An echocardiogram (also called echo, transthoracic echocardiogram or TTE, exercise or stress echocardiogram, dobutamine stress echocardiogram or DSE, or transesophageal echocardiogram or TEE) is a noninvasive (the skin is not pierced) procedure used to assess the heart's function and structures. A transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on your 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. The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into images of the heart walls and valves.
An echocardiogram may utilize one or more of several special techniques:
There are many diseases of the heart that may be detected by echocardiography, including the following:
An echocardiogram may be done to further evaluate signs or symptoms of these and other conditions. The echo can detect problems with the heart, such as enlargement, abnormalities in motion of the heart wall, blood clots, and heart valve abnormalities. It also measures the strength of the heart muscle (ejection fraction).The echo is more accurate than an ECG, but also more expensive.
A basic echocardiogram may be done in the doctor's office, a clinic, or in the hospital. For the procedure, you will remove your clothing from the waist up. Privacy will be ensured by using drapes across the chest and limiting access into the procedure room during the test. You will lie on your left side on a table or bed, but may be asked to change position during the procedure. EKG leads may be attached to your chest, so that the echo images can be compared to the EKG tracing during and after the procedure. The echocardiography technician will apply warmed gel to your chest. Then he or she will position the transducer on your chest and use a small amount of pressure to obtain the desired image. The technician will move the transducer around on your chest so that all areas and structures of your heart can be observed. During the test, the different echo techniques described above (M-mode, 2-D, 3-D, Doppler, and color Doppler) may be used. You will not be aware of the different techniques except that during the Doppler or color Doppler, you may hear a "whoosh-whoosh" sound. This whooshing sound is your blood moving through the heart.
Once all the images have been taken, the technician will wipe the gel from your chest, remove the EKG electrode pads, and provide you with privacy to dress. Once the procedure has been completed, you will be able to leave and return to your previous activities, unless your doctor instructs you differently. The procedure usually takes about 30-45 minutes to perform. However, factors such as schedule delays, emergencies, and other factors may delay the start of your procedure or prolong the length of it.
There are other types of echo procedures beyond the basic exam. These procedures are described below:
Once the target heart rate has been reached, you will contine to exercise if you are able, as exercise duration is an important piece of your stress test result. Immediately after the end of exercise, you will lie down on the table or bed and the echo procedure will be repeated. The doctor will compare the resting echo with the one done immediately after exercise. Once all the images have been taken, the technician will wipe the gel from your chest, remove the EKG electrode pads, and provide you with privacy to dress.
Once the procedure has been completed, you will be able to leave and return to your previous activities, unless your doctor instructs you differently. The procedure usually takes about 45 minutes to an hour to perform. However, factors such as schedule delays, emergencies, and other factors may delay the start of your procedure or prolong the length of it.
Some reasons for having an exercise echocardiography include, but are not limited, the following:
The preparation for the DSE procedure is similar to that of the basic echo described above. In addition, an IV line will be started in your hand or arm, and a blood pressure cuff will be placed on your arm. You may be asked not to take certain medications before the procedure that could interfere with the test results. A baseline assessment of your heart rate and blood pressure will be done.
The echocardiography technician will apply warmed gel to your chest. Then he or she will position the transducer on your chest and use a small amount of pressure to obtain the desired image. The dobutamine infusion will begin at a rate determined by your weight. The rate of the infusion will be increased every three minutes until you have reached your target heart rate (determined by the doctor based on your age and physical condition) or until the maximum dose of dobutamine has been reached. After the dobutamine is started and after each increase in the dobutamine rate, your blood pressure will be checked, an EKG tracing will be made, and echo images will be obtained. The technician will move the transducer around on your chest so that all areas and structures of your heart can be observed. During the test, the different echo techniques described above (M-mode, 2-D, 3-D, Doppler, and color Doppler) may be used.
You will not be aware of the different techniques except that during the Doppler or color Doppler, you may hear a "whoosh-whoosh" sound. This whooshing sound is your blood moving through the heart.
Once your have reached your target heart rate or the maximum amount of the dobutamine, the medication will be stopped. Your heart rate, blood pressure, EKG, and echo will continue to be monitored for 10-15 minutes until they have returned to the baseline state, or close to it. Once all the images have been taken, the technician will wipe the gel from your chest, remove the EKG electrode pads, take out the IV line, and provide you with privacy to dress.
Once the procedure has been completed, you will be able to leave and return to your previous activities, unless your doctor instructs you differently. A DSE usually takes about one to one and a half hours to perform. However, factors such as schedule delays, emergencies, and other factors may delay the start of your procedure or prolong the length of it.
Some reasons for having a dobutamine stress echo include, but are not limited to, the following:
TEE may also be used during surgery to assess the cardiac status of patients with known cardiac disease who are undergoing noncardiac procedures, and during heart surgery to evaluate the effects of surgical intervention to the heart, such as bypass surgery or valve repair or replacement.
For a TEE procedure, you are taken to a special area with echocardiography and EKG equipment. You will undress from the waist up, and EKG pads will be attached to your chest. You will be given a gown to wear. You will lie on a table or bed for the procedure. An intravenous (IV) line is placed in your hand or arm, so that sedative medication can be given. Sedatives are given to help you relax, but you will remain awake enough to assist in the procedure by swallowing as the TEE probe is passed down your throat. A numbing medication will be sprayed in the back of your throat to make passage of the TEE probe more comfortable. The echo images are obtained from various angles, as the doctor can position the TEE probe remotely. Once all the necessary images have been obtained, the TEE probe will be removed from your throat. You will continue to be monitored in a recovery area until your gag reflex returns and you can swallow adequately enough to take fluids without choking and until you are alert enough to leave. Your heart rate, EKG, blood pressure, and breathing rate will be monitored. Your oxygen level may also be monitored. You will need to make arrangements for someone to drive you home after the procedure, as you will not be allowed to drive after having IV sedation.
A TEE usually takes about two hours to perform. However, the length of the procedure can be affected by factors such as schedule delays, emergencies, and other factors which may delay the start of your procedure or prolong the length of it.
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