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Why Doctors Use Echocardiography
Eddy Barasch, M.D.
Dr. Barasch is the Director of the Cardiac Echo Laboratories at the Hermann Heart Center and the University of Texas Medical School, Houston.
Echocardiography is a modern technique that allows the physician to evaluate the heart without inserting any tubes or wires. This "non-invasive" method, like the sonogram pregnant mothers now routinely receive, uses sound waves, which reflect off the heart structures (hence the term echo) and are recorded to produce an image of the heart.
Computer processing of the precise arrival times of the sound signals provides a two-dimensional view of a "slice" through the heart. In the twenty years since it was first introduced, echocardiography has evolved into many specialized formats: color Doppler, three dimensional, tissue imaging and volumetric echocardiography.
Echocardiography can be very helpful in the diagnosis of:
Significant Heart Murmurs
First and foremost, doctors use echocardiography to evaluate the seriousness of heart murmurs. Murmurs are extra sounds, heard by the doctor through the stethoscope, that are produced as blood flows through an opening changed by disease or birth defect. Echocardiography records these blood flow measurements and converts them into pressure gradients, the difference in pressure between one side of the opening (at a valve, for example) and the other side, thus telling the doctor how severe the damage is. With the help of this test, the physician can determine how leaky or narrowed the valve is and identify which patients might benefit from medicines or corrective surgery.
Heart Enlargement
For patients with enlarged hearts, the echocardiogram will accurately measure the degree of enlargement of the upper collecting chambers (atria) or the lower pumping chambers (ventricles). If you have an atrial septal defect (ASD), a hole in the wall separating the two upper collecting chambers, transesophageal echocardiography (which uses a probe mounted on a flexible tube that is inserted through the mouth into the esophagus located just behind the heart) will identify the type of defect, its size, its direction and possible associated abnormalities. Similarly, for ventricular septal defect (a hole between the pumping chambers), which can be congenital or acquired (usually after a heart attack), characteristics of the defect can be determined.
Heart Infections and Emboli
Echocardiography is so sensitive that it can also detect mild murmurs not otherwise heard. This early warning system can alert your doctor to future problems. Infections of the heart (infective endocarditis) often occur at the site of a defective heart valve and, until echocardiography, it was difficult to pinpoint the infection's location. Artificial valves, for example, are prone to infection and echocardiography enables the doctor to better monitor their status. Sometimes, one type of echocardiography, transthoracic echocardiography (TTE), using a probe positioned on the chest, will be normal and transesophageal electrocardiography (TEE) will be needed to detect the problem.
Echocardiography has also been helpful in detecting cases where the outside lining of the heart is infected (pericarditis).
For a patient with an embolus [any undissolved material (usually a blood clot) carried by the blood to other organs, such as the brain in stroke patients], echocardiography can be used to identify from where in the heart or the aorta the embolus originated.
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