Echocardiography - (ECHO of the Heart)

If you know or suspect that you have heart problems, have risk factors, get tired quickly, have chest pain and similar problems, a cardiologist will suggest that you do an echo of the heart.

Echocardiography (ECHO of the heart, ultrasound of the heart) belongs to the group of so-called non-invasive methods – it is completely painless. No special preparation is required before the examination, there are no harmful effects and it can be performed at the earliest age.

Cardiac ultrasound is a simple and painless examination that is performed at the Pulse Cardiology Center without waiting, on modern devices, under the watchful eye of a cardiologist.

Echocardiography has become a routine procedure for diagnosing and monitoring patients with heart disease. It is also one of the most commonly used diagnostic procedures in cardiology. This method can provide a large amount of information including the size and shape of the heart, the location and size of damage to the heart tissue, the appearance of heart valves.

A heart echo or echocardiogram is a sonogram of the heart. Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.

Why is an ultrasound done – Echo of the heart?

The doctor may request an echocardiogram:

  • when he wants to find out if there is a problem on the valves or in one of the heart cavities
  • when he wants to find out if symptoms such as shortness of breath or chest pain are the result of heart tissue damage.
  • when a congenital heart anomaly is suspected

There are several types of echocardiography such as

  • Transthoracic echo of the heart
  • Transesophageal echocardiography
  • Doppler echocardiogram
  • Stress echocardiogram

Echocardiograms can also be used to determine and calculate the physiological characteristics of the heart, such as cardiac output (the volume of blood that the heart pumps over one minute, and depends on the heart rate as well as the volume of blood that is pumped out in one contraction), the ejection fraction (the amount of blood that is pumped out of the heart cavity during one contraction), diastolic function (how well the heart muscle wall relaxes).

Types of echocardiography

Transthoracic echocardiography

Standard echocardiography is also known as transthoracic echocardiography, or cardiac ultrasound (echo). In this case, an ultrasound transducer (probe) is placed on the anterior thoracic wall of the patient, through which ultrasound waves pass and thus images are obtained. This is a non-invasive, highly reliable, fast and cheap method for quick checking of the condition of the heart.

If the lungs or ribs block the “view”, the patient is given a small amount of a strengthening fluid (contrast) intravenously. The contrast is generally safe and well tolerated and is given with the aim of better visualizing the heart structures on the monitor.

Contrasts are made of microbubbles with a nucleus filled with gas and a shell made of protein. This structure allows the contrast to circulate in the cardiovascular system and restore ultrasound waves creating highly reflective images.

Transesophageal echocardiography

This is an alternative way echocardiography can be performed. A special probe containing an ultrasonic transducer on top is used to guide this method. This probe is inserted into the patient’s esophagus.

The transesophageal echo of the heart allows images to be created directly behind the heart. This method is used when it is not possible to visualize the heart by transthoracic imaging well enough to accurately assess the condition. During this procedure, the patient is sedated because the examination is uncomfortable.

Doppler echocardiogram

Ultrasound waves change their slope when they bounce off blood cells moving through the heart and blood vessels. These changes (Doppler signals) can help the doctor measure the speed and direction of blood flow in the heart.

Doppler techniques can also be used in Transthoracic and Transesophageal echocardiography. The movement of blood on the monitor is colored red and blue, which help to accurately determine the problem.

Stress echocardiogram

The stress echocardiogram, better known as the stress echo, uses ultrasound waves to create an image of the movement of the heart wall in response to stress. First, “at rest” images are recorded to establish the basic direction of movement of the patient’s heart wall.

The patient then walks on a treadmill or does some other way of exercising, or if the patient is unable to move, medications are given that will speed up the heart rate to the target heart rate, or 85% of the predicted maximum (220 – the patient’s age).

After that, images of the patient’s heart are made “under stress” in order to assess the movement of the heart wall at the peak of the heart work. Stress echo captures the heart wall, during this recording images of coronary arteries are not created directly. Cardiac tissue ischemia of one or more coronary arteries can lead to abnormalities in the contractility of the heart wall, which indicates coronary artery disease.

The gold standard in coronary artery testing is to create an image of the coronary arteries so that the site of narrowing or occlusion can be seen directly. Echo stress is not an invasive procedure.

Three-dimensional (3D) echocardiography

Three-dimensional (3D) echocardiography, also known as 4D cardiography (when the image is moved) is now possible using special probes and data processing systems. This enables a detailed anatomical evaluation of cardiac pathology, especially valvular defects and cardiomyopathies.

The ability to make a cross section of the heart in different planes and the possibility of reconstructing a three-dimensional image of anatomical structures, make this technique unique in understanding different pathological processes of the heart. Real-time three-dimensional echocardiography can be used during right ventricular endomyocardial biopsy, or other intraoperative procedures.

How an ECHO of the heart is done

Transthoracic echo:

The patient is required to remove clothing from the waist up and lie down on an examination table or bed.

The doctor will apply the gel to the probe and after that he will spread the gel on the chest wall with the probe, during the examination you can hear a “wow” sound, which is an ultrasound image of blood passing through the heart.

The patient may be required to breathe in a special way or to turn to the left side.

Transesophageal echo:

Patients are mostly anesthetized with a throat gel or spray containing an anesthetic (optional). The patient is given sedatives to help him to relax. The tube with the probe is introduced into the patient’s esophagus and positioned in order to obtain the desired images.

These examinations usually last less than an hour. If a transesophageal echocardiogram is required, the patient may be detained for some time after examination.

Risks of cardiac ultrasound

With standard transthoracic echocardiography of the heart, there are no real risks from the examination itself. For some patients, the examination may be uncomfortable due to the application of the gel used during the examination, or the pressure of the probe with which the examination is performed (pressure is necessary for good visualization).

During transesophageal echocardiography, sore throat may occur a few hours after the procedure. During the procedure, the level of oxygen in the patient’s blood is monitored due to possible problems that may occur during the patient’s sedation.

During a stress echo test, exercise or medications that are used, not echocardiography per se, can endanger the patient by causing an irregular heart rhythm. Serious complications, such as heart attack, are very rare.


Heart ECHO price

The price of a heart ultrasound is 7,400 dinars.