Echocardiology- Frequently Asked Questions
Q: What is a Transthoracic Echocardiogram (TTE; Echocardiogram; Echo)?
- A: An Echo is a useful tool to evaluate the structure and function of the heart and associated vessels. It is a painless and harmless test that uses ultrasound waves to produce images of the heart. In North America, the test is performed by a specially trained technologist, called a sonographer, and is interpreted by a specially-trained physician, usually a cardiologist, trained in reading echocardiograms.
Q: Why has my doctor requested that I have an Echo?
- A: If you are going to have an Echo, it is likely that it has been requested or ordered by your physician or a cardiologist. There are many reasons that your physician may request that you have an echo procedure. Physicians use it to look for abnormalities in the large physical structures of the heart, including the heart chambers and valves. An echo may sometimes also be used to look for the cause of an abnormal heart sound (a murmur), to check the size of the heart chambers, to check for fluid around the heart, or to inspect the pumping capability (the muscles) of the heart if a patient has short of breath or has complained of certain symptoms during exertion.
Q: How do I prepare for an echo?
- A: There is no special preparation required for an echocardiogram. You should come as you are and eat or drink as you normally do. If you take medications, you should continue to take them as normal. You should plan on being at the Echocardiography Lab for about forty-five minutes to one hour.
Q: What should I expect?
- A: Upon arrival at the lab our friendly staff will greet you. We may request you to provide additional insurance information, and will ask you to register, and may also ask that you provide a prescription or order for your exam.
We will then escort you into an ultrasound examination room. The room will be dimly lit and will contain a special examination table or stretcher and an ultrasound machine. You may be asked a few questions by the sonographer who will want to know why you are having the test, if you have had previous tests, and if you have ever had open heart surgery. Usually a brief explanation of the procedure will be given as well.
You will be asked to remove your clothing from the waist up. Women will be given a gown to wear during the procedure
If you need help, the sonographer will assist you in getting onto the stretcher, where you will be asked to lie on your left side. The sonographer will then attach ECG lead wires to electrodes adhered to your chest with simple medical tape.
The lights may be dimmed to allow the sonographer to see the monitor better.
The sonographer will apply ultrasound gel to a transducer. The transducer is a wand like device that sends and receives the harmless ultrasound waves. The gel allows the ultrasound beams to penetrate your chest wall so that it is possible to “see” your heart.
Next, the sonographer will begin to acquire ultrasound images and audio recordings by methodically and precisely moving the transducer around on your chest, stomach, and neck. The sonographer will be viewing these images on a monitor and will take various recordings at several different locations or “views”. During recording, you may be asked to change your position and to hold your breath. These variations in position and breathing allow the Sonographer to obtain the best quality pictures. The Sonographer will press the transducer against your skin and this pressure may be moderate at times to facilitate the transmission of ultrasound waves. If it becomes too uncomfortable, please let the sonographer know and he/she will allow you to take a short break.
You should try to remain still and quiet during the exam. The imaging will take about 30 to 45 minutes. Often, the Sonographer will review the study with a supervisor or physician while you are still in the room. You should not be alarmed; the technique to acquire images of the heart is technically demanding and sonographers frequently rely on the advice of others as they acquire these images.
The images and sounds of the exam will be recorded on a digital recorder, a computer disk and/or videotape for later review.
Q: What will I see and hear on the echocardiography machine during my exam?
- A: Ultrasound waves used in performing the echocardiogram are not audible to the human ear, so you will not hear the sound waves.
Structures will be displayed in “real-time” and appear as white moving objects on the screen. For example, the valves of the heart will look like white flap-like moving structures. Areas of the heart where there is fluid or blood look black on the screen.
During the exam, you will notice the sonographer placing marks on the screen with small computer calipers. The sonographer uses the calipers to perform various measurements of the size, function and blood flow of the heart.
An echocardiogram exam usually includes a Doppler recording of the blood movement or flow within the heart. When color flow Doppler is used in the exam it will appear as different colors moving within the white and black images on the monitor. The different colors represent the different speeds and directions of blood flow in the heart.
Doppler examinations often also include an audio signal of the blood flow. These audio signals can be heard and seen. During the audio Doppler recording, you will hear the sound of the blood moving through the heart and the sound of the heart valves opening and closing. The audio signals are also displayed as a graph on the monitor. These graphic recordings help the physician to determine valve function and heart pressures.
Q: What happens after the exam?
- A: Following the recording of the images, the Sonographer will remove the ECG electrodes from your chest, will wipe off the ultrasound gel from your skin, will help you off the stretcher and escort you out of the lab.
The ultrasound images and Doppler recordings will be submitted to a physician who is a specially-trained physician in reading echocardiograms. He or she will interpret the echocardiogram and will then provide your general physician with a written report. Often, you will not be given any results for one or two days. Generally, the Sonographer will not provide you with any results at the time of the examination. We appreciate your patience while we review your exam results and prepare our written report.
Stress Echocardiograms- Frequently Asked Questions
Q: What is a Stress Echo?
- A: An Exercise Stress Echocardiogram, sometimes called a stress echo, is a tool used to evaluate heart function by combining an exercise (stress) test with a transthoracic echocardiogram. A stress echocardiogram uses ultrasound waves to produce images of the heart both before (sometimes during) and immediately following exercise. Images of the heart at rest are compared with images of the heart during and/or after exercise to evaluate how the heart muscle responds to exercise.
The test is performed by a specially trained technologist, called a sonographer, and is interpreted by a physician trained in reading stress echocardiograms. During the exercise portion of the exam there will be a medical staff member, supervising the examination and there is sometimes a third person assisting, a physician is readily available should an emergency arise.
Q: Why has my doctor requested that I have a stress echocardiogram?
- A: If you are going to have a stress echocardiogram, it is more than likely that it has been requested or ordered by your physician or cardiologist. A stress echocardiogram is most often requested to check for good blood flow to the heart muscle. An ECG may help to provide an early detection of coronary artery blockage.
Q: What must I do to prepare for an echocardiogram?
- A: Your doctor and/or the laboratory where you will have the stress echocardiogram performed will provide you with written instructions to help you to prepare for the test. You may be asked to refrain from eating and drinking for a few hours before the stress echocardiogram and you may also be asked to limit your drinking to water and other caffeine free drinks for up to 24 hours before the test. You may be asked to temporarily hold off on taking some medications. You may also be asked to stop using tobacco products for a few hours before the test.
You should bring or wear comfortable walking shoes and wear suitable (warm-ups/loose fitting clothes) for the test. It is very important that you check with your doctor and/or the stress echocardiography laboratory staff a few days before your stress echocardiogram for any specific instructions. You should plan on being at the echocardiography lab for at least one hour.
Q: What should I expect while at the exam?
- A: Upon arrival at the office you will be greeted by our staff. We may need to obtain some insurance information from you. You will be asked to register and may also be requested to provide a prescription or order for your examination.
After processing these items, we will then escort you into an examination room. The room will have a special examination table and ECG machine, an ultrasound machine and a treadmill (or sometimes a stationary bicycle).
You may be asked a few questions by the sonographer who will want to know why you are having the test, if you have had any previous stress echocardiograms, and if you have ever had open heart surgery. Usually he/she will give you an explanation of the procedure also. You will also be asked to sign a consent form before beginning the test.
You will then be asked to remove your clothing from the waist up. Women will be given a gown to wear.
A staff member will attach ECG lead wires to electrodes attached to your chest. To ensure the ECG lead wires stay attached while you exercise, we will clean your skin and prepare it for the electrodes. For men, it may be necessary to shave small areas of chest hair.
A blood pressure cuff will be placed on your arm before you begin to exercise. The sonographer will obtain resting echo images before you begin to exercise. The lights will be dimmed to allow the sonographer to see the monitor better. You will be asked to lie on the bed on your left side.
The sonographer will apply ultrasound gel to a transducer. The transducer is a wand-like device that sends and receives the harmless ultrasound waves. The gel allows the ultrasound beams to penetrate your chest wall to your heart and makes it possible to “see” the heart.
The sonographer will then begin to acquire ultrasound images by methodically and precisely moving the transducer around on your chest and abdomen. The sonographer will be viewing these images on a monitor and will take various recordings at several different locations or “views”. During the recording you may be asked to change your position and to hold your breath. These variations in position and breathing allow the sonographer to obtain the best quality pictures possible. The sonographer will press the transducer against your skin and this pressure may be moderate at times to facilitate the transmission of ultrasound waves. If it becomes too uncomfortable, please let the sonographer know and he/she will let you take a short break. After the sonographer has obtained all of the resting images, the exercise portion of the exam will begin.
ECG and blood pressure readings will be taken before exercise begins and throughout the exercise portion of the test.
Usually exercise is performed on a treadmill. When using the treadmill, the treadmill will begin at a slow, warm-up speed. The speed and the incline (or slope) of the treadmill will be increased every few minutes throughout the test.
The test is most useful if your target heart rate is reached before exercise is stopped so your doctor will want you to exercise as long as you can. Exercise will usually continue until your target heart rate is reached unless you experience difficulty breathing, or show other symptoms, and we will immediately stop.
IT IS IMPORTANT THAT YOU IMMEDIATELY LET US KNOW IF YOU EXPERIENCE ANY CHEST PAIN, SEVERE SHORTNESS OF BREATH, DIZZINESS, LEG PAIN, CALF PAIN, OR OTHER SYMPTOMS DURING THE EXAM.
More images of your heart will be obtained immediately after exercise is stopped. After the treadmill is stopped, you will be escorted very quickly back onto the bed, and asked to lie on your left side. It is important that you are positioned on the bed very quickly so that we can capture images of your heart while your heart rate is still high.
The sonographer will obtain another set of images so that the resting images before you began exercise can be compared to the images of your heart when it is under stress (immediately after you have exercised).
You will be asked to remain on the bed until your heart rate has slowed. If you experience any symptoms during this time or at any other time, you should report them immediately to our staff.
We will record the resting and exercise images of the exam on a digital recorder, a video tape and/or computer disk for later review and analysis by a physician who is a physician in specially-trained in reading and interpreting ultrasound images.
Q: What happens after the exam?
- A: Following the recording of the images, the sonographer will remove the blood pressure monitoring cuff from your arm and the ECG electrodes from your chest, will wipe off the ultrasound gel, will help you off of the bed and will escort you out of the lab.
The ultrasound images will be interpreted by a physician and will be discussed with you at your next office visit by your physician. Sometimes the physician present during your stress echocardiogram will be able to tell you his or her preliminary findings although this immediate feedback varies depending on individual circumstances.
Q: What is an Electrocardiogram or EKG?
An Electrocardiogram is a noninvasive test that records the electrical activity of the heart.
The electrical activity is related to the impulses that travel through the heart that determine the heart's rate and rhythm.
Electrodes are placed on the chest, arms and legs.
The test takes about five to ten minutes.
This test must be ordered by a doctor.
Q: Why is an Electrocardiogram Done?
- A: This test will help the doctor to evaluate the patient's cardiac condition related to:
Acute or chronic heart attack
What part of the heart was damaged
If there are any irregular heart beats or rhythm
If there is a decreased supply of blood and oxygen to the heart
Q: What Preparation is Needed?
No restrictions on food, liquid or medications prior to the test.
Do not apply lotions, oils, or powder to the chest.
- The Intersocietal Commission For The Accreditation Of Echocardiography
- American College of Cardiology
- American Heart Association
- The American Society of Echocardiography