• Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Daniel Lee Kulick, MD, FACC, FSCAI
    Daniel Lee Kulick, MD, FACC, FSCAI

    Daniel Lee Kulick, MD, FACC, FSCAI

    Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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A Visual Guide to Heart Disease

What are the different types of echocardiograms?

Transthoracic echocardiogram: In this procedure, the echocardiographer places the transducer, or probe, on the chest wall and bounces sound waves off the structures of the heart. The return signals are received by the same transducer and converted by a computer into the images seen on the screen.

Transesophageal echocardiogram: In some situations, a clearer view of the heart is required and instead of placing the transducer on the chest wall, a cardiologist will direct the probe through the mouth into the esophagus. The esophagus is located right next to the heart in the middle of the chest and the sound waves can travel to the heart without the interference of the ribs and muscles of the chest wall.

This test usually requires intravenous medications to sedate the patient. Because of the sedation, monitors will also be used to measure blood pressure and oxygen levels in the blood.

Doppler echocardiogram: In addition to sound waves bouncing off the solid structures of the heart, they also bounce off the red blood cells as they circulate through the heart chambers. Using Doppler technology, the echocardiogram can assess the speed and direction of blood flow, helping increase the amount and quality of information available from the test. The computer can add color to help the doctor appreciate that information. Color flow Doppler is routinely added to all echocardiogram studies and is the same technology used in weather reports.

Stress echocardiogram: To help uncover abnormalities in heart wall muscle function, the patient may be asked to exercise, either walking on a treadmill or riding an exercise bicycle. The echocardiogram is performed before exercise as a baseline and then immediately afterwards.

When coronary arteries narrow due to atherosclerotic heart disease, the heart muscle may not get enough blood supply to meet its needs during exercise. This can cause chest pain (angina) or shortness of breath or no symptoms at all. On stress echocardiogram, those areas of heart muscle not receiving enough blood flow, may not squeeze as well as other parts of the heart and will appear to have motion abnormality. This can indirectly indicate narrowing, or stenosis, of the coronary arteries.

For a stress echocardiogram to be effectively interpreted, the exercise done needs to achieve certain minimum intensity. If the patient is unable to adequately exercise, medications can be injected intravenously to chemically make the heart respond as if exercise is occurring.

Contrast may be injected into the patient's vein to help enhance the images and increase the information that is obtained. The contrast material (Optison, Density) are microscopic protein shells filled with gas bubbles. The decision to use contrast depends upon the patient's specific situation.

Medically Reviewed by a Doctor on 5/7/2015

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