Echocardiography is the study of the internal structure and functions of the heart through sound waves (ultrasound). It is made by means of a device (transducer) that provides the transmission of sound waves. By applying the transducer to different parts of the chest wall, the walls and covers of the heart are examined in different positions.
There are 4 basic types of echocardiography methods.
Superficial (Transthoracic) Echocardiography (TTE)
via esophagus (Transesophageal) Echocardiography (TEE)
Strain and Strain Rate Echocardiography
How is superficial echocardiography performed?
While performing superficial echocardiography; the patient is placed on the left side and the transducer, where gel is applied on the patient’s chest, is circulated to examine different areas of the heart. X-ray rays are not used in this examination. In fact, superficial echocardiography is ultrasound technology. Usually the review is completed in 15 minutes. It is a painless procedure and has no side effects. Heart valves, sections and movements of the great vessels (aortic vessel, pulmonary artery) are displayed on the screen. The results are evaluated by the doctor who performed the test.
Why is superficial echocardiography performed?
- Finding the source of heart sounds (murmurs, etc.) heard through a stethoscope,
- To investigate the cause of heart enlargement, unexplained chest pain, shortness of breath or irregular heartbeat,
- Measuring the shape and dimensions of the heart cavities,
- Controlling the thickness and movements of the heart walls,
- Clear evaluation of heart valve structures and movements,
- Evaluation of the functions of the artificial cover,
- To evaluate heart functions,
- To detect diseases affecting the heart muscle (eg cardiomyopathies),
- Evaluation of clots and tumors inside the heart,
- To control congenital heart diseases or surgical interventions for this reason,
- For the evaluation of heart functions after a heart attack,
- Assessing the amount and type of fluid in the event of fluid accumulation around the heart and evaluating the structure and thickness of the pericardial membrane surrounding the heart,
- It is performed to evaluate the structure and diameters of the main arteries (aortic vessel, pulmonary artery) coming out of the heart.
What is transesophageal echocardiography?
In some cases where the commonly used superficial echocardiography method is insufficient, it may be necessary to perform echocardiography via esophagus. It is a similar examination to gastroscopy. Transesophageal echocardiography, as it is done through the esophagus.
Why is transesophageal echocardiography performed?
- For a more detailed examination of diseases related to heart infection called clot, mass or endocarditis inside the heart detected by superficial echocardiography,
- For a detailed examination of the functions of artificial caps,
- When aortic vessel dilatations and ruptures are suspected,
- Examining the holes on the membranes between the heart chambers,
- Determination of the severity of heart valve insufficiencies,
- Evaluation of the success of the procedure during and after heart valve repair or heart hole surgery,
- In cases where adequate quality superficial echocardiographic images cannot be obtained due to reasons such as lung disease, obesity or chest structure, the TEE method is used.
How is the patient prepared before transesophageal echocardiography?
Transesophageal Echocardiography is performed after 4-12 hours of fasting. Those with complaints such as allergy, asthma, high eye pressure, difficulty swallowing, nasal congestion, new throat infection, patients with esophagus and stomach problems should inform the doctor who will investigate these conditions.
How is transesophageal echocardiography performed?
Transesophageal echocardiography is a semi-invasive examination. Immediately before the procedure, the vascular access is opened in order to ensure that intravenous medication is administered. To suppress the nausea reflex and adapt the patient to the procedure, the mouth and soft palate area are locally anesthetized with the help of an anesthetic spray.
For the procedure and patient comfort, a sedative medication is made. In cases where patient compliance cannot be achieved during the examination, the procedure is repeated under the control of the anesthesiologist with the help of additional sedative drugs.
The cardiologist who will perform the procedure tells how to swallow the tube. A mouthpiece is placed in the mouth so that the patient does not bite the tube. The gel-lubricated transesophageal echocardiography probe is slowly advanced through the esophagus. It is normal to have gagging and nausea when swallowing the probe. This situation is temporary. Meanwhile, breathing through the nose is given.
Heart images that are deemed necessary are recorded by the doctor and their pictures are taken. At the end of the procedure, your doctor will inform you about the findings. The examination period is on average 15-20 minutes. However, with the preparation time, this period reaches 30-60 minutes.
What are the points to be considered after transesophageal echocardiography?
After the examination, something should not be eaten and drunk for about 2 hours until the drowsiness in the throat passes. Since the medications used to calm down during the examination may be drowsy for a while, tools and machines should not be used until this situation completely resolves. After the examination, there may be pain and loss of sensation in the throat for 1 or 2 days. This is a temporary condition and does not require treatment.
What is stress echocardiography?
Stress echocardiography (SE) is an echocardiography application with exercise methods or drugs that accelerate the heartbeat. Exercise echocardiography is performed in the form of recording echocardiographic images just before and immediately after the application of the exercise protocol in treadmill stress test or at every stage of the exercise with the help of a bicycle exercise test. In cases where an exercise test cannot be performed (leg vascular disease, muscle and bone structure limitation), medicated stress echocardiography is performed with the use of drugs that increase heart rhythm and contraction at certain intervals, such as dobutamine, adenosine, dipyridamole.
In which situations is stress echocardiography performed?
Permanent pacemaker, ECG left bundle branch block, left ventricular thickening and ECG are present when other diseases are difficult to assess due to the presence of some special findings (pre-excitation). In order to determine the risk after acute heart attacks and interventional procedures to the coronary vessels to detect the severity and severity of myocardial blood supply,
It is applied for the purpose of evaluating cardiac risk in patients who will undergo surgery other than cardiac surgery.
The aim is to observe the contractile capacity of the heart, to investigate signs of coronary insufficiency and to assist the surgical decision in some valve diseases.
What are the things to do before stress echocardiography?
An average of 4-6 hours of fasting is required for stress echocardiography. In addition, it should not be smoked in a 6 hour period and food (tea, coffee, chocolate, cola, etc.) or medication containing caffeine (as some painkillers may contain caffeine).
Some drugs used by the patient should be discontinued 24 hours before this test. The doctor who wants the test will decide this. It is not necessary to swallow the drugs that are allowed to be taken with a small amount of water 3-4 hours before the test.
In all tests that require fasting, diabetics should not take their diabetes medication until they are allowed to eat. Immediately after the SE test is over, the meal can be eaten.
How is stress echocardiography performed?
Test preparation consists of attaching electrodes to the chest and opening the vascular access. The test time is about 1 hour. This examination is done by recording from certain points on the chest. Resting images of the heart are recorded.
Depending on the preferred stress management, exercise test or medication is applied. Exercise images are taken. The recovery period images are then saved. Heart rhythm, blood pressure are monitored, ECG recordings are taken.
During the test, rapid and strong beating of the heart is perceived as palpitations. This is normal. During the Medicated Test (Dobutamine application), the sensation of warmth and redness on the cheeks and tingling of the scalp is normal. When pain and restlessness in the chest, arm and chin is felt during the procedure, the doctor who performs the operation should be informed in case of dizziness, dark eyes and shortness of breath.
The patient is kept under observation in the rest room for half an hour after the procedure. The interpretation of the test is made by comparing the contractile strength of the heart in images taken in different phases.
Findings obtained in stress echocardiographic examination are told to the patient by the doctor and given to him in one hour in a written report.
Is there a risk of stress echocardiography application?
Stress echocardiography is a reliable method. Medicated side effects are rarely seen during medicated stress echocardiography. These are headache, sweating, palpitations, chest pain, shortness of breath and nausea.
Rarely, sudden drops and rises in blood pressure, discontinuous sudden rhythm disturbance originating from the auricle and ventricle, slowing heart rate, chest pain of cardiovascular origin during the procedure.
What is strain ratio and vector velocity imaging echocardiography?
Strain, Strain ratio and vector velocity imaging echocardiography is the most sensitive, new and modern method developed to accurately measure the contraction and relaxation functions of the heart in various planes using tissue Doppler ultrasound method. This method is especially used to evaluate the strength and contractile functions of the heart muscle. Various regions of the heart muscle are selected and their dimensions and movements at the time of stress and rest are measured with different planes.
It is painless and has no side effects. No preparation is required before the procedure. No contrast agent is used. The process takes an average of 15-30 minutes.
The results are evaluated by the doctor performing the test and delivered to the patient. After the procedure, the patient can immediately stand up and continue his daily life.
In which situations is strain ratio and vector velocity imaging echocardiography performed?
In a patient with heart failure, the contractile strength of the heart muscle is most accurately calculated. In this way, the cause of heart failure is detected much earlier than the level that a normal eye can distinguish and the most appropriate treatment option is determined.
It provides a very accurate measurement opportunity in determining the damaged heart muscle mass and determining the extent of the damage in a patient who has had a heart attack. It is one of the most important methods used in the evaluation of heart muscle functions before the heart operation to be applied to the patient. It provides the most reliable way to detect inflammation of the heart membrane and to distinguish its varieties.
It is an unprecedented method for the instant detection of simultaneous working disorders of the right and left half of the heart and the treatment to be applied and the effectiveness of this treatment.