink as usual before the TTE.
While for TEE, the patient will be asked to fast for 6 hours before the procedure, to avoid nausea, vomiting, and the entry of gastric contents into the lungs during the examination.
In TEE, the doctor will also inject a sedative and spray a local anesthetic down the throat, so that the patient does not feel pain when the endoscope is inserted. If the patient is wearing dentures, the doctor will ask to remove them.
For preparation stress echocardiogram, The patient needs to fast and can only drink water for 4 hours before the procedure. In addition, patients were also asked not to smoke and not to consume drugs, foods, or drinks containing caffeine, such as chocolate, coffee, and tea, for 24 hours before the procedure.
On the day of the examination, the patient who will perform stress echocardiogram It is recommended to wear comfortable clothes and shoes for exercising.
In other types of echocardiography, the patient will be asked to change into hospital clothes, and remove all jewelry worn. If needed, the doctor will also inject a contrast dye before the echocardiography is performed, so that the resulting picture of blood flow becomes clearer.
Procedure Echocardiography
Each type of echocardiography has different stages and procedures. Here is the explanation:
Transthoracic echocardiogram (TTE)
The patient will be asked to lie down in bed and remove or undress, so that electrodes can be placed at several points on the chest.
The cardiologist will apply a lubricating gel around the chest and move the probe connected to the monitor. The sound waves from the electrodes and probe will be recorded and seen on a monitor that is placed not far from the patient's position.
The patient may hear a rustling sound during the scan. This is normal because probe was catching the sound of blood flowing.
The patient may be asked to take a deep breath and hold the breath, or to turn to the left while the doctor presses probe on the chest area to capture the image clearly. This can cause temporary discomfort.
Transesophageal echocardiogram (TEE)
After the patient lies down and is given an injection of a sedative and a local anesthetic spray, the doctor will insert the endoscope through the mouth and push it down the esophagus. Blood pressure and oxygen level measuring devices and electrodes will also be installed to monitor the patient's condition during the procedure.
After getting the right position, the doctor will record a picture of the heart, including the heart valves, in more detail through sound wave technology.
Stress echocardiogram
The doctor will perform a TTE at first. Then, the patient will be asked to do activities, either using treadmill or stationary bicycle provided, for 6–10 minutes or according to conditions.
If the patient is unable to exercise, the doctor will give an injection of a heart-inducing drug (dobutamine) so that the heart can pump as if it were exercising. Dobutamine may cause the patient 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. If during the examination the patient feels discomfort in the chest, arms or jaw, as well as symptoms such as dizziness or shortness of breath, notify the doctor immediately.
Once deemed sufficient, the intensity of the exercise will be reduced so that the patient's heart rate returns to normal. The doctor will then compare the condition of the patient's heart when exercising or being stimulated with the results of the initial examination.
intravascular ultrasound
After the patient lies in bed, the doctor will place electrodes on the patient's chest. The doctor will also put an IV tube in the patient's arm and inject a sedative to make the patient feel more relaxed.
Next, the doctor will inject an anesthetic on one side of the patient's groin and make a small incision in that area. A small tube will be inserted through the incision that has been made for later use as an access catheter.
The catheter used is equipped with an ultrasound wire (transducer) inside it. Transducer This function is to capture images of conditions in the blood vessels.
After completing the examination, the doctor will remove the catheter and tube from the patient's body. The doctor will also bandage the incision tightly to prevent bleeding.
The patient is required to lie down for 3–6 hours. If needed, the patient may have to be hospitalized.
Fetal echocardiography
Fetal echocardiography can be performed on the abdomen (abdominal echocardiography) or vaginally (transvaginal echocardiography).
Abdominal echocardiography is similar to an ultrasound examination in general. In the process, the patient will be asked to lie down and remove or undress, so that the abdomen is exposed.
The doctor will apply a lubricating gel on the skin of the abdomen to prevent friction, facilitate movement transducer, and helps the probe transmit sound waves to the inside of the abdomen.
High-frequency sound waves will bounce when they touch solid objects in the stomach, such as the fetal heart, so they can be captured and seen on a monitor. The doctor will move transducer around the abdomen in order to see all parts of the fetal heart.
After the examination has been completed, the doctor will remove the lubricating gel from the stomach and the patient can return to normal activities.
Meanwhile, to perform transvaginal echocardiography, the patient must remove the lower clothes before lying in bed. After the patient lies down, the doctor will insert probe into the vagina which will emit sound waves to produce an image of the fetal heart on a monitor screen.
Compared to abdominal echocardiography, transvaginal echocardiography can produce clearer images. Generally, this examination is done in early pregnancy.
The entire echocardiography process usually takes 15 minutes to 1 hour, depending on the type of echocardiography being performed and the patient's condition.
After Echocardiography
Patients are generally allowed to go home and carry on with their normal activities after echocardiography. However, for those who are given a sedative injection, the patient is not allowed to drive a vehicle, operate heavy equipment, or consume alcohol for 24 hours.
Patients are also advised to contact their family or relatives to accompany and take them home. Meanwhile, for patients who need to be hospitalized, the patient will be escorted back to the treatment room.
Usually, the patient will get the scan results right away. However, if in-depth analysis is still needed, the new results will be completed in a few days later.
The results of the examination can be in the form of information related to the size of the heart, the ability of the heart to pump blood, damage to the heart muscle, heart valve abnormalities, and blood vessel disorders. If necessary, the doctor will advise the patient to do a follow-up examination.
Echocardiography Side Effects
Echocardiography is a safe procedure, including the fetus. However, in certain cases, echocardiography can cause the following side effects:
- Pain and discomfort after the electrodes are removed from the chest
- Discomfort, irritation, and sore throat for several hours after doing transesophageal echocardiogram (TEE)
- Nausea, dizziness, or chest pain after doing stress echocardiogram
- Mild allergic reactions, such as hives, after being given a contrast agent injection or smeared with lubricating gel
Although rare, echocardiography can also cause severe side effects, such as:
- Heart beat
- Fainting or having a heart attack while doing stress echocardiogram
- Severe allergies after being given a contrast agent injection or smeared with lubricating gel
The risk of these side effects can be minimized by monitoring by a doctor during the procedure. Echocardiography will be stopped immediately if side effects occur.