The Role of Echocardiography in Diagnosing Heart Conditions

Echocardiography is a common and painless diagnostic procedure that utilises ultrasound technology to create detailed images of the heart (echocardiograms). This allows cardiologists to evaluate the size and shape of the heart chambers, the thickness and pumping function of the heart muscle, and the proper functioning of your heart valves. It also allows them to assess blood flow patterns and even detect the presence of blood clots or excess fluid surrounding the heart.

Typically lasting between 30⁠–⁠60 minutes, the procedure is safe and involves a technician applying gel to your chest and using a handheld device (transducer) to capture the ultrasound images for analysis. Afterwards, your healthcare team will analyse the images and measurements obtained during the test and interpret the results. The doctor will then schedule a follow-up appointment to discuss the findings and recommend further testing or treatments if any abnormalities are detected during the test.

When Would I Need an Echocardiography?

A heart specialist may order echocardiography if an individual exhibits signs or symptoms of cardiac issues, such as:

• An unusual sound or murmur during heart monitoring
• Unexplained chest pain, shortness of breath, or fatigue
• An irregular or abnormal heart rhythm, known as arrhythmia
• An inflammatory condition, such as rheumatic fever
• A congenital heart defect or valvular heart disease

Furthermore, doctors may conduct this procedure as part of a routine cardiac evaluation to monitor the progression of pre-existing heart disease and assess the outcome of a recent surgery or heart treatment.

What Conditions Can Be Diagnosed with an Echocardiogram?

Based on the patient’s medical history and clinical presentation, a doctor recommends echocardiography to detect a wide range of heart conditions. These include:

• Atherosclerosis: This condition is the buildup of cholesterol, fat, or other substances (plaque) in the lining of the arteries, leading to the narrowing and hardening of the blood vessels.
• Cardiomyopathy: This condition affects the heart muscle (myocardium), causing it to become thickened, stiff, and unable to circulate blood to the rest of the body.
• Congenital Heart Disease: This refers to structural abnormalities that occur within the heart at birth and interfere with the normal flow of blood through the heart.
• Heart Failure: This condition occurs when the heart muscle weakens or becomes stiff and fails to deliver an adequate supply of blood throughout the body.
• Aortic Aneurysm: This bulge develops in the wall of the aorta, the body’s largest artery that carries oxygenated blood from the heart to the body.
• Heart Valve Disease: This condition refers to the dysfunction of one or more heart valves responsible for maintaining blood flow in one direction through the heart.

What Are the Different Types of Echocardiograms?

There are several types of echocardiograms, with each providing a different approach to investigating the heart and detecting heart conditions. These include:

Transthoracic Echocardiogram (TTE)

This is the most common type of echocardiogram that works similarly to an X-ray without radiation and a regular ultrasound used during pregnancy.

• How to Prepare for the Test No preparation is required for a transthoracic echocardiogram since the test is non-invasive. Patients can eat, drink, and take necessary medications before the test.
• What to Expect During the Procedure During a transthoracic echocardiogram, the doctor will ask the patient to lie down on their left side on an examination couch. Several small, sticky patches called electrodes are attached to the chest to record heart rate and rhythm. The doctor will then apply a lubricating gel to the skin and move an ultrasound probe around the chest to transmit sound waves and pick up images of the heart.
• What to Expect After the Procedure Once the doctor obtains all the necessary images, they will clean off the gel and remove the electrodes. Patients should be able to go home immediately and resume their regular activities.

Transoesophageal Echocardiogram (TEE)

Typically, this test is performed to provide high-resolution images of a specific region of the heart or when a transthoracic echocardiogram fails to produce clear images of the heart’s structures.

• How to Prepare for the Test Your doctor may recommend fasting for 6-8 hours before the test to ensure clear images. In some cases, they may also advise adjusting certain medications, particularly blood thinners, to minimise bleeding risks. If sedation is used during the procedure, arranging for transportation home afterwards is important. Finally, to avoid any potential complications, be sure to inform your doctor about any allergies or sensitivities you may have.
• What to Expect During the Procedure In this procedure, the patient will be given a mild intravenous (IV) sedative for comfort before the doctor applies an anaesthetic gel or spray to numb the throat and prevent a gag reflex during the test. Afterwards, the doctor will carefully insert a flexible tube with a probe down the throat and into the oesophagus. They may ask the patient to swallow a few times to position the probe accurately to take accurate images of the heart.
• What to Expect After the Procedure After the test, patients must remain in the recovery area for a few hours while the healthcare team monitors their heart rate, blood pressure, and oxygen levels. They may experience throat soreness and drowsiness due to sedatives, which usually subsides within 24 hours.

Exercise Stress Echocardiogram

This diagnostic procedure involves taking images of the heart before and after a patient exercises. In this way, doctors can assess the heart's response to physical activity or stress and identify the presence and extent of coronary artery disease (CAD).

• How to Prepare for the Test Wear loose-fitting clothes and comfortable shoes suitable for light exercise. You may also be advised to avoid heavy meals and caffeine for several hours before the appointment, as these can affect the test results. Finally, your doctor may recommend abstaining from tobacco products for a few hours beforehand, as tobacco use can temporarily alter your heart rate and blood pressure, potentially impacting the accuracy of the test.
• What to Expect During the Procedure The doctor will first conduct an echocardiogram to collect images of the heart before starting exercise. Then, the patient will be instructed to walk on a treadmill machine or ride a stationary bike. The speed and incline of the equipment will increase every three minutes during the exercise to gradually stress the heart. Once the patient reaches the targeted heart rate, they will return to the examination couch for a repeat echocardiogram to compare the pre-exercise images and look for any abnormal heart pumping.
• What to Expect After the Procedure Following the stress test, the doctor monitors the patient’s heart activity and blood pressure until they return to normal. The patient should be able to return to normal activities immediately after diagnosis.

What Techniques are Used in Echocardiography?

Echocardiography employs various advanced imaging techniques to provide doctors with a detailed view of the heart's structure and function. These techniques include:

• Two-Dimensional (2D) Echocardiography: This offers 2D images displayed as slices on the monitor to allow real-time observation of the structures and movements of the heart.
• Three-dimensional (3D) Echocardiography: This captures multiple 3D slices of the heart structures from different angles, allowing for more thorough analysis and assessment.
• Doppler Echocardiography: This technique uses the Doppler effect to measure the speed and direction of blood flow within the heart chambers and valves.
• Colour Doppler Ultrasound: This specialised Doppler technique uses colour-coding to visualise blood flow direction and detect abnormalities or irregularities.
• Strain Imaging: This advanced echocardiographic method evaluates the function and contractility of the heart muscle (myocardium) and identifies early signs of cardiac conditions.
• Contrast Imaging: This involves injecting a contrast agent into the veins to enhance the visibility of the heart's structures and improve the overall quality of the echocardiogram.

Headed by experienced cardiologist Dr Ang Teck Kee, Ace Cardiology Clinic is a heart clinic in Singapore that specialises in advanced echocardiography techniques for comprehensive and accurate diagnoses of various heart conditions. The clinic also develops personalised treatment plans to address every patient’s heart-related needs. To book an appointment, contact the clinic at 9155 2942 today.