Echo of the heart - comprehensive knowledge

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• Transthoracic echo - the test is performed through the chest wall. It is the basic diagnostic method in identifying the causes of syncope, heart murmurs, chest pains, and in the diagnosis of infarcts, ischemic disease, arterial and pulmonary hypertension, and pericardial and aortic diseases.
• Transesophageal echocardiogram (TEE) - The echocardiogram probe is inserted through the throat, making it directly adjacent to the heart. Before the procedure, local anesthesia in the form of a spray is used, and sometimes a sedative to relax and facilitate the insertion of the probe. It is recommended not to eat any food a few hours before the test. The indications for esophageal examination are suspected thrombus in the heart cavities, dysfunction or inflammation of artificial valves, and problems with aortic dissection. The image of the TEE examination is clear, thanks to the proximity of the esophagus to the left side of the heart, and therefore a shorter distance between the probe and the heart. Additionally, anatomical conditions (e.g. obesity) do not disturb the examination image.
• Stress echocardiogram - echocardiographic examination in which two diagnostic methods are used, i.e. exercise electrocardiography (ECG stress test) and echocardiography (heart echo). Exercise echocardiogram is based on the use of different tests to stimulate contractility and induce controlled hypoxia of the heart muscle. At the same time, echocardiographic assessment of cardiac contractility is performed. The test is most often carried out during or after the immediate completion of the treadmill exercise. Before starting the measurements, the patient is injected with dobutamine or vasodilators to make the heart work harder. Stress echocardiogram is used in the diagnosis of coronary heart disease, valvular heart disease, and hypertrophic cardiopathy.
• Contrast echocardiogram - the examination is based on the administration of a contrast agent to the patient by injection into the bloodstream, which effectively improves the clarity of the echocardiogram image. The method is used to obtain better image quality in the study.
• Intracardiac echocardiogram (ICE) - echocardiography performed during cardiac catheterization, not requiring general anesthesia. This type of echocardiography is performed with the help of special probes.
• M-mode echocardiography - one of the simplest methods of echocardiography, which allows to obtain a dynamic cross-section of the heart on a selected plane. This type of echocardiography is used in the diagnosis of rapidly moving structures (e.g. valves, thrombus, tumors or vegetation). In addition, the method allows you to measure the thickness of individual walls of the heart, the dimensions of the cavities, periocardial spaces and large vessels (e.g. aorta, inferior and superior vena cava, and pulmonary artery). The test also allows the assessment of contractility and asynchrony of contractions of the heart chambers.
• Doppler echocardiography (Doppler technique) - the test is mainly used to measure and assess blood flow through the chambers and valves of the heart. The Doppler technique detects abnormalities in the blood flow within the heart, as well as the presence of an opening between the heart chambers, problems with one or more heart valves and with the walls of the heart.
• Color Doppler - is an improved version of the Doppler technique, creating a color image of the examination. Colors help define the directions of blood flow within the heart, which allows easier and more precise interpretation of the Doppler technique.
• 2-D echocardiography - technique of performing technical activities of their movement. The image has a 2D view that is left to be monitored for exams that allow motion that allows movement through time. In the ten visible structures of the heart as part of an assessment of how they work the way they work.

Preparing for a heart echo

Preparation for cardiac echocardiography varies according to the method of the procedure. In the case of a standard transthoracic examination, no special preparation is required, because it is enough to undress from the waist up and lay down
in the supine position. In turn, for transesophageal or exercise echocardiography, it is recommended to perform the examination on an empty stomach (at least a few hours before the procedure).

The course of the echo of the heart

Standard chest examination must be performed
in a properly soundproofed room. The patient should lie in an upright position on the back, and a special ultrasonic conductive gel is applied to the skin of the cage. Then the ultrasound head is placed on the lubricated area. The equipment receives an echo which it saves in the form of an image of the heart on the monitor. During the test, you must not move, and the procedure itself lasts from several minutes to half an hour. In the case of transesophageal examination, local aerosol anesthesia is used on the back wall of the throat,
and then inserts a special probe up to a depth of 38 centimeters below the tooth line. The transesophageal examination procedure takes about a dozen or so minutes.

Prophylaxis by echo of the heart

After the echocardiogram, there are no restrictive prophylaxis rules, although it is recommended not to overexert the body. In the case of transesophageal examination, it is recommended not to consume alcohol for 24 hours after the procedure and to drink fluids so as not to experience dryness or irritation inside the throat. However, it is normal to feel slight discomfort, sore throat, dryness or hoarseness with a transesophageal echo of the heart. In turn, shortness of breath or severe pain should be disturbing,
as well as speech problems - most often they are symptoms of complications.

Side effects in the event of a heart echo

Most often, the echo of the heart is smooth and leaves no trace of it, but some methods may have postoperative side effects. These effects are harmless as the test takes place under controlled conditions and is completely safe for patients' health. People who are allergic to ultrasound gel most often suffer from side effects after the procedure. After the procedure, you may experience discomfort or temporary pain in your esophagus if you have a transesophageal test. If sedatives have been used, you may, of course, feel dull or sleepy. In the case of an exercise test, you may experience temporary pain in the breast, nausea and dizziness, or a feeling of tiredness due to the physical exertion or temporary stress associated with the test. Echocardiography can cause irregular heartbeat and, in extreme cases, a heart attack - however, the test conditions are controlled, so there is a minimal risk. Some people also react more strongly to the contrast agent in the contrast echo of the heart. As a consequence, an allergic reaction in the form of itching may appear.

Sources:

Machaj I., i in.. Nieinwazyjne badania obrazujące w kardiologii. Medycyna Ogólna Nauk o Zdrowiu. 21(4). 2015, 362-368.

Piórkowski A., Kempny A. CT2TEE - a novel, internet-based simulator of transoesophageal echocardiography in congenital heart disease. Kardiol Pol. 2010, 374-379.

Piórkowski A., Kempny A. The transesophageal echocardiography simulator based on computed tomography images. IEEE Transactions on Biomedical Engineering. Vol 60(2). 2013, 292-299.

Podstawy echokardiografii, Collegium Medicum. 2014, http://kardiologia.biziel.pl/4f3.pdf [dostęp online dnia 10. 06. 2020].

Przymuszała-Staszak D., Guzik P. Podstawowe wskazania i techniki echokardiograficzne. Anestezjologia i Ratownictwo. 5. 2011, 462-467.