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hqip српски srpski svenska ไทย türkçe українська oʻzbekcha ўзбекча tiếng việt 中文 edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url print export download as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia medical imaging technique of the heart not to be confused with electrocardiography or other types of electrography or ecmo this article needs additional citations for verification please help improve this article by adding citations to reliable sources unsourced material may be challenged and removed find sources echocardiography news newspapers books scholar jstor september 2017 learn how and when to remove this message medical intervention echocardiography three dimensional echocardiogram of a heart viewed from the apex icd 9 cm 88 72 mesh d004452 ops 301 code 3 052 medlineplus 003869 edit on wikidata echocardiography also known as cardiac ultrasound is the use of ultrasound to examine the heart it is a type of medical imaging using standard ultrasound or doppler ultrasound 1 the visual image formed using this technique is called an echocardiogram a cardiac echo or simply an echo echocardiography is routinely used in the diagnosis management and follow up of patients with any suspected or known heart diseases it is one of the most widely used diagnostic imaging modalities in cardiology it can provide a wealth of helpful information including the size and shape of the heart internal chamber size quantification pumping capacity location and extent of any tissue damage and assessment of valves an echocardiogram can also give physicians other estimates of heart function such as a calculation of the cardiac output ejection fraction and diastolic function how well the heart relaxes echocardiography is an important tool in assessing wall motion abnormality in patients with suspected cardiac disease 2 it is a tool which helps in reaching an early diagnosis of myocardial infarction showing regional wall motion abnormality also it is important in treatment and follow up in patients with heart failure by assessing ejection fraction 2 3 echocardiography can help detect cardiomyopathies such as hypertrophic cardiomyopathy and dilated cardiomyopathy the use of stress echocardiography may also help determine whether any chest pain or associated symptoms are related to heart disease the most important advantages of echocardiography are that it is not invasive does not involve breaking the skin or entering body cavities and has no known risks or side effects 4 not only can an echocardiogram create ultrasound images of heart structures but it can also produce accurate assessment of the blood flowing through the heart by doppler echocardiography using pulsed or continuous wave doppler ultrasound this allows assessment of both normal and abnormal blood flow through the heart color doppler as well as spectral doppler is used to visualize any abnormal communications between the left and right sides of the heart as well as any leaking of blood through the valves valvular regurgitation and can also estimate how well the valves open or do not open in the case of valvular stenosis the doppler technique can also be used for tissue motion and velocity measurement by tissue doppler echocardiography echocardiography was also the first ultrasound subspecialty to use intravenous contrast echocardiography is performed by cardiac sonographers cardiac physiologists uk or physicians trained in echocardiography the swedish physician inge edler 1911 2001 a graduate of lund university is recognized as the father of echocardiography he was the first in his profession to apply ultrasonic pulse echo imaging which the acoustical physicist floyd firestone had developed to detect defects in metal castings in diagnosing cardiac disease edler in 1953 produced the first echocardiographs using an industrial firestone sperry ultrasonic reflectoscope in developing echocardiography edler worked with the physicist carl hellmuth hertz the son of the nobel laureate gustav hertz and grandnephew of heinrich rudolph hertz 5 6 medical uses edit sonographer doing an echocardiogram of a child echocardiogram in the parasternal long axis view showing a measurement of the heart s left ventricle health societies recommend the use of echocardiography for initial diagnosis when a change in the person s clinical status occurs and when new data from an echocardiogram would result in the physician changing the person s care 7 diagnostic criteria for numerous cardiac diseases are based on echocardiography studies for example the differentiation of mild moderate and severe valvular disease is based upon measured criteria 8 another example is the estimation of heart function by the left ventricular ejection fraction lvef has vast uses including classification of heart failure and cut offs for implantation of implantable cardioverter defibrillators citation needed health societies do not recommend routine testing when the patient has no change in clinical status or when a physician is unlikely to change care for the patient based on the results of testing 7 a common example of overuse of echocardiography when not indicated is the use of routine testing in response to a patient diagnosis of mild valvular heart disease 9 in this case patients are often asymptomatic for years before the onset of deterioration and the results of the echocardiogram would not result in a change in care without other change in clinical status 9 echocardiography has a vast role in pediatrics diagnosing patients with valvular heart disease and other congenital abnormalities an emerging branch is fetal echocardiography which involves echocardiography of an unborn fetus 10 types edit transthoracic echocardiogram edit main article transthoracic echocardiogram a standard echocardiogram is also known as a transthoracic echocardiogram tte or cardiac ultrasound and it is used for rapid evaluation of a patient at their bedside 11 12 in this case ultrasound gel is applied to the chest wall to help transmitt the ultrasound waves 13 then the echocardiography transducer or probe is placed on the chest wall or thorax of the subject and images are taken through the chest wall this is a non invasive highly accurate and quick assessment of the overall function of the heart transthoracic echocardiography can display structure of heart chambers myocardial motion and valvular function in real time and is widely used to access a variety of cardiovascular diseases such as ventricular systolic dysfunction valvular heart disease and pericardial disease 14 but although tte is a non invasive and widely used examination method its image quality can be influenced by body fat thickness of chest and other factors tte utilizes several windows to image the heart from different perspectives each window has advantages and disadvantages for viewing specific structures within the heart and typically numerous windows are utilized within the same study to fully assess the heart parasternal long and parasternal short axis windows are taken next to the sternum the apical two three four chamber windows are taken from the apex of the heart lower left side and the subcostal window is taken from underneath the edge of the last rib 15 tte utilizes m mode 2d and 3d ultrasounds time is implicit and not included from the different windows these can be combined with pulse wave or continuous wave doppler to visualize the velocity of blood flow through the left ventricle and structure movements images can be enhanced with contrast that are typically some sort of micro bubble suspension that reflect the ultrasound waves 16 transesophageal echocardiogram edit this section needs more reliable medical references for verification or relies too heavily on primary sources please review the contents of the section and add the appropriate references if you can unsourced or poorly sourced material may be challenged and removed find sources echocardiography news newspapers books scholar jstor march 2023 main article transesophageal echocardiogram a transesophageal echocardiogram 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 via the mouth allowing image and doppler evaluation from a location directly behind the heart it is most often used when transthoracic images are suboptimal and when a clearer and more precise image is needed for assessment or in specific conditions such as being in a critical condition such as having low oxygen levels or needing heart surgery 17 because the esophagus is located behind and close to the heart this method can provide higher resolution images than transthoracic echocardiography tte 18 this test is performed in the presence of a cardiologist anesthesiologist registered nurse and ultrasound technologist during the examination patients need to be fasting before the examination begins the doctor will administer local anesthesia to patient s throat and administer sedative drugs if necessary 19 tee is invasive during the examination a flexible scope with an ultrasound probe will be slowly inserted into the esophagus the position and angle of the probe can be adjusted as needed to obtain different angle of view additionally modern multiplane tee probes use transducer elements to generate a two dimension plane 20 21 and the ultrasound plane can be rotated electronically to permit an additional dimension to optimize views of the heart structures often movement in all of these dimensions is needed tee can be used as stand alone procedures or incorporated into catheter or surgical based procedures for example during a valve replacement surgery the tee can be used to assess the valve function immediately before repair replacement and immediately after this permits revising the valve mid surgery if needed to improve outcomes of the surgery 22 stress echocardiography edit main article cardiac stress test a stress echocardiogram also known as a stress echo uses ultrasound imaging of the heart to assess the wall motion in response to physical stress first images of the heart are taken at rest to acquire a baseline of the patient s wall motion at a resting heart rate the patient then walks on a treadmill or uses another exercise modality to increase the heart rate to his or her target heart rate or 85 of the age predicted maximum heart rate 220 patient s age finally images of the heart are taken at stress to assess wall motion at the peak heart rate a stress echo assesses wall motion of the heart it does not however create an image of the coronary arteries directly ischemia of one or more coronary arteries could cause a wall motion abnormality which could indicate coronary artery disease the gold standard test to directly create an image of the coronary arteries and directly assess for stenosis or occlusion is a cardiac catheterization a stress echo is not invasive and is performed in the presence of a licensed medical professional such as a cardiologist and a cardiac sonographer 23 a systematic review and meta analysis published in heart in 2024 studied the long term capabilities of stress echocardiography being used to identify coronary artery disease data were collected from over 16 000 patients from a total of six clinical trials the results from the meta analysis show that patients with a positive stress echocardiography test indicative of reduced blood flow to the heart from coronary arteries had higher annual rates of major adverse cardiovascular events mace and all cause mortality than those with negative results the annual mace rate was 1 99 for patients with a positive test compared to 1 54 in those with negative tests the mortality rates for the patients were 1 68 and 1 02 respectively the results from the meta analysis show that stress echocardiography may be able to provide predictive long term information and can be used for better risk assessment in patients with coronary artery disease 24 intracardiac echocardiography edit main article intracardiac echocardiogram intracardiac echocardiography ice is specialized form of echocardiography that uses catheters to insert the ultrasound probe inside the heart to view structures from within the heart ice is often used as a part of the cardiac procedure of crossing the interatrial septum with a transseptal puncture to permit catheter access from the right atrium to the left atrium alternative access to the left heart would be retrograde through the aorta and across the aortic valve into the left ventricle 25 ice has the benefit over transthoracic echocardiography in that an operator who is performing a sterile procedure can also operate the ice catheter and it is not limited to visibility problems that can arise with transthoracic or transesophageal echo though there are image quality limitations due to size constraints of the probe being limited to a catheter 26 ice is often inserted through the femoral vein and into the right atrium from the right atrium visualization of the interatrial septum all four cardiac chambers all four valves and the pericardial space for an effusion can be readily visualized it can also be advanced across the atrial septum into the left atrium to visualize the left atrial appendage during left atrial appendage occlusion device deployment 27 according to singleton osorio electrophysiologic studies and catheter ablation have been done using fluoroscopic guidance but have recently transitioned to using electroanatomic mapping eam and ice to stop using fluoroscopy eam and ice allow for three dimensional accurate images of the chamber being imaged guidewires and catheter tissue interfaces this combination has replaced fluoroscopy for electrophysiologic procedures 28 intravascular ultrasound edit coronary artery ivus with lumen inside yellow line and atherosclerotic plaque in green intravascular ultrasound ivus is an intravascular technique that uses a catheter to insert the ultrasound probe inside blood vessels this is commonly used to measure the size of blood vessels and to measure the internal diameter of the blood vessel for example this can be used in a coronary angiogram to assess the narrowing of the coronary artery 29 ivus images the inside of blood vessels so it allowed direct observation of the inside of vessels during the examination a catheter with ultrasound probe is inserted into a blood vessel through the femoral or radial artery then the probe can be pushed to the target vessel location such as coronary artery when probe reached it emits ultrasound waves and received reflected echoes as the catheter is retraced in a controlled manner then an internal map can be generated ...
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