Echocardiogram: Understanding Heart Ultrasound Procedures & Benefits

Echocardiogram (Echo) = Ultrasound of the heart. Non-invasive, no radiation, real-time cardiac imaging.

Procedure Steps (Transthoracic Echo — TTE):

1. Preparation: Remove upper clothing; gown. ECG leads placed (gating).
2. Position: Left lateral decubitus (best acoustic window).
3. Gel: Water-based on probe/chest.
4. Imaging windows:
   • Parasternal long/short axis
   • Apical 4-chamber, 2-chamber, 3-chamber, 5-chamber
   • Subcostal (IVC, hepatic veins)
   • Suprasternal (aortic arch)
5. Modes used:
   • 2D (anatomy)
   • M-Mode (motion timing)
   • Color Doppler (flow direction/velocity)
   • Spectral Doppler (PW/CW — velocities, gradients)
   • Tissue Doppler (myocardial velocity)
   • 3D/4D (volumes, en face views)
   • Strain imaging (deformation)
6. Measurements: Chamber sizes, wall thickness, EF (Simpson's biplane), valve areas, gradients, pressures (PA systolic), diastolic function.
7. Duration: 30–60 min.

Other Types:

• TEE (Transesophageal): Probe in esophagus — higher resolution, posterior structures. Sedation required.
• Stress Echo: Exercise or dobutamine + echo — ischemia detection.
• Contrast Echo: IV microbubbles — endocardial border definition, shunt detection.

Benefits:

• First-line for: HF, valve disease, congenital, pericardial, aortic, cardioembolic source.
• Guides therapy (GDMT, intervention timing, device management).
• Serial monitoring (chemo cardiotoxicity, post-op, device).