An echocardiogram. Image shows that the human heart has four chambers. Apical view - left side of the heart to the right. Anatomically correct image - heart's apex at bottom. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic The trace in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Cardiac cycle is the term referring to all or any of the events related to the flow of blood that occur from the beginning of one heartbeat to the beginning of the next

An abnormal echocardiogram. Image shows a mid-muscular ventricular septal defect. A ventricular septal defect ( VSD) is a defect in the Ventricular septum, the wall dividing the left and right ventricles of the Heart. The trace in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Cardiac cycle is the term referring to all or any of the events related to the flow of blood that occur from the beginning of one heartbeat to the beginning of the next Colors are used to represent the velocity and direction of blood flow.

An echocardiogram is a sonography of the heart. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging.

In addition to creating two-dimensional pictures of the cardiovascular system, an echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave doppler ultrasound. This allows assessment of cardiac valve areas and function, any abnormal communications between the left and right side of the heart, any leaking of blood through the valves (valvular regurgitation), and calculation of the cardiac output as well as the Ejection fraction. Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute In cardiovascular physiology, ejection fraction ( Ef) is the fraction of Blood pumped out of a ventricle with each heart beat

Echocardiography was an early medical application of ultrasound. Echocardiography was also the first application of intravenous contrast-enhanced ultrasound. Contrast-enhanced ultrasound (CEUS is the application of Ultrasound contrast agents to traditional medical sonography. This technique injects gas-filled microbubbles into the venous system to improve tissue and blood delineation. Contrast is also currently being evaluated for its effectiveness in evaluating myocardial perfusion. It can also be used with Doppler ultrasound to improve flow-related measurements (see Doppler echocardiography). Doppler Echocardiography is a procedure which uses Ultrasound technology to examine the Heart.

Echocardiography is usually performed by cardiac sonographers and interpreted by a cardiologist. Cardiac sonographer (also known as Echocardiographer, or cardiac ultrasound technologist is a medical profession of Sonographers that specialize in the anatomy and

Purpose

Echocardiography is used to diagnose cardiovascular diseases. In fact, it is one of the most widely used diagnostic tests for heart disease. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity and the location and extent of any damage to its tissues. It is especially useful for assessing diseases of the heart valves. It not only allows doctors to evaluate the heart valves, but it can detect abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation. By assessing the motion of the heart wall, echocardiography can help detect the presence and assess the severity of coronary artery disease, as well as help determine whether any chest pain is related to heart disease. Echocardiography can also help detect hypertrophic cardiomyopathy, in which the walls of the heart thicken in an attempt to compensate for heart muscle weakness. The biggest advantage to echocardiography is that it is noninvasive (doesn't involve breaking the skin or entering body cavities) and has no known risks or side effects.

Transthoracic echocardiogram

A standard echocardiogram is also known as a transthoracic echocardiogram (TTE), or cardiac ultrasound. In this case, the echocardiography transducer (or probe) is placed on the chest wall (or thorax) of the subject, and images are taken through the chest wall. The thoracic cavity (or chest cavity) is the chamber of the human body (and other animal bodies that is protected by the Thoracic wall ( Thoracic cage This is a non-invasive, highly accurate and quick assessment of the overall health of the heart. A cardiologist can quickly assess a patient's heart valves and degree of heart muscle contraction (an indicator of the ejection fraction). Cardiology (from Greek grc καρδίᾱ kardiā, "heart" and grc -λογία -logia) is the branch of Internal medicine In cardiovascular physiology, ejection fraction ( Ef) is the fraction of Blood pumped out of a ventricle with each heart beat The images are displayed on a monitor, and are recorded either by videotape (analog) or by digital techniques.

An echocardiogram can be used to evaluate all four chambers of the heart. It can determine strength of the heart, the condition of the heart valves, the lining of the heart (the pericardium), and the aorta. It can be used to detect a heart attack, enlargement or hypertrophy of the heart, infiltration of the heart with an abnormal substance. Weakness of the heart, cardiac tumors, and a variety of other findings can be diagnosed with an echocardiogram. With advanced measurements of the movement of the tissue with time (tissue doppler), it can measure diastolic function, fluid status^[1], and dys-synchrony.

The TTE is highly accurate for identifying vegetations (masses consisting of a mixture of bacteria and blood clots), but the accuracy can be reduced in up to 20% of adults because of obesity, chronic obstructive pulmonary disease, chest-wall deformities, or otherwise technically difficult patients. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Chronic obstructive pulmonary disease ( COPD) is a Disease of the lungs in which the Airways become narrowed TTE in adults is also of limited use for the structures at the back of the heart, such as the left atrial appendage. Transesophageal echocardiography, if available, may be more accurate than TTE because it excludes the variables previously mentioned and allows closer visualization of common sites for vegetations and other abnormalities. An echocardiogram is a Sonography of the Heart. Also known as a cardiac ultrasound it uses standard ultrasound techniques to image two-dimensional slices of Transesophageal echocardiography also affords better visualization of prosthetic heart valves.

Transesophageal echocardiogram

This is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in This allows image and Doppler evaluation which can be recorded. This is known as a transesophageal echocardiogram, or TEE (TOE in the United Kingdom). The advantage of TEE over TTE is usually clearer images, especially of structures that are difficult to view transthoracicly (through the chest wall). The explanation for this is the heart rests directly upon the esophagus leaving only millimeters in distance that the ultrasound beam has to travel. This reduces the attenuation (weakening) of the ultrasound signal, generating a stronger return signal, ultimately enhancing image and Doppler quality. Comparatively, transthoracic ultrasound must first traverse skin, fat, ribs and lungs before reflecting off the heart and back to the probe before an image can be created. All these structures, and the distance the beam must travel, attenuate the ultrasound signal, degrading image and Doppler quality.

In adults, several structures can be evaluated and imaged better with the TEE, including the aorta, pulmonary artery, valves of the heart, both atria, atrial septum, left atrial appendage, and coronary arteries. While TTE can be performed quickly, easily and without pain to the patient, TEE requires a fasting patient, a team of medical personnel, takes longer to perform, is uncomfortable for the patient and has some risks associated with the procedure (esophageal perforation--1 in 10,000, and adverse reactions to the medication).

Before inserting the probe, conscious sedation is induced with the patient to ease the discomfort of the individual and to decrease the gag reflex, thus making the ultrasound probe easier to pass into the esophagus. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. The pharyngeal reflex or gag reflex is a Reflex contraction of the back of the throat evoked by touching the Soft palate, that prevents something from Conscious sedation is a light sedation usually using the medications midazolam (a benzodiazepine with sedating, amnesiac qualities) and fentanyl. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. Midazolam (marketed under brand names Dormicum, Flormidal, Versed, Hypnovel and Dormonid, pronounced mɪˈdæzəlæm The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Sometimes a local anesthetic spray is used for the back of the throat, such a xylocaine and/or a jelly/lubricant anesthetic for the esophagus. Children are anesthetized. Anesthesia, or anaesthesia (see spelling differences; from Greek grc αν- an-, "without" and grc αἲσθησις Unlike the TTE, the TEE is considered an invasive procedure and is thus performed by physicians in the U. S. , not sonographers.

3-dimensional echocardiography

3D echocardiogram of a heart viewed from the apex

3-D echocardiography is now possible, using an ultrasound probe with an array of transducers and an appropriate processing system. Three-dimensional space is a geometric model of the physical Universe in which we live This enables detailed anatomical assessment of cardiac pathology, particularly valvular defects,^[2] cardiomyopathies,^[3] and congenital abnormalities.

Accreditation

The "Intersocietal Commission for the Accreditation of Echocardiography Laboratories" (ICAEL) sets standards for labs and technicians in the US to comply to. Once all requirements have been met, the lab or technician will receive ICAEL certification. A lab that has received the certification may also receive higher reimbursement from insurance companies such as Medicare. http://www.icael.org/icael/index.htm

See also

• Aortic valve area calculation

References

A good introduction to Echo: http://www.echoincontext.com/

Examples of TransThoracic and TransEsophageal Echocardiograms: http://congenitalechocardiography.info/ http://www.ucsf.edu/teeecho/ http://info.med.yale.edu/intmed/cardio/chd/contents/index.html http://www2.umdnj.edu/~shindler/echo.html http://depts.washington.edu/anesth/tips/tee.shtml

External links

• SeeMyHeart - Patient Information on Echocardiograms (Heart Ultrasounds)
• American Society of Echocardiography
• Echobasics Basic introduction to echocardiography
• Stress Test with Echocardiography from Angioplasty. Org
• Echocardiography information from Children's Hospital Heart Center, Seattle.
• Coronary heart disease And echocardiography
• Echocardiography Resources Simple echocardiography tutorials
• Atlas of Echocardiography Echocardiography Database
• E-chocardiography Internet Journal of Cardiac Ultrasound
• Echocardiography Basic information about echocardiography - HealthwoRx
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International Society of Cardiovascular Ultrasound

• Congenital EchocardiographyInformation about pediatric Echocardiography & Adult congenital echocardiography