Echocardiography is a painless procedure that enables heart specialists to “see” the heart, much like an ultrasound is used to see a baby within the mother’s womb. Echocardiography bounces sound waves off of the heart, enabling the cardiologist to view the heart in real time. It also measures the speed and direction of blood flow, allowing the specialist to evaluate heart and valve function.

A basic transthoracic echocardiogram is an excellent way to get a broad-based view of the heart. It provides a lot of information about a heart’s size and structure, how strong the heart is and how well the valves are working. It is safe and painless and can be performed in the office. More specialized echocardiograms (described below) can further diagnose or confirm heart problems, assess whether treatments are working properly and help guide future treatments.

Transthoracic echocardiography

A cardiac sonographer spreads a thin gel across the patient’s chest and then places a handheld transducer (or probe) on the patient’s chest. The transducer transmits a sound (the frequency of the sound is so high you won’t be able to hear it) and collects the echoes. The resulting images are viewed on a computer screen and recorded. The procedure can take between 15 and 30 minutes and does not require a hospital stay or any sedation.

Stress echocardiography

The heart specialist watches how the heart performs under stress, usually to diagnose coronary artery disease (blocked heart arteries) in a patient with chest pain. A cardiologist may also use stress echocardiography to monitor the progress of a patient who has already been diagnosed with coronary artery disease. The echocardiogram is first performed with the patient at rest. The patient then exercises on a treadmill and is monitored continuously with an EKG. Immediately after exercise, the sonographer repeats a portion of the echocardiogram. Heart abnormalities that develop after exercise suggest that a heart artery has a significant blockage.

Dobutamine stress echocardiography (DSE)

DSE is an alternative to a treadmill stress echocardiogram. Instead of exercising on a treadmill, the patient is slowly given dobutamine through an intravenous tube. Dobutamine is similar to adrenaline, so it speeds up the heart like the stress of exercise. DSE is usually performed when the patient has limitations to exercise, such as lung problems, back pain or arthritis.

Transesophageal echocardiography (TEE)

TEE is performed in the hospital by a specially trained cardiologist. TEE is used to evaluate heart valve function, look for a clot or infection, find the cause of a stroke or diagnose a hole in the heart. While the patient is under sedation, the heart specialist passes a long, slender ultrasound probe (about the width of your pinky finger) through the patient’s mouth into the esophagus (swallowing pipe). The TEE takes pictures from the backside of the heart, showing the heart in ways that other techniques cannot. The procedure takes 30-45 minutes, and there is about a two-hour observation period afterwards (because of the sedation used).

The transthoracic echocardiogram has essentially no side effects or complications. Transiently abnormal heart rhythms may occur during stress echocardiography. In very rare cases, a heart attack may occur during a stress test. After transesophageal echocardiography, the patient’s throat may be sore due to minor throat injury. The patient also may have an adverse reaction to the sedative or local anesthetic.

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