Ultrasound examination is today the most common examination method. Doctors appreciate it for its accessibility, simplicity, and the ability to clearly visualize organ structures. Patients - for the need for minimal preparation, painlessness and prevalence of services.
Ultrasound of the heart is one of the most popular studies of internal organs. This is due to the high frequency of cardiovascular diseases among the population. The article will tell you in detail about what shows an ultrasound of the heart, what are its types, why is it needed, are there any contraindications for the examination, what are the preparation methods and how to decipher the results.
Definition
Ultrasound examination is a method for the diagnosis of internal organs and structures located below the surface of the skin. The heart, organs of the gastrointestinal tract, genitourinary system, brain, vessels of large, medium diameter, lymph nodes - almost everything is subject to ultrasound.
Ultrasound of the heart is also called echocardiography or echocardioscopy, for short - ECHO-KG, ECHO-KS. All these are equivalent concepts in which patients are periodically confused.
Types of echocardiography
For examination of the heart, there are 4 ways to conduct echocardioscopy:
- Transthoracic ultrasound. Research through the chest is a kind of fact-finding. He is assigned to everyone. The study is a first-line diagnostic method.
- Transesophageal (PEECHO) is prescribed solely according to indications according to the results of transthoracic ECHO-KS. The quality of imaging is much higher, since the ultrasound probe in the esophagus is closer to the heart. In addition, there is no exposure to lung tissue. It is also possible to examine structures invisible when examined through the chest with the help of PEECHO.
- Stress-ECHO-KG is strictly necessary. Allows you to evaluate the work of the heart during exertion. To do this, use ordinary physical exercises, such as squats, pedaling on a stationary bike. Or the study is carried out by using drugs that increase the load on the heart.
- ECHO-KG with contrasting diagnostics differs from conventional transthoracic ultrasound only in that a contrast agent is injected into the patient’s bloodstream before examination. This contributes to a better examination of the internal structures of the heart, the boundaries of the cavities. It is prescribed very rarely due to the high price of the drug.
In addition, ECHO of the heart is divided by visualization methods:
- One-dimensional image or M-mode (at the bottom of the photo). The earliest of all. It was used at the dawn of ultrasound research.
- Two-dimensional or B-mode. The second oldest is considered the main one for the study (in the upper photo in the upper part).
- Doppler echocardiography allows you to evaluate the direction of flows, their speed. Thus, defects of the partitions, insufficiency and stenosis of the valves are detected.
- Three-dimensional or 3D mode. Not widely distributed yet due to the high price. It is used more often for the most accurate determination of the size of the heart before operations on it.
The first 3 types are carried out on all devices and are the basis of modern diagnostics, which is quite enough for a correct diagnosis.
Principle of operation
Ultrasound is based on the principle of reflection of an ultrasound beam from the boundary of various body fluids. This can be the border of an organ or any formation in it, the edge of a vessel or blood, if it has increased coagulability.
The only thing where ultrasound does not spread is air. That is why the lungs are not amenable to such research. However, you can see the pleural cavity for the presence of fluid or volume formations.
So that the air on the skin surface does not interfere with the diagnosis, and the sensor glides freely on the surface, the required area of the body is covered with a special ultrasonic gel. Sometimes during the study, the substance must be applied several times.
How is the examination done?
When the patient entered the office, he was asked to undress from the top to the waist. To conduct a good ultrasound of the heart, you must:
- Lie on your left side.
- Put your left hand under your head.
These actions help bring the heart closer to the front wall of the chest to improve image quality. But each rule has exceptions. For example: children under one year old and sometimes older are looked at in the “on the back” position. Adults who have difficulty visualizing the organ due to the increased airiness of the lung tissue (in case of chronic obstructive pulmonary disease or when the ventilator is connected) are often examined in the supine position from the subcostal access (under the xiphoid process).
Whether the patient is asked to lie facing the apparatus or on it depends on the doctor how it will be more convenient for him to work. If the patient is lucky and he sees the monitor screen, the study will become much more interesting.
Examination time depends on the presence or absence of heart disease. An experienced specialist from the first seconds can estimate how long the procedure will last. This can take 5 minutes or stretch for 30 if a consultation is required (joint examination by several doctors).
During an ultrasound of the heart, the patient must listen carefully, answer questions, follow all the instructions of the doctor. Such actions are aimed at drawing up the correct picture of the disease and creating an appropriate assessment of the work of the heart.
At the end of the procedure, it will take time to complete the examination protocol and write a conclusion.
Fetal Examination
An important stage of prevention is the diagnosis of diseases when a small patient is still in the womb. The heart develops at 3-4 weeks of gestation. Naturally, it is not possible to discern anything. There is a chance only to determine the presence of a heartbeat. Therefore, an ultrasound of the fetal heart is performed during the second and third screening.
At week 12, the organ is still quite small. But thanks to modern ultrasound programs, one can consider the structure of the heart. The best option would be an examination at weeks 18-22, when the amniotic fluid volume still allows you to clearly see the internal organs of the fetus. But it’s better to examine the heart every trimester.
Ultrasound assesses the heartbeat, its frequency, and heart structure: the size of the chambers, the location of the main vessels, the presence of defects in the partitions, and other types of defects.
What does it show?
The heart is surrounded on almost all sides by the lungs. But there is a “window” - a little to the left of the sternum - where specialists have the opportunity to examine the organ in all details. For a detailed study, there are certain access points where the ultrasound doctor applies the sensor. They are standard thanks to the experience gained over several decades.
Each ultrasound specialist has his own protocol for work: what to look for first and last. Usually at the beginning of the study, the sensor is placed to the left of the sternum. Then you can see a longitudinal section of the heart, when you turn the sensor, a section appears along the short axis. Thus, you can see both ventricles, the aorta with the valve, the left atrium. When the sensor is tilted, a pulmonary trunk appears on the screen, which is divided into two pulmonary arteries, the right atrium, the mitral valve, and the papillary muscles of the left ventricle.
Examining the heart, the doctor determines the size of all structures, the thickness of the interventricular septum. There is also an assessment of contractility of the heart muscle. When the Doppler option is enabled, the speed indicators of blood flow through the valves or defects of the partitions are evaluated.
At other access points, grading is the same, but from different angles. Sometimes the doctor uses additional access above the sternum to examine the aorta for its expansion or contraction.
Thus, when using all accesses, a complete picture of the structure of the organ, its work is created. This helps to understand what actions need to be taken next, what treatment should be prescribed if it is required.
Indications
Like every examination, an ultrasound of the heart has its own indications, its own goals. Of course, there is always the opportunity to go for a fee to just make sure of your health. However, at the reception, the echocardiographer will still ask why the person came, what worries him.
So, why prescribe echocardioscopy for adults:
- ECG changes;
- heart murmur;
- interruptions in the work of the body;
- complaints of pain in the heart, shortness of breath with little physical exertion;
- control studies in the presence of a history of acquired and congenital malformations;
- assessment of cardiac activity during emergency hospitalization in a hospital;
- risk assessment of upcoming surgical interventions;
- compulsory examination of professional athletes and other persons engaged in heavy physical labor, for example, firefighters, rescue services.
In addition to the previous paragraphs, ultrasound of the heart of the child is carried out according to several indications:
- standard examinations at 1 month to identify congenital malformations, small developmental abnormalities;
- standard examinations before admission to kindergarten or school;
- with a blue nasolabial triangle;
- insufficient weight gain or its reduction.
Contraindications
There are no contraindications to ECHO-CS as such. The only thing that can complicate the procedure is the presence of open wounds. But even in this case, the doctor will have a ton of other access points, where he will be able to examine the heart in detail.
Difficulties can also arise when a patient is on a ventilator and with a concomitant diagnosis of COPD. And some may not be able to do a lying test because of severe heart failure. In these cases, non-standard patient positions are used. So the study may drag on.
General rules for preparing for the examination
Before carrying out transthoracic ECHO-KS special preparation is not required. It is advisable to take with you the results of previous examinations, a fresh electrocardiogram. During the procedure, you should calm down as much as possible to reduce the heart rate. Otherwise, the picture will be slightly different. This can lead to errors in the diagnosis, and therefore in the treatment.
Before conducting a transesophageal ECHO-KG, due to the invasiveness of the procedure, it is important to properly prepare:
- Hunger for more than 8 hours before the study.
- Refusal of water in 2 hours.
- Quitting smoking in 4 hours.
- The daily intake of medicines prescribed by the doctor according to the previous schedule, it is impossible to cancel them on the day of the ECEE.
- Take out dentures before diagnosis.
- Notify staff of potential allergic reactions to pain medication.
- Indicate the presence of diseases of the oral cavity and esophagus.
Doctors also advise to maintain a positive attitude, which will contribute to a decrease in heart rate and thereby to a quick end to the procedure.
Children training
Particular attention is paid to the preparation of a survey of children. Often parents and their children have no idea about the diagnosis. It is important to understand that for a child who is new to everything, a doctor, an incomprehensible device, a sensor is a huge stress. Some children are absolutely sure that the diagnosis is extremely painful. As a result, parents, dumbfounded by the doctor’s offer to postpone the procedure the next time the child is mentally prepared, hold the baby’s hands and feet with fury, demand to complete the examination. It is not right.
To avoid such difficulties and crippled souls, before conducting an ultrasound of the heart, the child recommends to the child:
- Explain in advance to children how the procedure goes. It will be wonderful to prepare at home with the help of the game: mother - doctor, child - patient.
- Take a dummy, your favorite toys with you, to distract the baby's attention as much as possible.
- During the study, it is necessary to distract the child in every possible way.
If the child feels that there is no threat to him, then the examination will pass quickly.
Where do they do it?
The diagnostic method is so widespread that there are no questions where to make an ultrasound of the heart. If the patient has a referral for examination, they immediately explain to him which office and when to come. Most often, ECHO-KS is carried out in the same medical institution. If a person is in the hospital, an ultrasound of the heart will be done if there are strict indications.
However, it often happens that the queue for examination is 1-2 months. Therefore, many are looking for other places for ultrasound of the heart, where you can not wait for such a long time. Private medical centers are a great help in solving the queue problem. Fortunately, today they are widespread. Most often, the equipment is better there, and sometimes they spend more time on examination.
Ultrasound of the heart in Minsk
In the capital of Belarus, there are a huge number of medical centers offering echocardiography:
- "Vita" - st. M. Bagdanovich, 6;
- "ECO" - st. Surganova, 54;
- "New Healer" - st. Engels, 34A / 2;
- “Lode” - 58 Independence Avenue;
- "MedKlinik" - st. Pritytsky, 9;
- SinLab - st. Academic. 26.
And a great many others. There are about 50 private centers that offer an ultrasound scan of the heart. Addresses can be easily found on official sites. State health care facilities and heart ultrasound are not far behind, where they can be performed free of charge in the direction of a doctor. All city clinics are happy to accept patients for examination.
Where to go next?
After receiving the results of echocardiography in a patient, there are 2 ways:
- To the one who sent to ECHO-KS (pediatrician, therapist or any other specialist).
- To the cardiologist.
In the end, a person will still be directed to the latter, if there is a serious pathology. The doctor will evaluate the results of ECHO-KG, compare with the clinic and prescribe treatment, give general recommendations. It may be necessary to repeat the examination at some intervals.