Ultrasound is the most common examination method today. Doctors appreciate it for its accessibility, simplicity, and the ability to clearly visualize the structures of an organ. Patients - for the need for minimal preparation, painlessness and prevalence of the service.
Ultrasound of the heart is one of the most sought-after studies of internal organs. This is due to the high incidence of cardiovascular disease in the population. The article will tell in detail about what ultrasound of the heart shows, what are its types, why it is needed, whether there are contraindications for the examination, what methods of preparation and how to decipher the results.
Definition
Ultrasound is a method of diagnosing internal organs and structures located under the surface of the skin. 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 otherwise called echocardiography or echocardioscopy, abbreviated as ECHO-KG, ECHO-CS. All thisequivalent concepts in which patients are periodically confused.
Types of echocardiography
There are 4 ways to perform echocardioscopy to examine the heart:
- Transthoracic ultrasound. The study through the chest is a kind of fact-finding character. He is assigned to everyone. The study is a first-line diagnostic method.
- Transesophageal (TECHO) is prescribed only according to indications according to the results of transthoracic ECHO-CS. The imaging quality is much better because the ultrasound transducer in the esophagus is closer to the heart. In addition, there is no impact on the lung tissue. Also, with the help of TEE it is possible to examine structures that are invisible when examining through the chest.
- Stress-ECHO-KG is carried out strictly as needed. Allows you to evaluate the work of the heart during exercise. To do this, use the usual physical exercises, for example, squats, pedaling on an exercise bike. Or the study is carried out by the use of drugs that increase the load on the heart.
- ECHO-KG with contrast diagnostics differs from conventional transthoracic ultrasound only in that a contrast agent is injected into the patient's bloodstream before the 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.
Besides, ECHO of the heart is subdivided according to imaging methods:
- One-dimensional image or M-mode (at the bottom of the photo). Mostthe earliest of all. It was used in the early days of ultrasound research.
- 2D or B-Mode. The second oldest, considered the main study (on the top photo at the top).
- Doppler echocardiography allows you to evaluate the direction of flows, their speed. Thus, septal defects, insufficiency and stenosis of the valves are detected.
- Three-dimensional or 3D mode. Not widely used yet due to 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.
Working principle
Ultrasound is based on the principle of reflection of an ultrasonic beam from the boundary of various body media. This may be the border of an organ or any formation in it, the edge of a vessel or blood, if it has increased clotting.
The only place where ultrasound doesn't travel is air. That is why the lungs are not amenable to such a study. However, the pleural cavity can be examined for fluid or masses.
So that the air on the skin surface does not interfere with the diagnosis, and the sensor slides freely over the surface, the necessary area of the body is covered with a special ultrasound-conducting gel. Sometimes during the study, the substance has to be appliedseveral 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 need:
- Lie on your left side.
- Put your left hand under your head.
These steps help bring the heart closer to the anterior chest wall to improve image quality. But every rule has exceptions. For example: children up to a year old, and sometimes even older, are looked at in the “on their back” position. Adults in whom visualization of the organ is difficult due to increased airiness of the lung tissue (with chronic obstructive pulmonary disease or with a connected ventilator) are often examined in the supine position from the subcostal approach (under the xiphoid process).
Whether the patient will be asked to lie facing the machine or away from it depends on the doctor, how it will be more convenient for him to work. If the patient is lucky and sees the monitor screen, the study will become much more interesting.
The examination time depends on the presence or absence of heart pathology. 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 you need a consultation (joint examination by several doctors).
During an ultrasound of the heart, the patient must listen carefully, answer questions, follow all the doctor's instructions. Such actions are aimed at compiling a correct picture of the disease and creatingappropriate evaluation of the work of the heart.
At the end of the procedure, it will take time to fill out the examination protocol and write a conclusion.
Fetal examination
An important step in 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 see anything. It is only possible to determine the fact of the presence of a heartbeat. Therefore, an ultrasound of the fetal heart is performed during the second and third screenings.
At 12 weeks, the organ is still quite small. But thanks to modern programs of ultrasound machines, it is possible to examine the structures of the heart. The best option would be an examination at 18-22 weeks, when the volume of amniotic fluid still allows you to clearly see the internal organs of the fetus. But it is better to examine the heart every trimester.
Ultrasound evaluates the heartbeat, its frequency, the structure of the heart: the size of the chambers, the location of the main vessels, the presence of septal defects 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 decades of experience.
Each ultrasound specialist has his own protocol for work: what to look for infirst and last turn. 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 cut along the short axis will appear. Thus, you can see both ventricles, the aorta with a valve, the left atrium. When the transducer is tilted, the pulmonary trunk appears on the screen, which divides into two pulmonary arteries, the right atrium, the mitral valve, and the LV papillary muscles.
Examining the heart, the doctor determines the size of all structures, the thickness of the interventricular septum. There is also an assessment of the contractility of the heart muscle. When the Doppler option is enabled, the speed indicators of blood flow through valves or septal defects are evaluated.
In other assessment access points, everything is the same, but from different angles. Sometimes the doctor will use an additional access over the sternum to examine the aorta for expansion or narrowing.
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 to prescribe, if any.
Indications
Like every examination, ultrasound of the heart has its own indications, its own goals. Of course, there is always the opportunity to go through it for a fee, just to make sure of your he alth. However, at the appointment, the echocardiographer will still ask why the person came, what worries him.
So, why do adults order echocardioscopy:
- ECG changes;
- heart murmurs;
- 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;
- risk assessment of upcoming surgical interventions;
- mandatory screening of professional athletes and other hard workers such as firefighters, rescue workers.
In addition to the previous points, ultrasound of the heart of the child is carried out for several more indications:
- Standard examinations at 1 month to detect congenital malformations, minor developmental anomalies;
- standard screenings before admission to kindergarten or school;
- when the nasolabial triangle turns blue;
- Insufficient weight gain or loss.
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 plenty of other access points where he can examine the heart in detail.
Difficulties can also arise when the patient is on a ventilator and with a concomitant diagnosis of COPD. And some cannot be examined lying down due to severe heart failure. In these cases, non-standard patient positions are used. So the study may be delayed.
General rules for preparing for the examination
Beforetransthoracic ECHO-CS does not require special preparation. 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 somewhat different. This can lead to errors in diagnosis, and therefore in treatment.
Before performing a transesophageal ECHO-KG, due to the invasiveness of the procedure, it is important to properly prepare:
- Hunger more than 8 hours before study.
- Get off water in 2 hours.
- Quit smoking in 4 hours
- Daily intake of medicines prescribed by the doctor according to the previous schedule, they cannot be canceled on the day of the TEE.
- Remove dentures before testing.
- Notify staff of possible allergic reactions to pain medications.
- Indicate the presence of diseases of the oral cavity and esophagus.
Also, doctors advise to keep a positive attitude, which will help to reduce the heart rate and thus the quick end of the procedure.
Preparing children
Special attention is paid to the preparation of the examination 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 quite sure that the diagnosis is extremely painful. As a result, the parents, dumbfounded by the doctor's proposal to postpone the procedure for another time, when the child is mentally prepared, furiously hold the baby by the arms and legs,required to complete the survey. This is wrong.
To avoid such difficulties and crippled souls, experts recommend before an ultrasound of the heart of a child:
- Explain to the children in advance how the procedure works. It will be great to prepare at home with the help of the game: mom is a doctor, a child is a patient.
- Take a pacifier with you, your favorite toys to distract your baby 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 common that there are no questions about where to do an ultrasound of the heart. If the patient has a referral for an 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 an ultrasound of the heart, where they can not wait for such a long time. A great help in solving the problem of queues are private medical centers. Luckily, they are widespread today. Most often, the equipment is better there, and sometimes more time is spent on examination.
Ultrasound of the heart in Minsk
There are a huge number of medical centers in the capital of Belarus offering echocardiography:
- "Vita" - st. M. Bagdanovich, 6;
- "ECO" - st. Surganova, 54;
- "New Doctor" - st. Engels, 34A/2;
- "Lode" - Independence Avenue, 58;
- "MedClinic" - st. Pritytsky, 9;
- SinLab - st. Academic. 26.
And a huge number of others. There are about 50 private centers that offer cardiac ultrasound. Addresses can be easily found on official websites. State medical facilities are not lagging behind, where ultrasound of the heart can be performed free of charge in the direction of a doctor. All city polyclinics will gladly accept patients for examination.
Where to go next?
After receiving the patient's echocardiography results, 2 ways:
- To the one who referred to the ECHO-CS (pediatrician, therapist or any other specialist).
- To the cardiologist.
Ultimately, a person will still be referred to the latter if there is a serious pathology. The doctor will evaluate the results of the ECHO-KG, compare them with the clinic and prescribe treatment, and give general recommendations. It may be necessary to repeat the examination at some intervals.
