Echocardiogram (“Echo”)

An Echocardiogram, or “Echo,” is an ultrasound of the heart, which can give all sorts of important information.ย  It doesn’t hurt at all, and uses sound waves (no radiation).ย  We can watch the heart how it pumps, making crucial measurements.ย  It’s also called a “Transthoracic Echo” (TTE) because it’s done beaming sound waves through the outside of the chest (see #8 below for more complicated technique).ย  Some of the reasons we order Echos are:

1.  To diagnose and evaluate Heart Failure, maybe for a patient with shortness of breath or swollen feet.  We can see how well the heart pumps blood, estimating what percentage gets pumped out with each beat (the “ejection fraction,” adequate = >60%, extremely serious = <20%).  The Echo can help us find the cause of heart failure, depending on whether the heart muscle is thick (hypertrophic) or ballooned out (dilated), and whether it’s the right or left side or both that aren’t pumping well.

2.  Heart murmurs may be signs of damaged heart valves; the Echo shows this clearly.

3.  Presence of certain lung diseases (pulmonary hypertension) can be gleaned by how well the right side of the heart works.

4.ย  For certain abnormal electrocardiograms (EKG), we can see to what extent the heart might be affected (EKG’s may be false-positive more often than we’d like).

5.  Prior Heart Attacks can be noted if part of the heart muscle isn’t pumping.

6.ย  For patients with Hypertension, we can see if the years of high blood pressure have had any negative effect on the heart (like abnormal thickening of the muscle, called hypertrophy).

7.  Rare cardiac tumors, or pericardial effusions (collections of fluid around the heart) can be seen.

8.  To rule out blood clots in the heart (causing fevers, or strokes).  To be most accurate, we’d need to order a “Trans-Esophageal Echo” (TEE), for which part of the exam is obtained by a recorder in the esophagus.  That’s more invasive, carrying rare but serious risks, so it’s never routine. 9.  A “Stress Echo” is used to see if a patient’s chest pain or other symptoms are due to Coronary Artery Disease, which could lead to a Heart Attack.  First we do an Echo at rest, then repeat it during exercise (or after injecting medication to make the heart beat fast, for patients who can’t exercise).  If part of the heart muscle contracts normally at rest, but not with exercise, it means blood flow may be obstructed when it’s really needed.  Such patients may need procedures or surgery to open the artery and prevent a future heart attack.

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