Echocardiography

(Cardiac Echography, Heart Sonography)

Normal Findings:

Normal position, size, and movement of the cardiac valves and heart muscle wall
Normal directional flow of blood within the heart chambers



Indications:

Echocardiography is performed most commonly to evaluate heart wall motion (a measure
of heart wall function) and to detect valvular disease, evaluate the heart during stress
testing, and identify and quantify pericardial fluid




Test Explanation:


Echocardiography is a noninvasive ultrasound procedure used to evaluate the
structure and function of the heart. In diagnostic ultrasonography, harmless, high-
frequency sound waves emitted from a transducer penetrate the heart and are
reflected back to the transducer as a series of echoes. These echoes are amplified
and displayed on a cathode ray tube. Tracings also can be recorded on moving graph
paper or videotape. The study usually includes M-mode recordings, two-
dimensional recordings, a Doppler study, and real-time three-dimensional imaging.



Interfering Factors:


Patients with chronic obstructive pulmonary disease (COPD) have a substantial amount of air
between the heart and the chest cavity. Air space does not conduct ultrasound waves well.

In obese patients, the space between the heart and the transducer is greatly enlarged;
therefore, accuracy of the test is decreased

Test Results and Clinical Significance:


Valvular heart disease (e.g., stenosis, regurgitation, mitral valve prolapse):
This is readily evident on echocardiograms. All valves can be easily seen with the linear mode. The
circulatory effects of valvular disease are apparent on Doppler studies.

Pericardial effusion: Fluid around the heart is easily evident. Echocardiography can be used to guide a
needle into the pericardial space for aspiration of fluid for analysis and treatment.


Ventricular or atrial mural thrombi: When these are evident, anticoagulation therapy is required. These
thrombi may be the result of previous myocardial infarction (MI), ventricular aneurysm, congestive heart
failure (CHF), or cardiomyopathy.

Myxomas: These tumors are often evident as a mass partially attached to the endocardium.
Poor ventricular muscle motion: Hypokinesia is evident in a portion of or in the entire myocardial wall in
patients with myocardial ischemia, cardiomyopathy, and CHF.

Ventricular hypertrophy: This chronic disease is evident as an unusually thickened myocardium.
Endocarditis: Vegetations are readily evident on the valves. Aggressive antibiotic or anticoagulation
therapy, or both, is needed.

Septal defects: Left-to-right shunting is readily evident with color flow Doppler imaging