Echocardiography

Seventeen people die from cardiovascular illnesses every day in Singapore, according to the Ministry of Health. In 2017 alone, it has been reported that heart-related illnesses accounted for 30.1% of deaths in the country. Such conditions are chronic and progressive in nature, yet there’s still no telling when a stroke, heart failure or cardiac arrest may occur.

Fortunately, you can take simple steps to prevent cardiovascular illnesses, or if you’re already diagnosed with one, slow its progression and improve heart health. For high-risk and diagnosed patients, this includes having an echocardiogram.

What Is an Echocardiogram For?

An echocardiogram, also known as a cardio echo, is a test that uses ultrasound to capture images of the heart. It is done to assess the heart’s overall condition and detect any problems concerning its function and structure. As a diagnostic tool, an echocardiogram can be performed to find the root cause of symptoms like palpitations, angina or shortness of breath. It can identify the type and progression of heart diseases in all ages, even congenital defects in foetuses. The test may also be ordered post-treatment to evaluate its outcome and effectiveness.

When Is an Echocardiogram Recommended?

An individual who is healthy and has no medical or family history of cardiovascular illnesses is not required to undergo an echocardiography during routine check-ups. However, a cardiologist may order an echocardiogram for those who are at risk of developing heart diseases or are exhibiting symptoms indicative of such conditions. This may include heart murmurs, high blood pressure, chest pain or breathing difficulties. Factors like age and lifestyle are also considered to assess the need to undergo this test.

Those who are already diagnosed with a heart illness need to have an echocardiogram more regularly to monitor the overall condition of the heart before and after treatments. The frequency will also depend on the cardiologist’s recommendation.

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If you are at risk for heart disease, a cardiologist may recommend an echocardiography for a clearer look at your heart structure and function.

What Are the Different Types of Echocardiograms?

Various types of echocardiography are available, all of which use ultrasound. Which method is best for you will be determined by your cardiologist.

Transthoracic Echocardiogram

The most standard type, transthoracic echocardiogram, is non-invasive and works similarly to an X-ray and a regular ultrasound. In this method, a handheld transducer will be placed on your chest over the heart. A transducer is a device that transmits ultrasound waves to capture live images (sonograms) of the heart’s chambers and vessels, which can be viewed from a monitor. A transthoracic echocardiogram is done to check for structural heart defects and evaluate cardiac function and blood flow.

Transesophageal Echocardiogram

In cases where high-resolution images of a specific part of the heart are required, or if a transthoracic echocardiogram is unable to provide clear images of the heart’s structures, a transesophageal echocardiogram is recommended. It involves a thin, flexible tube equipped with a small transducer, which is inserted down the throat, and into the oesophagus behind the heart. This method gives more access to the heart and reduces sound wave interference from the lungs, ribs and chest.

Doppler Echocardiogram

The Doppler echocardiogram is done to measure and evaluate the amount, speed and direction of blood flow to the heart’s chambers and vessels. Performed alongside transthoracic or transesophageal echocardiograms, this method is used to detect abnormal blood flow and pressure indicative of issues in the heart’s valves or walls.

Stress Echocardiogram

Coronary artery problems can be detected and assessed through a stress echocardiogram. In this method, the patient undergoes a standard echocardiogram before and after exercising on a stationary bike or treadmill. This test helps the cardiologist determine the effects of stress on the heart, as well as the amount of stress that the heart can handle.

How Should You Prepare For an Echocardiogram?

No special preparations are required for transthoracic and Doppler echocardiograms.

For a transesophageal echocardiogram, however, you will be instructed to refrain from eating or drinking for several hours before the procedure.

Aside from wearing comfortable clothes and footwear suitable for exercising, no additional preparations are needed for a stress echocardiogram.

What to Expect During an Echocardiogram

This strongly depends on the type of echocardiography being performed. Main features include:

Transthoracic Echocardiogram

You will wear a gown and lie comfortably on a table. A technician applies gel to your chest and glides a handheld device over it to capture images. You might need to change positions or hold your breath briefly for optimal views. If your lungs or ribs block the view, a contrast dye may be given to get better images. The entire procedure usually takes about 30-60 minutes to complete.

Transesophageal Echocardiogram

To ensure your comfort, you will be given a mild sedative and a numbing agent for your throat (gel or spray). Afterwards, a thin, flexible tube with a transducer at the tip is carefully inserted through your mouth and guided down your oesophagus. This tube is manoeuvred up, down, and sideways to capture optimal images of your heart structures. You should not experience any pain during the procedure, and you can breathe comfortably throughout. The entire procedure may take up to 90 minutes to complete.

Stress Echocardiogram

Electrodes will be attached to your chest to monitor your heart rhythm. Your doctor might also measure your blood pressure. Afterwards, your heart will be gently stressed in one of two ways: exercise or medication. In the first approach, you will be asked to walk on a treadmill or pedal a stationary bike with increasing intensity. For individuals with pacemakers, adjustments can also be made to increase heart rate. Throughout the stress phase, echocardiogram images will be captured at intervals to visualise your heart's function under increased workload. This test takes around 40-90 minutes to complete.

What to Expect After an Echocardiogram

Echocardiography is typically painless, although a transesophageal cardiogram may cause minor discomfort to the throat, which should subside in a few hours. In general, you should be able to resume your usual diet and activities immediately unless your doctor provides specific instructions otherwise.

On your follow-up consultation, your doctor will discuss the findings of your echocardiogram. This may include a diagnosis or a recommendation for further tests. If you are diagnosed with heart disease, your cardiologist will work with you to create a customised treatment plan. Thismight involve lifestyle modifications, medications, or other interventions to manage your symptoms and prevent future complications.

What Results Does an Echocardiogram Usually Show?

An echocardiogram may reveal issues concerning:

Heart Defects - The test can be done to check for structural and congenital heart problems that are either a result of age, infection or injury or causing symptoms indicative of an underlying illness.
Heart Size - Cardiomegaly (enlargement of the heart) may be congenital, or caused by high blood pressure, cardiomyopathy (disease of the heart muscle), heart valve disease and arrhythmia (irregular heartbeat), all of which can be detected through an echocardiogram.
Damaged Heart Muscles - An echocardiogram can show if all areas of the heart wall and the heart muscles are intact, working properly and getting sufficient oxygen to support the organ’s blood-pumping function.
Pumping Strength - As a diagnostic tool, an echocardiogram can measure and evaluate the percentage of blood being pumped per heartbeat (ejection fraction) and the volume of blood being pumped per minute (cardiac output). A heart that pumps blood inadequately and irregularly is at risk of sudden failure or a stroke.
Heart Valve Issues - An echocardiogram helps show whether there are problems with the structure and function of the heart’s four valves in regulating blood flow.

If you have a high risk of developing cardiovascular illnesses or have been diagnosed with a congenital or an acquired one, an echocardiogram may be recommended to identify the issues and tailor an effective treatment plan for you.

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