Transthoracic Echocardiogram

Echocardiogram

Definition

An echocardiogram uses ultrasound and Doppler principles to create images of the heart. This is a common procedure that shows if the heart is beating and pumping blood normally. The images created are used to identify abnormalities in the heart muscle, chambers, and valves. It also provides information on whether your heart is enlarged (dilated cardiomyopathy) or stiff (diastolic dysfunction/diastolic heart failure/heart failure with normal left ventricular ejection fraction or HFnEF). Echocardiograms are usually one of the first tests ordered by cardiologists to find out more about your potential cardiac condition.

Transthoracic Echocardiograms (TTE), when read correctly prove very useful for almost any condition your heart.

Why Performed

Echocardiograms are ordered for suspicions of abnormalities in the heart valves, heart chambers, or the heart muscle itself. There are two types of echocardiograms. One is performed non-invasively (transthoracic) and the other is performed invasively (i.e. transesophageal – down the esophagus). Some common symptoms that an echocardiogram are ordered for:

  • Murmurs
  • Palpitations
  • Chest pain
  • Abnormal electrocardiogram
  • Heart failure
  • Shortness of breath
  • Passing out (syncope)

Risks

There minor risks the patient is subjected to during a transthoracic echocardiogram (TTE). A limited amount of energy is transferred to organs during ultrasound image acquisition. This is a minimal risk and is usually not even disclosed since the chances of causing damage to a solid organ by echocardiograms are so minimal it is considered inconsequential. There may be minor discomfort when electrodes are removed from your chest after the procedure. You may also develop a rash from the adhesive on the electrodes. Overall, the risks undergoing an echocardiogram are almost nil.

Preparation

You do not need to undergo any special preparations prior to a surface echocardiogram (TTE, or transthoracic echocardiogram). Be prepared to arrive early to your appointment to have the technician set up properly to obtain the heart images. Preparation time usually takes less than 15 minutes (get into a gown, warm up machine, input your information into the machine such as blood pressure and a brief reason for obtaining the procedure).

Expectation

During the procedure

A transthoracic echocardiogram, also known as TTE, is a noninvasive form of an echocardiogram. It is the echocardiogram used most commonly. A trained sonographer applies gel on your chest and uses an ultrasound probe to obtain images of the heart. The pressure of the probe against your chest wall may cause a small bit of discomfort. If the images are not optimal, intravenous contrast may be injected to create better images for the doctor to read.

Echocardiograms are performed anywhere the machine can be mobilized to. It is usually performed in a doctor’s office or the hospital. It is usually performed after partially removing clothing to make way for the ultrasound probe. The patient will lay down and asked to perform different maneuvers. Electrodes (stick patches) will be applied to your skin to detect electrical impulses from your heart.

Usually, the length of an echocardiogram is less than an hour, but depends on the complexity of your particular situation. You may be asked to perform different maneuvers such as taking deep breaths.

After the procedure

Your images will most likely be reviewed by a heart specialist. Some general practioners or anesthesiologists also read echocardiograms. Any follow up or additional testing depends on the results of the echocardiogram. There is no recovery period for a transthoracic (TTE) echocardiogram.

Results

The echocardiogram evaluates valves, chambers, chamber pressures, and general function of the heart. More specifically:

  • Heart size. Many different diseases can cause a distortion of your heart walls. Echocardiograms may be used to diagnose or follow response to treatment for certain diseases. Echocardiograms are extremely useful to determine if you have a dilated heart (“enlarged heart”) or a thick heart (“stiff heart”).
  • Pumping strength. Measurements such as ejection fraction (EF or LVEF) is usually a common and easy assessment of heart strength. There are qualitative and quantitative assessments made with echocardiograms. There are also subjective and objective assessments of heart pumping strength. Ejection fraction is the percent of blood pumped out of the heart. Also measured is amount of blood per beat (stroke volume) or in unit of time (cardiac output – i.e. amount of blood per minute). EF is the easiest determination heart function, but there are pitfalls to solely relying on just EF.
  • Abnormal heart muscle movement. Wall motion is the interpretation on how the heart walls behave during different parts of the cardiac cycle. Wall motion abnormalities may represent obstructive coronary artery disease (CAD) or insults to the heart from various toxins or viruses.
  • Valve problems. Evaluation for different valve problems are commonly assessed with echocardiograms. Disease states such as mitral regurgitation, aortic regurgitation, tricuspid regurgitation, or pulmonic regurgitation are commonly evaluated (leaky valves or incompetent valves). Stenosis of valves (calcified or ‘tight’ valves) such as aortic stenosis, mitral stenosis, tricuspid stenosis, and pulmonic stenosis are also commonly evaluated. Echocardiograms can tell doctors are severe the valvular problem is and if a certain form of treatment may be required (open heart surgery, catheter/minimally invasive treatments, and/or medicines).
  • Heart defects. Congenital heart defect and acquired heart defects can be assessed with echocardiograms. There are many abnormalities that may be accurately diagnosed with transthoracic echocardiograms. Some disease states may require a transesophageal echocardiogram. For most congenital heart defects you are best served by seeing a cardiologist. Some more rare or complicated heart defects may require a subspecialist (subspecialized cardiologist) such as a congenital heart defect cardiologist. Sometimes echocardiograms may be performed while the baby is in the womb, i.e. fetal echocardiogram.