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By Medifit Biologicals




(Alternate Names: Echocardiography, Echo, Cardiac Ultrasound, Cardiac Ultrasonography, Cardiac Doppler, Transthoracic Echocardiogram, TTE)


What is an echocardiogram?

An Echocardiogram (Echo) is a non-invasive test that uses sound waves to make pictures that look at the structure and function of your heart (two dimensional Echo or 2D Echo). A transducer or ultrasound probe is held against your chest wall with special ultrasound gel to help get good transmission of the sound waves. The transducer converts electrical energy into very high frequency sound waves (ultrasound), which are then sent into your body. When the sound waves reach your heart, they are reflected back and received back by the transducer. The machine creates a picture by determining the time it took for the sound wave pulse be reflected from a heart structure and how much of the pulse is reflected. The pictures that are created are like “slices of bread” with the heart being the bread loaf. The transducer is moved back and forth on the skin over the chest wall creating new pictures (ultrasound slices).

An echocardiogram is a noninvasive (the skin is not pierced) procedure used to assess the heart’s function and structures. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or “echo” off of the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves.

2 D Echo 4



  • M-mode echocardiography. This, the simplest type of echocardiography, produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart’s pumping chambers, the size of the heart itself, and the thickness of the heart walls.
  • Doppler echocardiography. This Doppler technique is used to measure and assess the flow of blood through the heart’s chambers and valves. The amount of blood pumped out with each beat is an indication of the heart’s functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate a problem with one or more of the heart’s four valves, or with the heart’s walls.
  • Color Doppler. Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.
  • 2-D (two-dimensional) echocardiography. This technique is used to “see” the actual motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart’s structures can be observed. This enables the doctor to see the various heart structures at work and evaluate them.
  • 3-D (three-dimensional) echocardiography. 3-D echo technique captures three-dimensional views of the heart structures with greater depth than 2-D echo. The live or “real time” images allow for a more accurate assessment of heart function by using measurements taken while the heart is beating. 3-D echo shows enhanced views of the heart’s anatomy and can be used to determine the appropriate plan of treatment for a person with heart disease.

Other related procedures that may be used to assess the heart include resting or exercise electrocardiogram (ECG or EKG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and cardiac CT scan. Please see these procedures for additional information.





Echocardiography is an invaluable tool in providing the doctor with important information about the following:

Size of the chambers of the heart, including the dimension or volume of the cavity and the thickness of the walls. The appearance of the walls may also help identify certain types of heart disease that predominantly involve the heart muscle. In patients with long standing hypertension or high blood pressure, the test can determine the thickness and “stiffness” of the LV walls. When the LV pump function is reduced in patients with heart failure, the LV and RV tends to dilate or enlarge. Echocardiography can measure the severity of this enlargement. Serial studies performed on an annual basis can gauge the response of treatment.

Pumping function of the heart can be assessed by echocardiography. One can tell if the pumping power of the heart is normal or reduced to a mild or severe degree. This measure is known as an ejection fraction or EF. A normal EF is around 55 to 65%. Numbers below 45% usually represent some decrease in the pumping strength of the heart, while numbers below 30 to 35% are representative of an important decrease.




Echocardiography can also identify if the heart is pumping poorly due to a condition known as cardiomyopathy (pronounced cardio-myo-puth-e), or if one or more isolated areas have depressed movement (due to prior heart attacks). Thus, echocardiography can assess the pumping ability of each chamber of the heart and also the movement of each visualized wall. The decreased movement, in turn, can be graded from mild to severe. In extreme cases, an area affected by a heart attack may have no movement (akinesia, pronounced a-kine-neez-ya), or may even bulge in the opposite direction (dyskinesia, pronounced dis-kine-neez-ya). The latter is seen in patients with aneurysm (pronounced an-new-riz-um ) of the left ventricle or LV. It must be remembered that LV aneurysm due to an old heart attack does not usually rupture or “burst.”Valve Function: Echocardiography identifies the structure, thickness and movement of each heart valve. It can help determine if the valve is normal, scarred from an infection or rheumatic fever, thickened, calcified (loaded with calcium), torn, etc. It can also assess the function of prosthetic or artificial heart valves.
The additional use of Doppler helps to identify abnormal leakage across heart valves and determine their severity. Doppler is also very useful in diagnosing the presence and severity of valve stenosis (pronounced stee-no-sis) or narrowing. Remember, unlike echocardiography, Doppler follows the direction and velocity of blood flow rather than the movement of the valve leaflets or components. Thus, reversed blood direction is seen with leakages while increased forward velocity of flow with a characteristic pattern is noted with valve stenosis.
Echocardiography is used to diagnose mitral valve prolapse (MVP), while Doppler identifies whether it is associated with leakage or regurgitation of the mitral valve (MR). The presence of MR frequently prompts the use of antibiotics prior to any dental or non-sterile surgical procedure. Such action helps reduce the rare complication of valve infection.Volume status: Low blood pressure can occur in the setting of poor heart function but may also be seen when patient’s have a reduced volume of circulating blood (as seen with dehydration, blood loss, use of diuretics or “water pill.”, etc.). In many cases, the diagnosis can be made on the basis of history, physical examination and blood tests. However, confusion may be caused when patients have a combination of problems. Echocardiography may help clarify the confusion. The inferior vena cava (the major vein that returns blood from the lower half of the body to the right atrium) is distended or increased in size in patients with heart failure and reduced in caliber when the blood volume is reduced.Other Uses: Echocardiography is useful in the diagnosis of fluid in the pericardium (the sac that surrounds the heart). It also determines when the problem is severe and potentially life-threatening. Other diagnoses (plural for diagnosis) made by Doppler or echocardiography include congenital heart diseases, blood clots or tumors within the heart, active infection of the heart valves, abnormal elevation of pressure within the lungs, etc.




Echocardiography is extremely safe. There are no known risks from the clinical use of ultrasound during this type of testing.



A brief examination in an uncomplicated case may be done within 15 to 20 minutes. The additional use of Doppler may add an additional 10 to 20 minutes. However, it may take up to an hour when there are multiple problems or when there are technical problems (for example, patients with lung disease, obesity, restlessness, and significant shortness of breath may be more difficult to image).



If a doctor is present during the test or reviews it while you are still in the office, you may be able to get the results before you leave. However, the doctor is not routinely present during the test and you may have to wait from one to several days before the images have been reviewed by a physician and the results are sent to you by phone or mail. Some physicians will discuss your case before the study is performed and will contact you if there are significant unexpected findings. For example, if you are expected to have a finding or known to have a given disease, your physician may indicate that he or she will call you only if there are significant unexpected findings. You may also be contacted if echocardiography reveals a finding that influences a change in treatment. For example, the presence of a distended inferior vena cava (discussed above) may result in increasing the dose of your diuretic or water pill, if it is indicated by other aspects of your condition.

If you are anxious or confused about the results feel free to contact the consulting department of Medifit.



By Medifit Biologicals