Echocardiography Laboratory

Echocardiography Laboratory:
Transthoracic Echocardiogram  
Transesophageal Echocardiogram
Stress Echocardiogram

Echocardiography Laboratory:

The ICA clinic in the medical center has an in house state-of-art echocardiography lab. Each year ICA performs more than 1000 stress test annually.

What is an Echocardiogram (also called Cardiac Ultrasound)?

An echocardiogram is a noninvasive test, which uses ultrasound, or high frequency sound waves, to create graphic images of the heart's structures, pumping action, and direction of blood flow within the heart.

What are the different types of Cardiac Ultrasound tests?

• Transthoracic echocardiogram ( routine cardiac ultrasound/echo)
• Transesophageal echocardiogram (TEE)
• Stress echocardiogram (Treadmill and Dobutamine)
  

Back to top

Transthoracic Echocardiogram 
(Also called Routine Echo, or Cardiac Ultrasound)

Why do a transthoracic echocardiogram?

• Assess the heart’s function
• Determine the presence of disease of the heart muscle, valves and pericardium, heart tumors, and congenital heart disease
• Evaluate the effectiveness of medical or surgical treatments
• Follow the progress of valve disease

To prepare:

• You can wear whatever you like. You will need to change into a hospital gown to wear during the procedure. Do not bring valuables.
• You may eat and drink as you normally would on the day of the test.
• Take all of your medications at the usual times, as prescribed by your doctor.

What to expect:

• Before the test, a cardiac sonographer (an allied health professional who has been trained specifically to perform ultrasound examinations) will explain the procedure in detail, including possible complications and side effects. They will be available to answer any questions you may have.
• You will be given a hospital gown to wear. You will be asked to remove your clothing from the waist up.
• The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of cool gel on the end, which will not harm your skin. This gel helps get clearer pictures.
• You may be asked to change positions during the exam in order to take pictures of different areas of your heart. You may be asked to hold your breath at times.
• You should feel no major discomfort during the test. You may feel coolness from the gel on the transducer and a slight pressure of the transducer on your chest.

Time duration of the test:  40-60 minutes. After the test, you may get dressed and go home or go to your other scheduled appointments.

Back to top

Transesophageal Echocardiogram

Transesophageal echocardiogram (TEE) is an invasive form of cardiac ultrasound, which involves putting a long, thin, flexible endoscope with an ultrasound tip down the food pipe. The food pipe sits behind the heart and allows ultrasound images of high resolution to be taken without the interference of lung tissue and bones.

The need for TEE is determined by your cardiologist and is indicated in highly selective cases.

We perform TEE at The Methodist Hospital Echocardiogram Laboratory only. TEE requires highly skilled nursing and recovery suite available in hospital.

• You can wear whatever you like. You will need to change into a hospital gown to wear during the procedure. Do not bring valuables.
• DO NOT eat or drink anything for at least six hours before the test. Take your medications with only a small sip of water.
• Take all of your medications at the usual times, as prescribed by your doctor.
• If you have diabetes and take medications to manage your blood sugar, ask your physician how to adjust your medications the day of your test.
• Tell your doctor if you have any problems with your esophagus (tube connecting mouth to the stomach), such as hiatal hernia, problems swallowing, or cancer.
• Bring someone with you to drive you home after the test. You should not drive until the day after the procedure. Sedation given during the procedure causes drowsiness, dizziness and impairs your judgment, making it unsafe for you to drive or operate machinery.

• Informed consent will be obtained from the patient after procedure, risks, benefits and alternatives are explained to the patient.
• Moderate sedation is used during the procedure. Let your doctor know if you are allergic to any medications.
• Local anesthetic spray is used to suppress the gag reflex and involves spraying the back of the throat with a lidocaine/cetacaine spray.
• BP, pulse, EKG and oximetry are continuously monitored during the procedure.

• After you have recovered from the sedation, you may go home or to your other scheduled appointments. You may NOT drive yourself home after the test.
• You may feel a temporary soreness or numbness in your throat after the test.
• Wait at least two hours after the test (or until the numbness in your throat is gone) before eating or drinking. Start by drinking a cool liquid. If you have no problems drinking cool liquids, eat and drink as you normally would.

Time duration of entire testing: 3-4hours (includes registration at TMH, prep. time, procedure and recovery). The TEE it self only takes about 45 minutes usually.

Back to top

Stress Echocardiogram

What is a stress echocardiogram?

The stress echo test involves exercising on a treadmill or stationary cycle while you are closely monitored. The test is used to evaluate your heart and valve function at rest and with exertion.

What are the types of stress echocardiogram?

There are two types of stress echocardiogram:

Exercise stress echocardiogram where echocardiogram is combined with exercising on treadmill. This is preferred method for patients who can exercise.

Dobutamine stress echocardiogram which is usually reserved for patients who can not exercise. Dobutamine stress echo test involves infusing a medication through an intravenous (IV) line, called dobutamine, while you are closely monitored. The medication stimulates your heart and makes it "think" it is exercising.

What information is obtained from the stress echocardiogram?

• Determine how well your heart tolerates stress or exertion
• Evaluate the function of your heart and valves
• Evaluate the effectiveness of your cardiac treatment plan
• Determine the likelihood of having coronary artery disease and the need for further testing

To prepare:

• DO NOT eat or drink anything except water for four hours before the test.
• Ask your doctor what medications should be taken on the day of your test. DO NOT take the following heart medications on the day of the test unless your physician tells you otherwise or if the medication is needed to treat chest discomfort:
• Beta blockers [for example: atenolol (Tenormin), metroprolol (Lopressor, Toprol), Propranolol (Inderal)]
• Isorbide dinitrate (for example: Isordil, Sorbitrate)
• Isosorbide mononitrate (for example: Ismo)
• Nitroglycerin (for example: Deponit, Nitrostat)

Your physician may also ask you to stop taking other heart medications on the day of the test. If you have questions about your medications — ask your physician. Do not stop any medication without first talking with your doctor.

What to expect:

Cardiac ultrasound images will be taken at baseline.

Stress test will subsequently be administered; either treadmill or dobutamine as determined by the physician.

Post stress cardiac ultrasound images will be taken next.

BP, heart rate and EKG will be constantly monitored during the procedure and lab personal will ask you periodically during the stress for any symptoms such as chest pain, SOB etc that you may experience.

Contrast agent may be used during the study to get better images and lab personal will discuss this with you prior to use.

Post stress testing you may proceed with your day in a regular manner.

Back to top