What Is Echocardiography?

Echocardiography uses sound waves (ultrasound) to produce images of inner structure and functions of the heart. It is performed by a device (transducer) that transmits the sound waves. Transducer is placed on various locations of the chest wall to examine the walls and valves of the heart in different positions.

What are the Methods of Echocardiography?

  1. Transthoracic Echocardiography (TTE)
  2. Transesophageal Echocardiography (TEE)
  3. Stress Echocardiography
  4. Strain and Strain Rate Echocardiography

I. Transthoracic Echocardiography

How is Transthoracic Echocardiography done?

Patient will lie down on the left side.
Transducer is covered with gel and placed on various locations of the chest wall.
No X- rays are used for this procedure and it is based on ultrasound technology.
Heart valves, sections and moves of major vessels (aorta, pulmonary artery) are displayed on the screen.
It usually takes only 15 minutes.
It is a painless procedure and has no side effects.
Results will be evaluated by the doctor who performed the test.

Why is it done?

  • To investigate the causes of heart sounds auscultated (e.g. murmurs), cardiac dilation, unexplained chest pain, dyspnea, or irregular heartbeats;
  • To measure the shape and size of cardiac cavities;
  • To check thickness and moves of heart walls;
  • To clearly evaluate the structure and moves of heart valves;
  • To evaluate functions of artificial valve;
  • To evaluate cardiac functions;
  • To detect the diseases (e.g. cardiomyopathy) affecting myocardium;
  • To evaluate clots and tumors in the heart;
  • To control congenital heart diseases or related surgical interventions

To assess cardiac functions after a heart attack;

  • To evaluate the type and volume of liquid if accumulated around the heart, and the quality and thickness of pericardium enveloping the heart;
  • To evaluate structure and diameter of aortas arising from the heart (aorta, pulmonary artery).

II. Transesophageal Echocardiography

What is Transesophageal Echocardiography (TEE)?

An echocardiography through esophagus may be required in some cases where commonly used TTE is insufficient. It is a similar technique to gastroscopy.

Why is it done?

To examine, in depth, diseases associated with valvular infections called endocarditis, or clots and masses in the heart detected by TTE. To examine, in depth, functions of artificial valves;

When suspected aortic vasodilatation or rupture;

  • To examine the pores on the membranes between the heart chambers;
  • To determine the severity of heart valve regurgitation;
  • To assess the success of procedure during or after heart valve repair or closure of cardiac defect;
  • When it is difficult to get images of sufficient quality by transthoracic echocardiography due to a pulmonary disease, obesity, or structure of the chest.

How the patient is prepared prior to procedure?

Patient will be asked not to eat for 4-12 hours before the procedure. The patients who have complaints of allergy, asthma, high eye pressure, swallowing difficulty, blocked nose, recent throat infection, and patients who have problems with esophagus and stomach should inform the doctor who will perform the procedure.

How is the procedure performed?

TEE is a half invasive procedure. Immediately prior to the procedure, a vascular access is established to administrate IV drugs when required.
The mouth and soft palate are locally anaesthetized by a spray to suppress the nausea reflex and have the patient compliant with the procedure.
An IV tranquillizer is applied for a smooth procedure and the comfort of the patient. When it is difficult to have the patient compliant with the procedure, repetition of the procedure is done by the supervision of anesthesiologist and additional tranquillizer.
The cardiologist to perform the procedure will explain how the tube is swallowed. A mouthpiece is placed in the mouth for the patient not to bite the tube. TEE probe covered with gel is slowly guided down the esophagus. It is normal to have a gag reflex and nausea when swallowing the probe. This is only temporary. In the meantime the patient breaths through nose.
The doctor will record on the video and take pictures of the required cardiac images. Your doctor will provide you with information about findings. The procedure takes about 15-20 minutes; however it can be up to 30-60 minutes with preparation time.

III . Stress Echocardiography

What is a Stress Echocardiography?

Stress echocardiography (SE) is a method using exercises or medications to accelerate the heart rate. For an exercise echocardiogram, at the each stage of the echocargiographic images of the heart are taken before and immediately after walking on a treadmill or riding a stationary bike. If the patient is unable to exercise (e.g. leg vascular disease, limitation of musculoskeletal system), an intravenous injection of medication including dobutamine, adenosine, dipyridamole to accelerate cardiac rhythm and contraction is periodically applied in incremental doses.

When is a Stress Echocardiography required?

It is performed when it is difficult to assess heart diseases by other methods due to presence of permanent pacemaker, left branch block in the ECG, left ventricular thickening, and certain symptoms in the ECG (preexitation).

To assess the risk following an acute heart attack and invasive procedure on coronary vessels to determine myocardial blood flow disorder and its severity; To assess the cardiac risk of patients undergoing a surgical intervention prior to surgery except cardiac surgery.

It is intended to observe the capacity of heart to contract, investigate the symptoms of coronary regurgitation, and help surgical decision in some valve diseases.

Actions to take prior to the test

SE requires fasting of about 4 to 6 hours. In addition, no smoking and drinking caffeinated food (e.g. tea, coffee, chocolate, coke, etc.), or drugs (because some analgesics may contain caffeine) are allowed for 6 hours.
Certain drugs used by the patient should be discontinued 24 hours before this test. This will be decided by the doctor who has requested the test. The patient may take h/her drugs (if allowed) with a little amount of water 3-4 hours before the tests.
For all tests requiring fasting, diabetic patients should not take their diabetic medications until they are allowed to eat. They may eat immediately after completion of SE test.

Matters to consider after the procedure

The patient should not eat or drink for about 2 hours until numbness of throat disappears. Because the medications used during the procedure to sedate may cause drowsiness, use of a machine or vehicle is not allowed until it is completely cleared up. Pain in the throat and loss of sensation may be experienced for 1 or 2 days after the test. This is a temporary state and does not require any treatments.

How is the procedure performed?

Test preparation includes placing the electrodes on the chest and establishing a vascular access. Test takes around 1 hour. This procedure involves getting records of certain locations on the chest. Images of the heart are recorded.
The procedure requires exercise or medication depending on the stress method selected. Images of the exercise are taken. Then images of recovery period are taken. Cardiac rhythm and blood pressure are monitored; records of ECG are taken.
Fast and intense heartbeats, during the test, are considered a heart-throb. This is normal.

During medicated test (administration of dobutamine), it is normal to have warm and red cheeks, and tingling of hairy skin. During the procedure, if patient experiences pain and discomfort in the chest, arms and jaw, dizziness, grayout, and dyspnea, the doctor must be immediately informed.
Patient is supervised in the recovery room for half an hour after the procedure. The test is interpreted by comparing the images of heart’s capacity to contract taken at different stages.
The patient is explained the findings from stress echocardiogram by the doctor and delivered in a written report within an hour.

Is it likely to have adverse events related to Stress Echocardiography, What are the associated risks?

Stress echocardiography is a reliable method. Medication-related adverse effects are rare during medicated stress echocardiography. They are headache, sweating, heart-throb, chest pain, dyspnea, and nausea.
Sudden drop or raise in blood pressure, instant transient arrhythmia originated from the ventricles or atria, slowed heart rate, and chest pain originated from the vessels during the procedure are rare.

IV. Strain, Strain rate and Velocity Vector Imaging Echocardiography

What are Strain, Strain Rate and Velocity Vector Imaging Echocardiography?

Strain, Strain rate and velocity vector imaging echocardiography is the most precise, recent and modern method developed to most accurately measure heart’s functions of relaxing and contracting in various planes using tissue Doppler ultrasound method.

Why and how is it done?

This method is particularly used to assess power and contraction functions of myocardium. Various sections of myocardium are selected, and the size and moves of these sections are measured at different planes at the time of stress and rest.

It is painless and has no side effects. No preparation is needed prior to the procedure. No contrast material is used. The procedure takes about 15-30 minutes.
The results are evaluated and delivered to the patient by the doctor who performed the test. The patient can continue daily activities immediately after the procedure.

 When is it required?

Heart’s capacity to contract in a patient with heart failure is measured most accurately. So, the cause of heart failure is detected much earlier than that could be visually detected by a normal eye so that the most appropriate treatment option can be determined.

It provides highly precise measurement in identification of damaged mass of heart muscle and the size of damage in a patient who has had a heart attack. It is one of the critical methods used to assess myocardial functions prior to a cardiac surgery. It is the most reliable method to identify pericarditis and differentiate the types of pericarditis. It is a unique method to instantly detect simultaneous dysfunction of heart’s right and left halves, to select correct treatment and monitor effectiveness of this treatment.


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The information on this website is not intended to replace any medical advice given by physicians with access to your detailed medical history.