Echocardiogram

Echocardiogram, also known as echocardiography, or heart ultrasound is a noninvasive, painless test that uses
high-frequency sound waves to visualize the shape, size, and movement of the structures of the heart. It is useful to
evaluate patients with chest pain, enlarged cardiac silhouettes on X-rays, electrocardiogram (ECG) changes
unrelated to CAD, and abnormal heart sounds on auscultation.

In this test, a transducer directs ultrahigh-frequency sound waves toward cardiac structure, which reflect these
waves. The echoes are converted to images that are displayed on a monitor and recorded on a strip chart or
videotape. Results are correlated with clinical history, physical examination, and findings from the additional test.

The techniques most commonly used in echocardiography are M-mode (motion mode), for recording the motion
and dimensions of intracardiac structures, and two-dimensional  (cross-sectional), for recording lateral motion and
providing the correct spatial relationship between structures.

The responsibilities of a nurse during echocardiography includes explanation of the procedure to the patient,
monitoring during tranesophageal and stress examinations, and establishing intravenous access for sonicated
saline, microsphere contrast, and medication administration.

 Types
 Indication
 Procedure
 Interfering factors
 Nursing Responsibilities
 o Before the procedure
o During the procedure
o After the procedure
 Normal results
 Abnormal results:
 Gallery
 References

Types

The different types of echocardiogram are:

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 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.

 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.

 Doppler echocardiogram. Measures and assess the blood flow through the heart and blood vessels.

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.

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
The following are the nursing interventions and nursing care considerations for a patient undergoing a normal
echocardiogram:

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Before the procedure

The following interventions are done prior and during the study:

 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.

 Instruct patient to resume regular diet and activities. There is no special type of care given following the test.

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.

Echocardiogram
Facebook Twittern echocardiogram is a noninvasive (the skin is not pierced) procedure used to assess the heart's
function and structures. During the procedure, a transducer (like a microphone) sends out sound waves at a frequency too
high to be heard. When the transducer is placed on the chest at certain locations and angles, the sound waves move
through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures.
These sound waves are sent to a computer that can create moving images of the heart walls and valves.

An echocardiogram may use several special types of echocardiography, as listed below:

 M-mode echocardiography. This, the simplest type of echocardiography, produces an image that is similar to a
tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring or viewing heart
structures, such as the heart's pumping chambers, the size of the heart itself, and the thickness of the heart walls.
 Doppler echocardiography. This Doppler technique is used to measure and assess the flow of blood through
the heart's chambers and valves. The amount of blood pumped out with each beat is an indication of the heart's
functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate a problem with one
or more of the heart's four valves, or with the heart's walls.
 Color Doppler. Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different
colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.
  2-D (two-dimensional) echocardiography. This technique is used to "see" the actual motion of the heart
structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart's structures
can be observed. This enables the doctor to see the various heart structures at work and evaluate them.
 3-D (three-dimensional) echocardiography. 3-D echo technique captures three-dimensional views of the
heart structures with greater detail than 2-D echo. The live or "real time" images allow for a more accurate
assessment of heart function by using measurements taken while the heart is beating. 3-D echo shows enhanced
views of the heart's anatomy and can be used to determine the appropriate plan of treatment for a person with
heart disease.
Why might I need an echocardiogram?

An echocardiogram may be done for further evaluation of signs or symptoms that may suggest:

 Atherosclerosis. A gradual clogging of the arteries by fatty materials and other substances in the blood stream.
It can lead to problems in the wall motion or pumping function of your heart.
 Cardiomyopathy. An enlargement of the heart due to thick or weak heart muscle
 Congenital heart disease. Defects in one or more heart structures that occur during formation of the fetus, such
as a ventricular septal defect (hole in the wall between the 2 lower chambers of the heart).
 Heart failure. A condition in which the heart muscle has become weakened or stiff during heart relaxation and
blood can't be pumped efficiently. This can cause fluid buildup (congestion) in the blood vessels and lungs, and
edema (swelling) in the feet, ankles, and other parts of the body.
 Aneurysm. A widening and weakening of a part of the heart muscle or the aorta (the large artery that carries
oxygenated blood out of the heart to the rest of the body). The aneurysm may be at risk for rupture. .
 Heart valve disease. Malfunction of one or more of the heart valves that may cause an abnormality of the blood
flow within the heart. The valves can become narrowed and prevent blood from flowing through the heart or out to
the lungs and body. The valves can also become leaky with blood flow leaking backwards. An echocardiogram can
also check for infection of the heart valve tissue.
 Cardiac tumor. A tumor of the heart that may occur on the outside surface of the heart, within one or more
chambers of the heart , or within the muscle tissue (myocardium) of the heart.
 Pericarditis. An inflammation or infection of the sac that surrounds the heart.
 Pericardial effusion or tamponade. The sac around the heart can become filled with fluid, blood, or infection.
This can compress the heart muscle and prevent it from beating and pumping blood normally. This can cause
symptoms of feeling dizzy, lightheaded, or a dangerous drop in blood pressure.
  Atrial or septal wall defects. Irregular channels between the right and left sides of the heart may be present at
birth, or may occur form trauma, or after a heart attack. These defects occur in the upper filling chambers (atria) or
the lower pumping chambers (ventricles). This may cause heart failure or poor blood flow, or increase your risk for
stroke.
 Shunts. Shunts can be seen in atrial and ventricular septal defects but also when irregular blood flow is pushed
through the circulation from the lungs and liver.

An echocardiogram may also be done to assess the heart’s overall function and general structure.

Your doctor may have other reasons to recommend an echocardiogram.

What are the risks of an echocardiogram?

This imaging procedure is not invasive and carries little to no risks. You may have discomfort from the positioning of the
transducer because it can put pressure on the surface of the body. For some people, having to lie still on the exam table
for the length of the procedure may cause some discomfort or pain.

You may have other risks depending on your specific health condition. Discuss any concerns with your doctor before the
procedure.

How do I get ready for an echocardiogram?

 Your doctor will explain the procedure to you and ask if you have any questions.

 Generally, you don't need to do any preparation such as fasting or having sedation.

 Tell your doctor of all prescription and over-the-counter medicines and herbal supplements that you are taking.

 Tell your doctor if you have a pacemaker.

 Based on your medical condition, your doctor may request other specific preparation.
What happens during the procedure?

An echocardiogram (ECG) may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary
depending on your condition and your doctor’s practices.

Generally, an echocardiogram follows this process:

1. You will remove any jewelry or other objects that may interfere with the procedure. You may wear your glasses,
dentures, or hearing aids if you use any of these.

2. You will remove clothing from the waist up and will be given a gown to wear.

3. You will lie on a table or bed, on your left side. A pillow or wedge may be placed behind your back for support.

4. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart
during the procedure using small, adhesive electrodes. The ECG tracings that record the electrical activity of the
heart will be compared with the images displayed on the echocardiogram monitor.

5. The room will be darkened so that the images on the echo monitor can be seen by the technologist.

6. The technologist will place warmed gel on your chest and then place the transducer probe on the gel. You will feel
a slight pressure as the technologist positions the transducer to get the desired images of your heart.

7. During the test, the technologist will move the transducer probe around and apply varying amounts of pressure to
get images of different locations and structures of your heart. The amount of pressure behind the probe should not
be uncomfortable. If it does make you uncomfortable, let the technologist know. You may be asked to hold your
breath, take deep breaths, or even sniff through your nose during the procedure.

8. If the structures of your heart are hard to see, the technologist may use an IV contrast that helps the heart
chambers show up better. This is not an iodine based contrast so you don't have to worry if you have an allergy to
shrimp or shellfish with this type of contrast.
 9. After the procedure, the technologist will wipe the gel from your chest and remove the ECG electrode pads. You
may then put on your clothes.

What happens after an echocardiogram?

You may resume your usual diet and activities unless your doctor tells you differently.

Generally, there is no special type of care after an echo. Y Your doctor may give you other instructions after the
procedure, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

 The name of the test or procedure

 The reason you are having the test or procedure

 What results to expect and what they mean

 The risks and benefits of the test or procedure

 What the possible side effects or complications are

 When and where you are to have the test or procedure

 Who will do the test or procedure and what that person’s qualifications are

 What would happen if you did not have the test or procedure

 Any alternative tests or procedures to think about

 When and how will you get the results

 Who to call after the test or procedure if you have questions or problems

 How much will you have to pay for the test or procedure