Echocardiogram
An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or doppler imaging.
Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology. It can provide a wealth of helpful information, including the size and shape of the heart (internal chamber size quantification), pumping capacity, and the location and extent of any tissue damage. An echocardiogram can also give physicians other estimates of heart function, such as a calculation of the cardiac output, ejection fraction, and diastolic function (how well the heart relaxes).
Echocardiography can help detect cardiomyopathies (diseases of the heart muscle), such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and many others. The use of stress echocardiography may also help determine whether any chest pain or associated symptoms are related to heart disease.
The biggest advantage to echocardiography is that it is not invasive (does not involve breaking the skin or entering body cavities) and has no known risks or side effects.
Not only can an echocardiogram create ultrasound images of heart structures, but it can also produce accurate assessment of the blood flowing through the heart by Doppler echocardiography, using pulsed- or continuous-wave Doppler ultrasound. This allows assessment of both normal and abnormal blood flow through the heart. Color Doppler, as well as spectral Doppler, is used to visualize any abnormal communications between the left and right sides of the heart, any leaking of blood through the valves (valvular regurgitation), and estimate how well the valves open (or do not open in the case of valvular stenosis). The Doppler technique can also be used for tissue motion and velocity measurement, by tissue doppler.
How an echo is performed
ECG
An electrocardiogram (ECG) is one of the simplest and fastest tests used to evaluate the heart. Electrodes (small, plastic patches that stick to the skin) are placed at certain spots on the chest, arms, and legs. The electrodes are connected to an ECG machine by lead wires. The electrical activity of the heart is then measured, interpreted, and printed out. No electricity is sent into the body.
Natural electrical impulses coordinate contractions of the different parts of the heart to keep blood flowing the way it should. An ECG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart. Changes in an ECG can be a sign of many heart-related conditions.
Some reasons for your doctor to request an electrocardiogram (ECG) include:
- To look for the cause of chest pain
- To evaluate problems which may be heart-related, such as severe tiredness, shortness of breath, dizziness, or fainting
- To identify irregular heartbeats
- To help determine the overall health of the heart before procedures such as surgery; or after treatment for conditions such as a heart attack (myocardial infarction, or MI), endocarditis (inflammation or infection of one or more of the heart valves); or after heart surgery or cardiac catheterization
- To see how an implanted pacemaker is working
- To determine how well certain heart medicines are working
- To get a baseline tracing of the heart's function during a physical exam; this may be used as a comparison with future ECGs, to determine if there have been any changes
Exercise Tolerance Test (ETT)
An exercise tolerance test (ETT) is helpful in evaluating a patient's heart function during exertion, and detecting the presence of coronary artery disease and arrhythmias.
During an ETT, a patient exercises on either a treadmill or a stationary bike (cycle ergometer), and the intensity of the exercise is gradually increased until the patient becomes fatigued. Blood pressure, breathing, and heart rate are monitored throughout the test, which is administered by a clinical exercise physiologist and a physician. In some cases, oxygen saturation also is monitored. If a patient cannot exercise adequately on a treadmill, medications can be used to simulate exercise.
This test is commonly used to detect coronary artery disease (blocked arteries in the heart) or to determine safe levels of exercise following a heart attack or heart surgery.
Patient undergoing exercise tolerance test
Holter Monitoring
A Holter monitor is a type of portable electrocardiogram (ECG). It records the electrical activity of the heart continuously over 24 hours or longer while you are away from the doctor's office.
Your doctor may request a Holter monitor ECG if you have symptoms, such as dizziness, fainting, low blood pressure, ongoing tiredness, or palpitations and a resting ECG doesn’t show a clear cause. A Holter monitor may also be ordered if your resting ECG shows a problem, but more information is needed. You wear the same kind of ECG electrode patches on your chest, and the electrodes are connected by wires to a small monitor box (portable recording device).
Certain abnormal heart rhythms may occur only now and then. Or, they may occur only under certain conditions, such as stress or activity. These are hard to record on an ECG done in the office. Because of this, the healthcare provider might request a Holter monitor to get a better chance of catching any abnormal heartbeats or rhythms that may be causing the symptoms. Some Holter monitors also have an event monitor feature that you activate when you notice symptoms.
You will get instructions on how long you will need to wear the monitor (usually 24 to 48 hours). Your provider will also tell you how to keep a diary of your activities and symptoms during the test, and about any personal care and activity instructions. For example, you will need to keep the device dry while you are wearing it.
Patient undergoing holter monitoring
Coronary Angiography
A coronary angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. The test is generally done to see if there's a restriction in blood flow going to the heart.
Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of cardiac catheterization procedure.
During a coronary angiogram, a type of dye that's visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a look at your blood vessels. If necessary, your doctor can open clogged heart arteries (angioplasty) during your coronary angiogram.
Your doctor may recommend that you have a coronary angiogram if you have:
- Symptoms of coronary artery disease, such as chest pain (angina)
- Pain in your chest, jaw, neck or arm that can't be explained by other tests
- New or increasing chest pain (unstable angina)
- A heart defect you were born with (congenital heart disease)
- Abnormal results on a noninvasive heart stress test
- Other blood vessel problems or a chest injury
- A heart valve problem that requires surgery
Because there's a small risk of complications, angiograms aren't usually done until after noninvasive heart tests have been performed, such as an electrocardiogram, an echocardiogram or a stress test.
Coronary Angiogram
CT CORONARY ANGIOGRAPHY (CTCA)
CT coronary angiography (CTCA) is a non-invasive test that can be used to evaluate various parts of the heart.
A CT scan, is a noninvasive test where an X-ray machine rotates around a patient’s body while they lie on a table. Unlike traditional X-rays, a CT scanner makes highly detailed images of the internal organs and, in many cases, is able to distinguish healthy tissue from diseased tissue.
CTCA can be used to evaluate the cause of chest discomfort and/or shortness of breath in patients who do not have a prior history of coronary artery disease, such as prior heart attacks or coronary stents. CTCA also can be used to evaluate for the presence or absence of coronary artery disease in patients who had stress tests with uncertain findings.
CT coronary angiography image
CORONARY ANGIOPLASTY
Angioplasty is a procedure used to open blocked coronary arteries caused by coronary artery disease. It restores blood flow to the heart muscle without open-heart surgery. Angioplasty can be done in an emergency setting such as a heart attack. Or it can be done as elective surgery if your doctor strongly suspects you have heart disease. Angioplasty is also called percutaneous coronary intervention (PCI).
For angioplasty, a long, thin tube (catheter) is put into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the heart artery. This presses the plaque or blood clot against the sides of the artery, making more room for blood flow.
The cardiologist uses fluoroscopy during the surgery. Fluoroscopy is a special type of X-ray that’s like an X-ray "movie." It helps the doctor find the blockages in the heart arteries as a contrast dye moves through the arteries. This is called coronary angiography.
Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil. It is put into the newly opened area of the artery to help keep the artery from narrowing or closing again.
Coronary Angioplasty
ELECTROPHYSIOLOGY STUDY (EPS)
When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, ageing and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias (abnormal heart rhythms).
During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity.
Doctors use EPS to see:
- Where an arrhythmia is coming from.
- How well certain medicines work to treat your arrhythmia.
- If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called radiofrequency ablation (RFA).
- If a pacemaker or implantable cardioverter defibrillator (ICD) might help you.
- If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating).
During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity.
Radiofrequency Ablation during EPS offers the opportunity of a complete cure from abnormal heart rhythm, as well as avoidance of troublesome symptoms and having to take medicines for a lifetime.
EPS being performed
PACEMAKER IMPLANTATION
A pacemaker is a small device that's placed under the skin in your chest to help control your heartbeat. It's used to help your heart beat more regularly if you have an irregular heartbeat (arrhythmia), particularly a slow one. Implanting a pacemaker in your chest requires a surgical procedure.
Depending on your condition, you might have one of the following types of pacemakers.
- Single chamber pacemaker. This type usually carries electrical impulses to the right ventricle of your heart.
- Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers.
- Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people with heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower chambers of the heart (the right and left ventricles) to make the heart beat more efficiently.
An implanted electronic pacemaker mimics the action of your natural electrical system. A pacemaker comprises two parts:
- Pulse generator. This small metal container houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart.
- Leads (electrodes). One to three flexible, insulated wires are each placed in a chamber, or chambers, of your heart and deliver the electrical pulses to adjust your heart rate.
Pacemakers work only when needed. If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart to correct the beat.
Also, newer pacemakers have sensors that detect body motion or breathing rate, which signal the pacemakers to increase heart rate during exercise, as needed.
Permanent Pacemaker
ICD IMPLANTATION
An ICD is a battery-powered device placed under the skin that keeps track of your heart rate. Thin wires connect the ICD to your heart. If an abnormal heart rhythm is detected the device will deliver an electric shock to restore a normal heartbeat if your heart is beating chaotically and much too fast.
ICDs have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies have shown that they have a major role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.
Your doctor may recommend an ICD if you or your child is at risk of a life-threatening ventricular arrhythmia because of having:
- Had a ventricular arrhythmia
- Had a heart attack
- Survived a sudden cardiac arrest
- Long QT Syndrome
- Brugada syndrome
- A congenital heart disease or other underlying conditions for sudden cardiac arrest
It knows when the heartbeat is not normal and tries to return the heartbeat to normal.
- If your ICD has a pacemaker feature when your heartbeat is too slow, it works as a pacemaker and sends tiny electric signals to your heart.
- When your heartbeat is too fast or chaotic, it gives defibrillation shocks to stop the abnormal rhythm.
- It works 24 hours a day.
ICD device