PRESENTATION ON

ECHOCARDIOGRAM

SUBMITTED TO: SUBMITTED BY:

MRS.YADAMMA MADAM N.SONIYA

FACULTY MSC(N)2NDYR

GOVERNMENT COLLEGE OF NURSING

SOMAJIGUDA.HYDERABAD
 STUDENT PROFILE

Name of the student ; N.soniya

Class ; M.Sc (N)2nd year

Subject ; Medical surgical nursing

Name of the topic :ECHOCARDIOGRAM

Place of the presentation ; class room

Date &time of the presentation ‘; 11-01-2021

Group ; peer group

Method of teaching ; lecture cum discussion

AV aids ; flash card , ppt, black board.

Name of the supervisor ;Mrs.yadamma madam

faculty

Govt college of nursing

somajiguda
 ECHOCARDIOGRAM

(ECHOCARDIOGRAPHY)

INTRODUCTION

An echocardiogram (echo=sound + card=heart + gram=drawing) is

an ultrasound test that can evaluate the structures of the heart, as well
as the direction of blood flow within it.
An electrocardiogram (EKG, ECG) is the most common heart tracing
done. Electrodes are placed on the chest wall and collect information
about the electrical activity of the heart. Aside from the rate and
rhythm of the heartbeat, the EKG can provide indirect evidence of
blood flow within arteries to heart muscle and the thickness of heart
muscle.

DEFINITION

Echocardiogram is a diagnostic test which uses ultrasound waves to

make images of the heart chambers,valves and surrounding
structure.it can measures cardiac output and is a sensitive test to find
fluid around the heart

INDICATION

Indicati Echocardiogram is indicated for several reasons, provides

information about abnormalities of

(1) valvular structures and motion,

(2) cardiac chamber size and contents,

(3) ventricular and septal motion and thickness,

(4) pericardial sac for pericardial effusion and

(5) ascending aorta. The ejection fraction (EF), or the percentage of

end-diastolic blood volume that is ejected during systole, can also be
measured. The EF provides information about the function of the left
ventricle during systole.

Two commonly used types of echocardiograms are the

1. Motion-mode (M-mode) echocardiogram: a single ultrasound beam

is directed toward the heart, recording the motion of the
intracardiac structures and detecting wall thickness and chamber
size.
2. Two-dimensional (2-D) echocardiogram: sweeps the ultrasound
beam through an arc, producing a cross-sectional view. This shows
correct spatial relationships among the structures.
3. Doppler technology allows for sound evaluation of the flow or
motion of the scanned object (heart valves, ventricular walls, blood
flow).
4. Color-flow imaging (duplex) is the combination of 2-D
echocardiography and Doppler technology. It uses color changes to
demonstrate the speed and direction of blood flow. Pathologic
conditions, such as valvular leaks and congenital defects, can be
diagnosed more effectively.
5. Real-time three-dimensional (3-D) ultrasound
 6. is a technology that uses multiple 2-D echo images with computer
technology to provide a reconstruction of the heart. This technique
produces information about the structures of the heart and how
these structures change during the cardiac cycle.
7. TYPES

 Transthoracic Echocardiogram (TTE). It is the most common type

of echocardiogram and is noninvasive. A device called transducer is
placed on the patient’s chest and transmits ultrasound waves into the
thorax. These waves bounce off the structures of the heart, creating
images and sounds that are shown in a monitor.

 A transthoracic echocardiogram (TTE) is the most common type of

echocardiogram . In this case, the probe (or ultrasonic transducer) is
placed on the chest or abdomen of the subject to get various views of
the heart.

 It is used as a non-invasive assessment of the overall health of the

heart, including a patient's heart valves and degree of heart muscle
contraction (an indicator of the ejection fraction).

Advantages of TEE :-

 The advantage of TEE over TTE is usually clearer images, especially

of structures that are difficult to view transthoracically (through the
chest wall) since heart rests directly upon the esophagus leaving only
millimeters that the ultrasound beam has to travel

 This reduces the attenuation (weakening) of the ultrasound signal,

generating a stronger return signal.
  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.

 TEE has a very high sensitivity for locating a blood clot inside the left
atrium.

DISADVANTAGES

 It takes longer to perform a TEE than a TTE. It may be

uncomfortable for the patient, who may require sedation or
general anesthesia.
 Some risks are associated with the procedure, such as
esophageal perforation around 1 in 10,000, and adverse
reactions to the medication.

PROCESS OF TEE

 Before inserting the probe, mild to moderate sedation is induced in the

patient to ease the discomfort and to decrease the gag reflex, thus making
the ultrasound probe easier to pass into the esophagus.
 Mild to moderate Sedation is produced by midazolam (a
benzodiazepine , fentanyl (an opioid) or propofol
 Usually a local anesthetic spray is used for the back of the throat, such a
xylocaine /or a jelly /lubricant anesthetic for the esophagus. Children are
anesthetized
 CLINCAL USES
 TEE can be performed by a cardiac anesthesiologist to evaluate,
diagnose, and treat patients in the perioperative period.
 . TEE is very useful during many cardiac surgical procedures (e.g., mitral
valve repair and in aortic dissections). It is actually an essential
monitoring tool and to assess the results of surgery immediately after the
procedure.

Transesophageal Echocardiogram (TOE). It is a special type of

echocardiography that uses an endoscope to assist the transducer down to the
esophagus where it produces a more detailed image of the heart than a
transthoracic echocardiogram

Stress Echocardiogram. An echocardiogram that is performed while the

patient is using a treadmill or stationary bicycle. This type can be used to
measure the function of the heart both at rest and while exercising.

Dobutamine Stress Echocardiogram. For patients who are unable to exercise

on a treadmill, a drug called dobutamine is given instead through a vein that
stimulates the heart in a similar manner as exercise. This type of
echocardiogram is used to evaluate coronary artery disease and measures the
effectiveness of cardiac therapeutic regimen.

INDICATION

Echocardiogram is indicated for several reasons, which includes:

  Detect and evaluate valvular abnormalities

 Detect atrial tumors

 Measure the size of the heart chambers

 Evaluate chambers and valves in congenital heart disorders

 Diagnose hypertrophic and related cardiomyopathies

 Evaluate cardiac function or wall motion after myocardial infarctions

 Detect pericardial effusion and mural thrombi

PROCEDURE

The following are the steps and processes on how an echocardiography or

echocardiogram is performed:

1. Place patient in a supine position.

Patient is placed in a supine position and a conductive gel is applied to

the third or fourth intercostal space to the left of the sternum. The
transducer is placed directly over it.

2. Transducer is placed

The transducer directs ultra-high-frequency sound waves towards

cardiac structures, which reflect these waves; the transducer picks up
the echoes, converts them to electrical impulses, and relays them to an
echocardiography machine for display.

3. Motion mode is used

 In motion mode (M-mode), a single, pencil-like ultrasound beam
strikes the heart and produces a vertical view, which is useful for
recording the motion and dimensions of intracardiac structures

4.Change in position

In two-dimensional echocardiography, a cross-sectional view of the

cardiac structures is used for recording the lateral motion and spatial
relationship between structures. For a left lateral view, the patient is
placed on his left side.

5.Transducer is angled.

The transducer is systematically angled to direct ultrasonic waves at

specific parts of the patient’s heart.

6 .Record findings.

During the test, the screen is observed; significant findings are

recorded on a strip chart recorder or a video tape recorder.

7.Doppler echocardiography.
Doppler echocardiography also may be used where color flow
stimulates red blood cell flow through the heart valves. The sound of
blood flow also may be used to assess heart sounds and murmurs as
they relate to cardiac hemodynamics.
Imaging Windows

Ultrasound waves have significant attenuation through air and bone

and therefore, care must be taken to avoid the areas over the sternum,
ribs, and lungs. Imaging is thereby limited to the spaces between the
ribs. There are four standardized anatomic windows for the echo
examination and are usually acquired in the following order:
parasternal, apical, subcostal, and suprasternal.

Parasternal Window

The patient is positioned in the left lateral decubitus position and

imaging is performed in the rib spaces left of the sternum. Imaging is
performed in the long axis and short axis, The short axis can be
obtained at multiple levels of the heart from base to apex.

Apical Window

The patient is positioned in the left lateral decubitus position and

imaging is performed in the rib spaces overlying the apex of the heart.
In this window, imaging is performed only along the long axis of the
heart. By rotating the transducer, multiple different orientations of the
long axis of the heart are produced so that each wall of the left
ventricle can be visualized.
Subcostal Window

The patient is positioned in the supine position with the knees bent.
The transducer is placed just below the xiphoid process of the sternum
and images are obtained through the diaphragm. In this window,
imaging is performed in the long and short axis of the heart.
Suprasternal Window

The patient is positioned in the supine position with the chin tilted
upward and rightward. In this window, imaging is performed in the
long and short exis.

Interfering factors

These are factors that may affect the outcome of echocardiography:

 Patient doing unnecessary movement during the procedure.

 Incorrect placement of the transducer over the desired test area.

 Metallic objects within the examination field, which may hinder organ
visualization and cause unclear images

 Patients who are dehydrated, resulting in failure to demonstrate the

boundaries between organs and tissue structures.

 Patients who have a severe chronic obstructive pulmonary disease

have a significant amount of air and space between the heart and the
chest cavity. Airspace does not conduct ultrasound waves well.
  In obese patients, the space between the heart and the transducers is
greatly enlarged; therefore, the accuracy of the test is decreased.

Nursing Responsibilities

 Explain the procedure to the patient. Inform the patient that

echocardiography is used to evaluate the size, shape, and motion of
various cardiac structures. Tell who will perform the test, where it will
take place, and that it’s safe, painless, and is noninvasive.

 No special preparation is needed. Advise the patient that he doesn’t

need to restrict food and fluids for the test.

 Ensure to empty the bladder. Instruct patient to void prior and to

change into a gown.

 Encourage the patient to cooperate. Advise the patient to remain

still during the test because movement may distort results. He may
also be asked to breathe in or out or to briefly hold his breath during
the exam.

 Explain the need to darkened the examination field. The room may

be darkened slightly to aid visualization on the monitor screen, and
that other procedure (ECG and phonocardiography) may be performed
simultaneously to time events in the cardiac cycles.

 Explain that a vasodilator (amyl nitrate) may be given. The patient

may be asked to inhale a gas with a slightly sweet odor while changes
in heart functions are recorded.

During the procedure

The following are the nursing considerations during echocardiogram:

 Inform that a conductive gel is applied to the chest area. A

conductive gel will be applied to his chest and that a quarter-sized
transducer will be placed over it. Warn him that he may feel minor
discomfort because pressure is exerted to keep the transducer in
contact with the skin.

 Position the patient on his left side. Explain that transducer is angled

to observe different areas of the heart and that he may be repositioned
on his left side during the procedure.

After the procedure

The nurse should be aware of these post-procedure nursing interventions after

an echocardiogram, they are as follows:

 Remove the conductive gel from the patient’s skin. When the

procedure is completed, remove the gel from the patient’s chest wall.

 Inform the patient that the study will be interpreted by the

physician. An official report will be sent to the requesting physician,
who will discuss the findings with the patient.

Normal results

Normal findings of echocardiogram will reveal the following:

 For mitral valve: Anterior and posterior mitral valve leaflets
separating in early diastole and attaining maximum excursion rapidly,
then moving toward each other during ventricular diastole; after atrial
contraction, mitral valve leaflets coming together and remaining
together during ventricular systole.

 For aortic valve: Aortic valve cusps moving anteriorly during systole

and posteriorly during diastole.

 For tricuspid valve: The motion of the valve resembling that of the

mitral valve.

 For pulmonic valve: Movement occurring posterior during atrial

systole and ventricular ejection, cusp moving anteriorly, attaining its
most anterior position during diastole.

 For ventricular cavities: Left ventricular cavity normally an echo-

free space between the interventricular septum and the posterior left
ventricular wall.

 Right ventricular cavity: Normally an echo-free space between the

anterior chest wall and the interventricular septum.

Abnormal results:

Abnormal echocardiogram findings will show the following:

 In mitral stenosis:
  Valve narrowing abnormally because of the leaflets’ thickening and
disordered motion; during diastole, both mitral valve leaflets moving
anteriorly instead of posteriorly.

 In mitral valve prolapse: One or both leaflets ballooning into the left

atrium during systole.

 In aortic insufficiency: Aortic valve leaflet fluttering during diastole.

 In stenosis: Aortic valve thickening and generating more echoes.

 In bacterial endocarditis: Disrupted valve motion and fuzzy echoes

usually on or near the valve.

 Large chamber size: May indicate cardiomyopathy, valvular

disorders, or heart failure: small chamber size: may indicate restrictive
pericarditis.

 Hypertrophic cardiomyopathy: Identified by a systolic anterior

motion of the mitral valve and asymmetrical septal hypertrophy.

 Myocardial ischemia or infarction: May cause absent or paradoxical

motion in ventricular walls.

 Pericardial effusion: Fluid accumulates in the pericardial space,

causing an abnormal echo-free space.

 In large effusions: Pressure exerted by excess fluid restricting

pericardial motion

 Instruct patient to resume regular diet and activities. There is no

special type of care given following the test.
Summary

ultrasound test used t examine the size, shape, and motion of cardiac structures.
All these are safe and non-invasive tests to determine the functional and
structural abnormalities of the heart. .

Conclusion

Cardiac tests gives more information about the condition of heart and can help
to find out which treatment may be best for the diagnosed condition. As a
cardiac nurse it is important to know the normal and abnormal findings of chest,
Echocardiography, and ECG. The Knowledge of radiological examination,
Echo, and ECG interpretation and the disease processes that an abnormal film
indicate can help the nurse in understanding disease pathophysiology, thereby
allowing for better patient care; dual reading of radiographs significantly
increases diagnostic accuracy and decreases the incidence of missed
abnormalities.

Bibliography

1, Lewis et al. Medical Surgical Nursing: Assessment and management of

clinical problems.6" edition: Mosby publishers; United States of America,
2004.

2. Brunner and Suddharth’s. Text book of Medical-Surgical Nursing.8" edition:

Lippincott-Raven Publishers; Philadelphia, 1996.
3. Atul Luthra, ECG Made Easy.4" edition: Jaypee publishers; New Delhi,
2012.

A Snean L. Woods et al, Cardiac nursing. 6" edition: Wolters Kluwer’s