Echocardiography, also known as a cardiac ultrasound, is one of the most important heart examination methods. This non-invasive method can be used to examine the heart valves, the structure and thickness of heart walls, and the size, volume, pumping power and movements of the heart. Echocardiography thus helps to diagnose numerous heart diseases.
Overview of echocardiography
A cardiac ultrasound (sonography) is a key component of modern cardiology. Echocardiography uses high-frequency sound waves to generate detailed images of the heart in real time. This painless and non-invasive procedure is suitable for routine examinations and specific questions in cases of suspected heart disease. Depending on the diagnostic objective, different methods are available, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and stress echocardiography.
Transthoracic echocardiography (TTE)
This standard method is performed by placing a transducer (ultrasound wand) on the chest (thorax). It provides a comprehensive picture of the cardiac chambers, valves and vessels.
Transoesophageal echocardiography (TEE)
In TEE, a tube is inserted into the oesophagus. This examination method is particularly suitable for the detailed examination of cardiac structures, which are difficult to see or are not visible with external transducer placement (TTE). TEE is often used for complex valve diseases or suspected thrombosis.
Stress echocardiography (stress echo)
In this procedure, the heart is examined while under physical or pharmacological stress. It’s used to assess circulatory disorders or heart resilience.
Treatment goal
A cardiac ultrasound is used to detect functional disorders of the ventricles and atria. It also uncovers heart valve defects, heart defects, myocarditis, pericardial disorders and scarring after a heart attack. An echocardiogram is also used to measure the heart’s pumping capacity. The determined ejection fraction plays an important role in diagnosing cardiac insufficiency (heart failure).
The echocardiogram procedure
Echocardiograms are usually carried out on an outpatient basis and are performed differently depending on the chosen treatment method:
Procedure for a transthoracic echocardiogram (TTE)
To perform the TTE, the ultrasound transducer is placed on the chest together with a contact gel. The transducer is moved gently back and forth to create optimal images of the heart from different angles. The duplex sonography method is used to show the blood flow in the heart. With this method, the different directions of blood flow are displayed in different colours.
Procedure for a transoesophageal echocardiogram (TEE)
In TEE, the transducer is inserted into the oesophagus, similar to a gastroscopy. The patient lies on their left side. The examination takes about half an hour.
Procedure for a stress echocardiogram
Occasionally, it is necessary to examine the heart under stress, which is called a stress echocardiogram. Similar to a stress ECG, the examination is carried out under stress (e.g. while cycling). For patients who cannot be expected to carry out a stress test on a bicycle for physical reasons, the stress on the heart is triggered by a medication (dobutamine).
Preparation and precautions
No special preparation is required for the transthoracic echocardiogram. For a transoesophageal echocardiogram, on the other hand, the patient should be fasting, as a thin tube is inserted through the mouth and the examination is usually performed under light sedation.
Aftercare and recovery
No special follow-up treatment is required. Patients who have been given a sedative are not allowed to drive for 12 hours. If abnormal changes in the heart are detected during the examination, further examination may be necessary.
Potential complications
The transthoracic echocardiogram is completely risk-free and without complications. Transoesophageal echocardiograms may occasionally lead to harmless mucous injury to the oesophagus, changes in blood pressure or temporary cardiac arrhythmia. Serious complications are extremely rare.
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