Cardiac ultrasound / Echocardiography (ECHOKG)Time spending:
45 minutes.Introducing contrast:
not executed.Preparation for the examination:
not required.The presence of contraindications:
inflammatory diseases of the skin of the chest.
Cardiac ultrasound / Echocardiography (ECHOKG) is an ultrasound examination of the heart. Non-invasive, that is, not damaging tissues and organs, the technique allows you to identify a wide range of changes in the work of the heart, which do not manifest themselves in the form of painful sensations and are not detected during the ECG.
The main purpose of ultrasound diagnostics is to assess the functioning of the heart. With the help of Echo-KG, the volume and size of the organ cavities, the thickness of its walls are determined, structural changes in the valves and other parts of the heart are revealed.
Why is Echo-KG carried out?
The main objectives of the examination are always to assess the mechanical work of the heart and its morphological characteristics.
With the help of ECHO of the heart, it became possible:
- receive information about the size of the heart, the volume of its cavities;
- determine the state of the membranes of the organ (pericardium);
- record information about the thickness of the walls of the heart;
- detect cicatricial changes in the myocardium;
- to investigate the contractile function of the myocardium, that is, the ability to contract the muscles of the ventricles;
- analyze the work and condition of the valves of the organ;
- assess intracardiac blood flow, determine the presence of pathological blood flow, measure blood pressure in the heart chambers;
- assess the state of the largest vessels of the organ.
With the help of echocardiography, doctors identify a whole range of heart diseases and pathological conditions, including:
- ischemic disease;
- myocardial pericarditis, that is, the inflammatory process;
- aneurysms of any degree;
- hypertrophy and dilatation of the heart chambers;
- damage to the vessels of the organ;
- damage to the valves of the heart;
- the presence of intracardiac blood clots, heart tumors;
- identifying the level of pressure in the pulmonary artery.
To date, Echo-KG (ultrasound of the heart) is the only method for an informative and accurate diagnosis of acquired or congenital heart defects.
The examination is used not only in the diagnosis of functional disorders of the organ. It is also irreplaceable in preventive cardiology. With the help of this procedure, it is possible to identify even the slightest deviations in the functioning of the heart, to prevent a wide range of pathologies and prevent their further development.
With the help of this procedure, it is possible to identify even the slightest deviations in the functioning of the heart, to prevent a wide range of pathologies and prevent their further development.
Advantages of cardiac ultrasound (cardiac echocardiography) at the "SM-Clinic"
Ultrasound of the heart in Moscow at the "SM-Clinic" is carried out using the latest digital devices - expert-level echocardiographs from well-known manufacturers of equipment for medicine. Modern devices make it possible to carry out examination at high speed and obtain an impeccable quality of data processing. That is why research provides highly accurate results. Echocardiography in "SM-Clinic" is performed by diagnostic doctors of the highest qualification category, who have been trained in ultrasound diagnostics in the cardiological field and have certificates confirming this specialization. Our specialists have extensive practical experience in performing functional examinations.
Features of the ultrasound examination of the heart in the "CM-Clinic":
- echocardiographic devices, which are used for research, allow to obtain an image in four mutually perpendicular planes, which guarantees maximum diagnostic accuracy;
- using Doppler echocardiography, the velocity and direction of blood flow in the heart valves are determined, the dynamics of changes in these parameters is monitored;
- the study is absolutely safe for the patient, no effect on the body is carried out;
- The echo of the heart has a price that is affordable for most patients in the clinic.
Indications for echocardiography
Echocardiography is a mandatory annual study for people who have been diagnosed with heart disease or suspected of having it, as well as other pathologies of the cardiovascular system. Echo-KG of the heart is also prescribed to people who are professionally involved in sports and patients who have constant physical activity.
Echocardiography is necessarily performed after cardiac surgery or, if necessary, during preparation for surgery.
In addition, it is recommended to undergo an examination if you have the following symptoms:
- general weakness;
- sudden pain, trembling in the chest;
- swelling of the ankles;
- frequent nausea and vomiting.
Mandatory indications for echocardiography include the following:
- suspected thoracic aortic enlargement (aneurysm);
- suspicions of the presence of neoplasms in the region of the heart;
- high blood pressure;
- transferred myocardial infarction;
- any changes that were identified during the ECG.
Contraindications to echocardiography
There are no absolute contraindications for ultrasound of the heart. It is recommended to limit your food intake three hours before the procedure. Otherwise, the obtained information may be distorted due to the high position of the diaphragm.
Diagnosis is not recommended for patients with chest deformities, inflammatory diseases of the skin in the thoracic region. These pathologies also negatively affect the accuracy of the examination results.
ECG and EchoCG: what are the differences
There are four main differences between treatments:
Echocardiography is performed using a transducer that is applied to the patient's chest in the heart area. The transducer catches ultrasound waves that travel through the walls of the heart, and then reflects them and receives signals returned. They are processed by the computer. The ECG is performed according to a different principle: special sensors are attached to the patient's chest. They measure the activity of the heart. The sensors (electrodes) are connected to a special device that displays a graph indicating the nature and strength of the received electrical signals.
An ultrasound examination of the heart determines how well the organ pumps blood. With the help of such a diagnosis, it is also possible to identify violations of this function, which indicate heart failure. Electrocardiography, in turn, only measures the signal level and checks if the heart is sending steady impulses.
The ECG result is shown in the graph, and the EchoCG - in the form of photographs.
An electrocardiogram allows you to detect arrhythmia, tachycardia, disturbed heart rhythm, bradycardia. Echocardiography assesses the state of heart function after attacks, heart valves, possible localization of blood clots and other disorders in the functioning of the organ.
Almost always, the study is carried out through the chest. This method is called transthoracic. Transthoracic echocardiography, in turn, is divided into two-dimensional and one-dimensional.
In one-dimensional diagnostics, information is displayed in the form of a graph on a computer monitor. With the help of such a study, it is possible to obtain information about the size of the atrium, ventricles, to assess their performance.
In a two-dimensional examination, information is provided in the form of an image of an organ. Two-dimensional echocardiography makes it possible to obtain an accurate picture of the work of the heart, to determine its size, wall thickness, and chamber volume.
There is also Doppler echocardiography - a study that checks how well the blood supply to the organ is. For example, during the procedure, the doctor observes the movement of blood in the vessels and parts of the heart. Normally, blood flow should move in one direction, but if the valves are malfunctioning, reverse blood flow can be observed.
Doppler examination is usually prescribed in combination with one-dimensional or two-dimensional ultrasound examination.
Preparation for the examination
No additional preparation is required before performing an ultrasound examination of the heart. The patient only needs to come for the examination at the time appointed by the specialists. EchoCG is performed in the department of functional diagnostics "CM-Clinic".
How does echocardiography go
Before the procedure, the patient undresses to the waist. After that, the diagnostician applies a special acoustic gel to the chest area and places the subject on the couch in a reclining position on the left side. Next, the specialist installs the echocardiograph transducers in several positions. This position is most convenient for the patient. In addition, it is necessary for accurate diagnosis, since the heart, which is located at the anterolateral chest wall, is in this place least covered by lung tissue.
When a person lies on their left side, the acoustic window expands, so ultrasonic sensors pick up any vibrations and noises of organ structures. The echocardiograph does its job for 15 minutes. It processes, synchronizes the data received from the sensors through the electrocardiographic channel. During this time, the patient can relax, as the procedure is painless and does not cause discomfort.
Results of the diagnostic procedure
After the completion of the manipulation, the diagnostician "CM-Clinic" analyzes the results obtained. It determines the thickness of the heart septa, the size and condition of the heart, its topographic position within the anatomical structure. Also, the specialist evaluates the work of the heart valves and other functional structures, the state of soft tissues. Based on the results obtained, the doctor will identify possible pathologies.
After ultrasound examination of the heart at the "CM-Clinic", the patient receives:
- echocardiogram - visualization of soft X-ray negative tissues on photographic paper or ultrasound image of the heart;
- the conclusion of the diagnostician.
Also, in the EchoCG protocol, the norms for people that correspond to a certain age and gender group are necessarily denoted. When writing a conclusion, these norms are taken into account and correlated with the results obtained.
Diagnostics in "CM-Clinic" is carried out by qualified specialists with impressive practical experience. The availability of modern equipment, as well as the high qualifications of diagnostic doctors guarantee the receipt of the most accurate examination results.
You can make an ECHO of the heart in Moscow inexpensively with us - in the "CM-Clinic". We carry out research at the best price and quickly deliver diagnostic results to patients.
You can find out all the details you are interested in, clarify the cost of an ultrasound of the heart and other information, as well as make an appointment for an examination from the operators of the Contact Center "CM-Clinic".
Prices for ultrasound of the heart / Echocardiography (ECHOKG) in the "CM-Clinic"
|Name of service||Price, rub.)*|
|Echocardiography (ultrasound of the heart)||RUB 3 800|
Doctors consult in the following clinics:
Sign up for functional diagnostics
Кardiography using an ultrasound sensor is a routine technique based on the effect of high-frequency radiation on the patient's body and on his tissues. Within the practice of cardiology specialists, we are talking about an irreplaceable technique. Despite the simplicity of the method, it is extremely informative, convenient and accessible for the patient himself.
ECHO KG of the heart is an ultrasound diagnostic method that allows you to visualize the anatomical features of a muscular organ: the state of the valves, the myocardium itself and its vessels, therefore, the technique mainly detects defects. Also acquired over the years violations. For example, with a prolonged increase in blood pressure. There are many options.
In fact, this is a conventional ultrasound scan, only the sensor is used to diagnose cardiac structures.
Since the technique is safe, it is used many times. As often as the situation requires. There are no age or other serious restrictions. Although there are certain contraindications.
What does the patient need to know before echocardiography? How effective is this research?
The essence of the technique and what it shows
As already mentioned, ECHO of the heart is a modification of the standard ultrasound of the internal organs. However, unlike other methods that are similar in meaning, the cardiography apparatus can operate in several modes.
For example, a duplex scan is available to a diagnostician. Doppler ultrasonography is used, among other things, to examine the blood flow velocity. Its quality. What is important in diagnosing, for example, ischemic disease, assessing the state of an organ after a heart attack.
Like other ultrasounds, echocardiography is completely safe.
What does ECHO show as part of a routine examination:
- Mass, the amount of muscle tissue in the area of the left ventricle of the heart. As a rule, changes with prolonged increase in pressure. Untreated hypertension is especially dangerous.
- An echogram of the heart will show the intensity of the movement of blood through the pulmonary artery. This vessel is one of the largest. Any violation is fraught with early complications. Up to death. Especially the increase in local pressure.
- Impact volume. The amount of blood that the heart throws into the aorta and "drives" in a large circle. Many defects change these indicators, therefore deviations are quite informative.
- The state of the left atrium.
- Wall thicknesses.
- Echocardiography of the heart shows even the slightest changes in cardiac structures: the position of the myocardium, heart valves (tricuspid, mitral, etc.) at the time of contraction and return to a calm state. This indicator is defined as end systolic and diastolic volumes.
- General position of the heart. Its size, anatomical localization. Including with respect to other organs of the chest.
The technique shows the morphological features of cardiac structures.
What diseases can be detected
According to the results of echocardiography, specialists make several diagnoses.
This process can be identified indirectly. We are talking about a stable and regular increase in pressure in the vascular bed. If we talk about a full diagnosis, then the condition should be called hypertension.
The long course of the pathological process leads to organic changes in the heart - the left ventricle is transformed. The muscle layer at the level of this chamber becomes thicker.
Read more about left ventricular hypertrophy. in this article .
This is a kind of compensatory mechanism. So cardio structures can pump blood with more force. The intensity of each impact increases. This is not normal, but understandable.
The longer the pathology exists, the worse the situation is. Possible cardiomegaly ... Excessive growth of a muscular organ. Then they will not be able to fulfill their functions.
Both congenital and acquired. Basically, those that affect the valves - aortic, mitral, tricuspid, less often the septum between the chambers.
These conditions are extremely dangerous. Since, without treatment, they lead early to generalized dysfunction, impaired blood circulation. And this is a direct path to death from heart failure or heart attack. Therefore, immediately after detection, the issue of treatment is decided.
Some congenital anomalies are classified as malformations very conditionally. For instance, open oval window ... In this case, usually nothing is done. Just from time to time, every year, the patient is observed.
Dangerous disorder. Its essence lies in the blockage of large vessels with blood clots. Heart echo is a method that allows you to see blood clots in the pulmonary artery, coronary vessels. Thanks to this, you can undergo treatment in a timely manner. The patient will remain alive.
Read more about the types of thromboembolism here , blockage of the pulmonary artery, possible risks and treatment methods are described here .
Ischemic heart disease in the form of angina pectoris
The classic situation: violation of trophism (nutrition) of the heart, its tissues. It is accompanied by severe chest pain, shortness of breath, nausea and other symptoms. It's not yet a heart attack, but it's not that far. One step remains.
Especially dangerous unstable angina ... It proceeds unpredictably, because no one can say in advance how the process will end during the next attack.
An echocardiogram gives a picture in which areas of dystrophy are clearly visible, and areas where blood flow is disturbed will be detected by echocardiography with Doppler analysis.
Symptoms of an attack of angina pectoris and methods of correcting the condition are described in this article .
The actual heart attack
Medical emergency. When it happens to a patient, there is little time for diagnosis. Usually, the fact is stated after the initial treatment.
The chances of recovery depend on how quickly therapy is started. By means of ECHO Kg, a focus of necrosis (death of cardiac structures) is noticeable. The smaller it is, the easier the treatment will be.
The consequence of a heart attack, inflammatory processes in cardiac structures. This is a condition in which certain areas of the myocardium are scarred.
Connective tissue of this kind cannot contract or stretch. Therefore, part of the organ falls out of work.
The condition is dangerous because it provokes a further aggravation of dystrophy and problems with the nutrition of the heart. Lifelong treatment needed. ECHOKG shows how the focus itself cardisclerosis and the degree of violation.
Strange as it may seem, neoplastic processes in the muscular organ are quite rare. However, they carry a huge danger.
There are two reasons:
- The first - even benign formations (for example myxoma ), reaching sizes of more than 1 cm, compress, squeeze the heart. Hence, the violation of the shape of the organ, dysfunction, malnutrition.
- Secondly if the tumor is malignant, it grows through the muscle tissue. So it destroys them. Compression is also present, the harm is double.
Urgent and surgical treatment.
Inflammatory process. Provocateur - pyogenic flora and other agents. As a rule, streptococci or staphylococci are to blame. Rare.
The accumulation of fluid in the pericardium stands apart - hydropericardium ... If the sac fills with effusion, blood, local pressure rises. As soon as the indicator equals that inside the chambers of the muscular organ, cardiac arrest will occur. Therefore, the condition is considered urgent.
Inflammatory disease of the heart itself. It is accompanied by severe pain. When scanning, foci of changes are noticeable. If not treated in time, there will come consequences like a heart attack ... Perhaps even harder.
A typical pathological process for those who are engaged in intense physical labor. For example, for athletes. The high-risk group includes alcoholics and heavy smokers.
The essence of the process is a change in the myocardium: the muscle layer grows, becomes prohibitively large, or stretches.
This is not normal and requires therapy. As a rule, medicinal. Plus lifestyle correction.
Read more about the types of cardimipathy and methods of treatment. in this article .
Various. From atrial fibrillation before paroxysmal tachycardia ... Echocardiography alone is unlikely to help. To identify functional disorders, an ECG is also required.
Changes in the anatomical position of the heart
For example, mirrored ( dextrocardia ). It can be a vice, or it can be natural and completely normal.
Approximately such diagnoses can be made or confirmed by the results of echography. In addition, other examinations are needed. ECG, stress tests, bicycle ergometry, monitoring, etc.
Indications and contraindications
Since the technique is universal, there are quite a few reasons for ECHO KG.
- Chest pains of unknown origin. The patient is not always right in assessing well-being. Discomfort is found in diseases of the stomach, intercostal neuralgia and other conditions. Pains are successfully masked. But it is imperative to check the position of the muscular organ.
Read about how to understand that it is the heart that hurts and to distinguish heart pain from another. here .
- Systematic rise in blood pressure. Hypertension doesn't happen out of the blue. Secondary forms are caused by kidney disease, hormonal dysfunction. And the primary ones just develop with pathologies of cardiac structures. Therefore, you need to check the culprit using an ultrasound technique.
- Heart rhythm disturbances. Organic changes can be detected by the ultrasonic method. Physicians do not always receive information. Therefore, an echocardioraphic study is supplemented with an ECG, often also with daily Holter monitoring ... When an automatic device reads blood pressure and the frequency of contractions of a muscle organ during the day.
- Visible symptoms of probable heart disease. For example, cyanosis of the nasolabial triangle. Pallor of fingers, etc. Including shortness of breath. That is, those manifestations that usually indicate the pathology of the muscular organ. In this case, the technique is used as a prophylactic one.
- Suspected tumors. Indirectly, the neoplastic process is indicated by the same symptoms as above. Shortness of breath, weakness, blue discoloration of the area around the mouth, pallor, rhythm disturbances. Ultrasound gives a rough idea of neoplasia. The exact same result can be obtained through MRI.
- Physical intolerance. Decreased tolerance. Accompanies angina pectoris, ischemic disease. An ultrasound scan is mandatory.
- Treatment. In this case, echocardiography is used in order to identify possible complications and side effects of therapy. Also as part of a routine examination.
- Already established diagnoses of a cardiological profile. To identify deterioration (examine the dynamics of the disorder).
- Evaluation of the effectiveness of treatment. Including surgical.
Who is contraindicated in the study?
There are a minimum of contraindications, but they still exist.
- Diseases of the lungs. Because it is difficult for patients with respiratory distress to lie still for 10-20 minutes.
- Deformation of the sternum. For example, a hump. In this case, there will be problems with visualization of the heart tissue.
- Inflammatory processes of the skin of the breast.
- Mental disorders. Excluding adequacy. For example, exacerbations of schizophrenia.
Contraindications are not absolute. Doctors are working out options to perform the manipulation.
Types of Echo KG and their differences
There are several types of cardiac ultrasound. Basically, the methods are subdivided according to the method of access to the muscular organ.
- Classic or transthoracic form, through the anterior wall of the sternum. This is the most common option. The gold standard for primary diagnostics. The ultrasound probe is placed on the chest, after which the doctor changes its position. To visualize tissues in different projections and from multiple angles.
- The second option is an ECHO study with contrast enhancement. In fact - all the same transthoracic ultrasound. But this time, special substances are injected intravenously. They accumulate in blood vessels, tissues and enhance the reflection of the ultrasonic wave. They make the picture clearer. In general, the method differs little from the previous one. From a technical point of view, everything is the same. But you can get much more information with contrast.
- Finally, transesophageal echocardiography. Invasive research. Due to the high complexity, it is carried out only in a hospital setting. Moreover, there may be problems, unforeseen frustration after. It is considered a particularly accurate way compared to others. The technique is resorted to if the previous modifications did not work.
Another way of classification is by the nature of the study.
- ECHO alone. It is especially common. This is a typical cardiography.
- Assessment of the state of the heart after exercise. Appointed in controversial situations.
No special events needed. Conventionally, you can name the following requirements:
- Do not smoke the day before the study. Otherwise, the vessels will narrow and the doctor will detect false changes. In the coronary, pulmonary arteries.
- The same goes for alcohol. You should give up alcohol a few days in advance. To make the results more accurate.
- On the day of the procedure, you must not engage in intense physical activity. It is necessary to observe a sparing regimen. Peace is desirable.
- You should approach the appointed time. It is recommended to take a towel or disposable napkins with you. To remove excess gel after echocardiography.
For the rest, no preparation is needed. You can do your daily routine.
The patient goes to the functional diagnostician's office. Further, the procedure is carried out according to the scenario familiar to many, like a regular ultrasound scan.
- You need to lie down on the couch.
- The doctor will lubricate the chest with a special gel. It conducts ultrasonic waves better, so the picture will be more accurate.
- The specialist applies the transducer and begins to study the anatomical area.
- During the procedure, the doctor changes the position of the scanner and examines the organ from different angles. Works in several modes. Do not be afraid of the strange sounds that the device emits. This is normal.
- During the scan, the specialist may ask you to hold your breath. Roll over on your side. It is the patient's job to follow the doctor's instructions, and once the procedure is complete, you can go home.
Other modifications are different. If a contrast study is prescribed, a standard ultrasound is performed first, then the contrast is injected and the procedure is repeated. Everything takes about 10-20 minutes. Plus or minus. A transesophageal ultrasound of the heart takes longer.
An echocardiogram is given to the patient in his hands, after another 10-20 minutes. As a specialist must give an opinion. Sometimes a person receives only a diagnostic protocol, without the doctor's explanations.
Decoding the results
Interpretation is the responsibility of the attending specialist. Cardiologist. It is extremely difficult to independently understand what's what. Special medical knowledge is needed. To an inexperienced person, the conclusion and protocol will seem like a Chinese letter.
Normal indicators for an adult are presented in the tables:
Left ventricle and atrium
|Myocardial mass||85-220 g||65-160 g|
|Volume at rest||165-195 ml||60-135 ml|
|Size during diastole||35-55 mm|
|Size during systole||25-35 mm|
|Left atrial size||25-35 mm|
|Rear wall thickness at rest||8-11 mm|
|Resting ventricular septum thickness||8-10 mm|
Right ventricle and atrium
|Rest size||75-110 mm|
|RV wall thickness||2-5 mm|
|Right atrial size||25-45 mm|
|Right ventricular size||20-30 mm|
|The thickness of the interventricular septum at the time of systole||10-15 mm|
|The thickness of the interventricular septum at the time of diastole||6-11 mm|
Blood flow rate
|Transmitral||0.5 - 1.5 ms|
|Transtricuspid||0.3 - 0.7 ms|
|Transpulmonary||0.6 - 0.9 ms|
|Transaortic||1 - 1.7 ms|
|Pericardial fluid rate||10-30 ml|
|Aortic root diameter||20-35 mm|
|Amplitude of aortic valve opening||15-25 mm|
Poles and cons of the diagnostic technique
The research has a lot of advantages:
- Simplicity. An ECHO device is available in almost any district clinic. Even in the regions, not to mention the capital and large cities.
- Security. The technique does not create harmful radiation exposure. The study can be carried out as often as required by the clinical case.
- High scanning speed. Everything takes about 10-20 minutes. Plus or minus.
- Informativeness. Despite the availability and simplicity of the technique, it is effective enough to detect most diseases.
- Non-invasive and painless. Apart from the transesophageal method. It still belongs to invasive. But nevertheless, well tolerated. And the procedure is rarely required.
- A minimum of contraindications. They are rather formal.
- Variability. Several scanning modes. For example, echocardiography with Doppler analysis is a method of examining not only the heart itself, but also the vessels of the local circulatory network.
There is only one minus - ECHO KG does not provide accurate information in many cases. We have to appoint ancillary measures. Can this be called a negative trait? Hardly. Since the technique copes with its tasks one hundred percent.
ECHO of the heart shows the state of the myocardium, the entire organ and the local circulatory network. The initial sections of the aorta, pulmonary artery. It is a versatile, safe and effective diagnostic technique.
awesome video. "Fundamentals of echocardiography" "Ultrasound of the heart" Faculty of Medicine, University of Virginia, Charlottesville, USA
Echocardiography (EchoCG) provides an opportunity to examine the heart, its chambers, valves, endocardium, etc. using ultrasound, i.e. is part of one of the most common methods of radiation diagnostics - ultrasonography.
Echocardiography has come a long way of development and improvement and has now become one of the digital technologies in which the analog response - the electric current induced in the ultrasound transducer - is converted into digital form. In a modern echocardiograph, a digital image is a matrix consisting of numbers collected in columns and rows (Smith H.-J., 1995). Moreover, each number corresponds to a certain parameter of the ultrasonic signal (for example, strength). To obtain an image, the digital matrix is converted into a matrix of visible elements - pixels, where each pixel is assigned a corresponding shade of gray scale in accordance with the value in the digital matrix. The translation of the obtained image into digital matrices allows it to be synchronized with the ECG and recorded on an optical disc for subsequent playback and analysis.
Echocardiography is a routine, simple and bloodless method for diagnosing heart disease based on the ability of ultrasound signals to penetrate and bounce off tissues. The reflected ultrasonic signal is then received by the transducer.
Ultrasound - this is a part of the sound spectrum above the hearing threshold of the human ear, waves with a frequency of over 20,000 Hz. Ultrasound is generated by a transducer that is placed on the patient's skin in the precordial region, in the second to fourth intercostal spaces to the left of the sternum, or at the apex of the heart. There may be other transducer positions (eg epigastric or suprasternal approaches).
The main component of an ultrasonic transducer is one or more piezoelectric crystals. The supply of electric current to the crystal leads to a change in its shape, on the contrary, its compression leads to the generation of an electric current in it. The supply of electrical signals to the piezoelectric crystal leads to a series of its mechanical vibrations, capable of generating ultrasonic
high waves. The hit of ultrasonic waves on a piezoelectric crystal leads to its oscillation and the appearance of an electric potential in it. Currently, ultrasonic sensors are being produced that can generate ultrasonic frequencies from 2.5 MHz to 10 MHz (1 MHz is equal to 1,000,000 Hz). Ultrasonic waves are generated by the sensor in a pulsed mode, i.e. an ultrasonic pulse of 0.001 s duration is emitted every second. The remaining 0.999 s the sensor works as a receiver of ultrasonic signals reflected from the structures of the heart tissue. The disadvantages of the method include the inability of ultrasound to pass through gaseous media, therefore, for a more intimate contact of the ultrasonic sensor with the skin, special gels are used that are applied to the skin and / or the sensor itself.
Currently, so-called phase and mechanical sensors are used for echocardiographic studies. The former consist of a plurality of piezoelectric crystal elements - from 32 to 128. Mechanical sensors consist of a rounded plastic reservoir filled with liquid, where there are rotating or rocking elements.
Modern ultrasound devices with programs for the diagnosis of cardiovascular diseases are able to give a clear image of the structures of the heart. The evolution of echocardiography has led to the current use of various echocardiographic techniques and modes: transthoracic echocardiography in B- and M-modes, transesophageal echocardiography, Doppler echocardiography in duplex scanning mode, color Doppler examination, tissue Doppler, use of contrast agents, etc.
Transthoracic (superficial, transthoracic) echocardiography - a routine ultrasound technique for examining the heart, in fact, the technique that is most often traditionally called EchoCG, in which the ultrasound transducer contacts the patient's skin and the main techniques of which will be presented below.
Echocardiography is a modern bloodless method that allows you to examine and measure structures of the heart using ultrasound.
When researching by the method transesophageal echocardiography
a miniature ultrasound probe is attached to a device resembling a gastroscope and is located in close proximity to the basal parts of the heart - in the esophagus. In conventional, transthoracic echocardiography, low-frequency ultrasound generators are used, which increases the depth of penetration of the signal, but reduces the resolution. The location of the ultrasonic sensor in close proximity to the biological object under study allows the use of a high frequency, which significantly increases the resolution. In addition, in this way, it is possible to examine the parts of the heart, which, during transthoracic access, are obscured from the ultrasound beam by dense material (for example, the left atrium - with a mechanical mitral valve prosthesis) from the “back” side, from the side of the basal parts of the heart. Both atria and their ears, the interatrial septum, pulmonary veins, and the descending aorta become the most accessible for examination. At the same time, the apex is less accessible for transesophageal echocardiography, so both methods should be used.
The indications for transesophageal echocardiography are.
1. Infective endocarditis - with low information content of transthoracic echocardiography, in all cases of endocarditis of an artificial heart valve, with endocarditis of the aortic valve to exclude paraaortic abscess.
2. Ischemic stroke, ischemic cerebral attack, cases of embolism in the organs of the large circle, especially in persons under 50 years of age.
3. Examination of the atria before the restoration of sinus rhythm, especially if there is a history of thromboembolism and contraindications to the appointment of anticoagulants.
4. Artificial heart valves (with an appropriate clinical picture).
5. Even with normal transthoracic echocardiography, to determine the degree and cause of mitral regurgitation, suspected endocarditis.
6. Valvular heart disease, to determine the type of surgical treatment.
7. Atrial septal defect. To determine the size and options for surgical treatment.
8. Diseases of the aorta. For the diagnosis of aortic dissection, intramural hematoma.
9. Intraoperative monitoring for monitoring the function of the left ventricle (LV) of the heart, detecting residual regurgitation at the end of valve-sparing cardiac surgery, excluding the presence of air in the LV cavity at the end of cardiac surgery.
10. Poor "ultrasound window", excluding transthoracic examination (should be an extremely rare indication).
Two-dimensional echocardiography (B-mode) according to the apt definition of H. Feigenbaum (H. Feigenbaum, 1994) - this is the "backbone" of ultrasound cardiological studies, because echocardiography in B-mode can be used as an independent study, and all other techniques, as a rule, are carried out against the background of a two-dimensional image, which serves as a guide for them.
Most often, echocardiographic examination is performed with the subject on the left side. The sensor is first located parasternally in the second or third intercostal space. From this access, first of all, an image of the heart along the long axis is obtained. During echolocation, the hearts of a healthy person are visualized (in the direction from the transducer to the dorsal surface of the body) first a motionless object - the tissues of the anterior chest wall, then the anterior wall of the right ventricle (RV), then -
Figure: 4.1. Echocardiographic image of the heart along the long axis from the parasternal position of the transducer and its diagram:
PGS - anterior chest wall; RV - right ventricle; LV - left ventricle; AO - aorta; LP - left atrium; IVS - interventricular septum; ЗС - posterior wall of the left ventricle
RV cavity, interventricular septum and aortic root with aortic valve, cavity of the LV and left atrium (LA) separated by the mitral valve, the posterior wall of the LV and left atrium (Fig. 4.1).
To obtain an image of the heart along the short axis, the sensor is rotated in the same position through 90 ° without changing its spatial orientation. Then, by changing the inclination of the sensor, the heart is sliced along the short axis at different levels (Fig. 4.2a-4.2d).
Figure: 4.2 a. Scheme of obtaining images of slices of the heart along the short axis at different levels:
AO - the level of the aortic valve; MKa - the level of the base of the anterior cusp of the mitral valve; MKB - the level of the ends of the mitral valve leaflets; PM - papillary muscle level; TOP - level of the apex behind the base of papillary mice
Figure: 4.2 b. Echocardiographic section of the heart along the short axis at the level of the aortic valve and its scheme: ACL, LCS, NCS - right coronary, left coronary and non-coronary aortic valve leaflets; RV - right ventricle; LP - left atrium; PP - right atrium; LA - pulmonary artery
Figure: 4.2 in. Echocardiographic section of the heart along the short axis at the level of the mitral valve leaflets and its scheme:
RV - right ventricle; LV - left ventricle; PSMK - anterior cusp of the mitral valve; ZSMK - posterior cusp of the mitral valve
Figure: 4.2 g Echocardiographic section of the heart along the short axis at the level of the papillary muscles and its diagram:
RV - right ventricle; LV - left ventricle; PM - papillary muscles of the left ventricle
To visualize both ventricles of the heart and atria simultaneously (four-chamber projection), an ultrasound probe is installed at the apex of the heart perpendicular to the long and sagittal body axes (Fig. 4.3).
A four-chamber image of the heart can also be obtained by positioning the transducer in the epigastrium. If the echocardiographic transducer, located at the apex of the heart, is rotated along its axis by 90 °, the right ventricle and right atrium are displaced behind the left parts of the heart, and thus a two-chamber image of the heart is obtained, in which the cavities of the LV and LA are visualized (Fig.4.4).
Figure: 4.3. Four-chamber echocardiographic image of the heart from the transducer position at the apex:
LV - left ventricle; RV - right ventricle; LP - left atrium; PP - right atrium
Figure: 4.4. Two-chamber echocardiographic image of the heart from the position of the sensor at its apex: LV - left ventricle; LP - left atrium
Various technical developments are used in modern ultrasound devices to improve the quality of visualization in the two-dimensional echocardiography mode. An example of such a technique is the so-called second harmonic. With the help of the second harmonic, the frequency of the reflected signal is doubled, and thus
distortions that inevitably arise when an ultrasonic pulse passes through tissues are compensated. This technique eliminates artifacts and significantly increases the contrast of the endocardium in B-mode, but at the same time, the resolution of the method decreases. In addition, when using the second harmonic, the valve leaflets and the interventricular septum may appear thickened.
Transthoracic 2D echocardiography allows real-time visualization of the heart and is a reference point for examining the heart in M-mode and ultrasound Doppler mode.
Ultrasound examination of the heart in M-mode - one of the first echocardiographic techniques, which was used even before the creation of devices with which you can get a two-dimensional image. Currently, sensors are being produced that can simultaneously work in B and M modes. To obtain the M-mode, the cursor, which reflects the passage of the ultrasound beam, is superimposed on a two-dimensional echocardiographic image (see Fig. 4.5-4.7). When working in M-mode, a graph of the movement of each point of a biological object through which the ultrasonic beam passes is obtained. Thus, if the cursor passes at the level of the aortic root (Fig.4.5), then first receive an echo response in the form of a straight line from the anterior chest wall, then a wavy line reflecting the movements of the anterior wall of the pancreas of the heart, followed by the movement of the anterior wall of the aortic root, behind which thin lines are visible, reflecting the movements of the leaflets (most often two) of the aortic valve, the movement of the posterior wall of the aortic root, behind which the LA cavity is located, and, finally, the M-echo of the posterior wall of the LA.
When the cursor passes at the level of the mitral valve leaflets (see Fig. 4.6) (with sinus rhythm of the patient's heart), echo signals are received from them in the form of an M-shaped movement of the anterior leaflet and a W-shaped movement of the posterior leaflet of the mitral valve. Such a schedule of movement of the mitral valve leaflets is created, because in diastole, first in the rapid filling phase, when the pressure in the left atrium begins to exceed the filling pressure in the LV, blood flows into the cavity and the leaflets open. Then, around mid-diastole, the pressure between
Fig. 4.5. Simultaneous recording of a two-dimensional echocardiographic image of the heart and M-mode at the level of the aortic root:
PGS - anterior chest wall; RV - right ventricle; AO - lumen of the aortic root; LP - left atrium
Fig. 4.6. Simultaneous recording of a two-dimensional echocardiographic image of the heart and M-mode at the level of the ends of the mitral valve leaflets:
PSMK - anterior cusp of the mitral valve; ZSMK - posterior cusp of the mitral valve
the atrium and ventricle are aligned, blood movement slows down and the leaflets approach each other (diastolic closure of the leaflets of the mitral valve during diastasis). Finally, atrial systole follows, due to which the valves open again and then close with the onset of LV systole. The cusps of the tricuspid valve work in a similar way.
To obtain an echocardiographic image of the interventricular septum and the posterior wall of the left ventricle of the heart in M-mode, the echocardiographic cursor on a two-dimensional image is positioned approximately in the middle of the mitral valve chords (see Fig. 4.7). In this case, after imaging the immobile anterior chest wall, an M-echo of the movement of the anterior wall of the pancreas of the heart is visualized, then - the interventricular septum and then the posterior wall of the LV. In the LV cavity, echoes from the moving chords of the mitral valve can be seen.
Fig. 4.7. Simultaneous recording of a two-dimensional echocardiographic image of the heart and M-mode at the level of the mitral valve chords. An example of measuring the end diastolic (EDD) and end systolic (ESR) sizes of the left ventricle of the heart.
PGS - anterior chest wall; RV - right ventricular cavity;
IVS - interventricular septum; ZSLZH - back wall of the left
ventricle; LV - left ventricular cavity
The meaning of ultrasound examination of the heart in M-mode is that it is in this mode that the most subtle movements of the walls of the heart and its valves are revealed. Recent achievement has become the so-called physiological M-mode, in which the cursor is able to rotate around the central point and move, as a result of which it is possible to quantify the degree of thickening of any segment of the left ventricle of the heart (Fig. 4.8).
Fig. 4.8. Echocardiographic section of the heart along the short axis at the level of papillary muscles and study of local contractility of the tenth (lower intermediate) and eleventh (anterior intermediate) segments using the physiological M-mode
When visualizing the heart in M-mode, a graphic image of the movement of each point of its structures, through which the ultrasound beam passes, is obtained. This makes it possible to evaluate the delicate movements of the valves and walls of the heart, as well as to calculate the main parameters of hemodynamics.
The usual M-mode allows a fairly accurate measurement of the linear dimensions of the left ventricle in systole and diastole (see Fig. 4.7) and the calculation of hemodynamic parameters and systolic function of the left ventricle of the heart.
In everyday practice, to determine cardiac output, LV volumes of the heart are often calculated in the M-mode of echocardiographic examination. For this purpose, the formula of L. Teicholtz (1972) is included in the program of most ultrasonic devices:
where V is the end systolic (ESR) or end diastolic (EDV) volumes of the left ventricle of the heart, and D is its end systolic (ESR) or end diastolic (EDD) dimensions (see Fig. 4.7). Stroke volume in ml (SV) is then calculated by subtracting the LV end-systolic volume from the end-diastolic volume:
The measurements of LV volumes of the heart and calculation of the stroke and cardiac output using the M-mode cannot take into account the state of its apical region. Therefore, the program of modern echocardiographs includes the so-called Simpson method, which allows calculating the volumetric indicators of the LV in B-mode. For this, the LV of the heart is divided into several sections in four-chambered and two-chambered positions from the apex of the heart (Fig.4.9), and its volumes (EDV and CSV) can be considered as the sum of the volumes of cylinders or truncated cones, each of which is calculated according to the corresponding formula. Modern equipment makes it possible to break the LV cavity into 5-20 such slices.
Figure: 4.9. Measurement of the volume of the left ventricle of the heart in B-mode. The top two images are four-chamber projection, diastole and systole, the two bottom images are two-chamber projection, diastole and systole
It is believed that Simpson's method makes it possible to more accurately determine its volumetric indicators, since during the study, the region of its apex is included in the calculation, the contractility of which is not taken into account when determining the volumes by the Teikholz method. The minute volume of the heart (MO) is calculated by multiplying the SV by the number of heartbeats, and by correlating these values with the body surface area, the stroke and heart indices (SI and SI) are obtained.
The following values are most often used as indicators of the contractility of the left ventricle of the heart:
the degree of shortening of its anteroposterior dimension dS:
dS = ((KDR - DAC) / KDR)? one hundred%,
speed of circular shortening of myocardial fibers V cf:
Vcf = (KDR - KSR) / (KDR? Dt)? from -one ,
where dt is the time of contraction (expulsion period) of the left ventricle,
ejection fraction (FI) of the left ventricle of the heart:
FI = (UO / KDO)? one hundred%.
Doppler echocardiography is another ultrasound technique, without which it is impossible to imagine heart studies today. Doppler echocardiography is a method of measuring the speed and direction of blood flow in the cavities of the heart and blood vessels. The method is based on the effect of C.J. Doppler, described by him in 1842 (C.J. Doppler, 1842). The essence of the effect is that if the sound source is stationary, then the wavelength generated by it and its frequency remain constant. If the source of sound (and any other waves) moves in the direction of the sensing device or the human ear, then the wavelength decreases, and its frequency increases. If the sound source moves away from the receiving device, then the wavelength increases and its frequency decreases. A classic example is the whistle of a moving train or an ambulance siren - when they approach a person, it seems that the pitch, i.e. the frequency of its wave increases, if it moves away, then the pitch and its hour
tota are decreasing. This phenomenon is used to determine the speed of movement of objects using ultrasound. If it is necessary to measure the rate of blood flow, the object of the study should be a corpuscular element of blood - an erythrocyte. However, the erythrocyte itself does not emit any waves. Therefore, the ultrasonic sensor generates waves that are reflected from the red blood cell and are received by the receiving device. The Doppler frequency shift is the difference between the frequency reflected from a moving object and the frequency of the wave emitted from the generating device. Based on this, the speed of an object (in our case, an erythrocyte) will be measured using the equation:
where V is the speed of movement of the object (erythrocyte), f dis the difference between the generated and reflected ultrasonic frequencies, C is the speed of sound, f tis the frequency of the generated ultrasonic signal, cos θ is the cosine of the angle between the direction of the ultrasonic beam and the direction of movement of the object under study. Since the cosine of the angle from 20 ° to 0 degrees is close to 1, in this case its value can be neglected. If the direction of movement of the object is perpendicular to the direction of the emitted ultrasonic beam, and the cosine of the 90 ° angle is 0, such an equation cannot be calculated and, therefore, it is impossible to determine the speed of the object. For correct determination of blood velocity, the direction of the long axis of the sensor must correspond to the direction of its flow.
Echocardiography is the simplest, most accessible and convenient method for assessing the most important indicators of cardiac contractility (primarily the ejection fraction of the LV) and hemodynamic parameters (stroke volume and index, cardiac output and index). It is a method for diagnosing valvular pathology, dilatation of cardiac cavities, local and / or diffuse hypokinesis, calcification of heart structures, thrombosis and aneurysms, and the presence of fluid in the pericardial cavity.
Basic Doppler EchoCG techniques, allowing to conduct research using modern ultrasonic devices,
are various options for combining an ultrasonic wave generator and receiver and displaying the flow velocity and direction on the screen. Currently, the echocardiograph provides the ability to use at least three options for the ultrasound Doppler mode: the so-called constant-wave, pulse-wave and color Doppler. All these types of Doppler echocardiography are carried out using a two-dimensional image of the heart in the B-scan mode, which serves as a guide for the correct positioning of the cursor of one or another Doppler.
Continuous wave Doppler echo technique is a method for determining the speed of blood movement using two devices: a generator that continuously produces ultrasonic waves with a constant frequency, and also a continuously operating receiver. In modern equipment, both devices are combined into one sensor. With this approach, all objects falling into the zone of the ultrasonic beam, for example erythrocytes, send a reflected signal to the receiving device, and as a result, the information is the sum of the velocities and directions of all blood particles that fall into the zone of the beam. At the same time, the range of measurements of the speed of movement is quite high (up to 6 m / s and more), however, it is not possible to determine the localization of the maximum speed in the flow, the beginning and end of the flow, its direction. This amount of information is insufficient for cardiac studies, where it is required to determine the parameters of blood flow in a specific area of the heart. The solution to the problem was the creation of a methodology pulse-wave doppler.
With pulse wave Doppler echocardiography, in contrast to the constant-wave mode, the same sensor generates and receives ultrasound, similar to that used for echocardiography: an ultrasound signal (pulse) with a duration of 0.001 s is produced by it once a second, and the remaining 0.999 s the same sensor works as an ultrasound receiver signal. As in the case of constant-wave Doppler sonography, the speed of a moving stream is determined by the difference in the frequencies of the generated and received reflected ultrasonic signal. However, the use of an impulse sensor made it possible to measure the speed of blood movement in a given volume. The use of intermittent ultrasonic flow, in addition, made it possible to use the same transducer for Doppler sonography as for EchoCG. In this case, the cursor on which there is a label is limited
The so-called control volume, in which the velocity and direction of blood flow are measured, is displayed on a two-dimensional image of the heart obtained in B-mode. However, pulsed Doppler echocardiography has limitations associated with the emergence of a new parameter - the pulsed repetition frequency (PRF). It turned out that such a sensor is capable of determining the speed of objects, which creates a difference between the generated and reflected frequencies not exceeding 1/ 2 PRF. This maximum level of perceived frequencies of a pulsed Doppler echocardiographic transducer is called the Nyquist number (the Nyquist number is 1/ 2 PRF). If there are particles in the blood flow under study that move with a speed that creates a frequency shift (difference) exceeding the Nyquist point, then it is impossible to determine their speed using pulsed Doppler sonography.
Color Doppler Scan - a type of Doppler study, in which the speed and direction of the flow is coded in a certain color (most often towards the sensor - red, from the sensor - blue). The color image of intracardiac flows is essentially a variant of the pulse-wave mode, when not one control volume is used, but a multitude (250-500), which form the so-called raster. If the blood flows in the area occupied by the raster are laminar and do not go beyond the Nyquist point in speed, then they are colored blue or red depending on their direction with respect to the sensor. If the flow velocities go beyond these limits, and / or the flow becomes turbulent, then mosaic, yellow and green colors appear in the raster.
The objectives of color Doppler scanning are to detect regurgitation on valves and intracardiac shunts, as well as to semi-quantitatively assess the degree of regurgitation.
Tissue Doppler encodes in the form of a color map the speed and direction of movement of the structures of the heart. The Doppler signal reflected from the myocardium, leaflets and fibrous rings of valves, etc., has a much lower velocity and greater amplitude than that received from particles in the bloodstream. With this technique, the velocities and amplitudes of the signal characteristic of the blood flow are cut off using filters, and two-dimensional images or M-mode are obtained, in which the direction and speed of movement of any part of the myocardium or fibrous rings of the atriovenous are determined using color.
tricular valves. The method is used to detect contraction asynchrony (for example, with the Wolff-Parkinson-White phenomenon), study the amplitude and rate of contraction and relaxation of the LV walls to identify regional dysfunctions that arise, for example, during ischemia, incl. in a stress test with dobutamine.
In Doppler echocardiographic studies, all types of Doppler sensors are used: first, the speed and direction of blood flows in the heart chambers are determined using a pulsed and / or color Doppler, then, if a high flow rate is detected that exceeds its capabilities, it is measured using a constant wave.
Intracardiac blood flows have their own characteristics in different chambers of the heart and on the valves. In a healthy heart, they almost always represent variants of the laminar movement of blood corpuscles. With laminar flow, almost all blood layers move in the vessel or cavity of the ventricles or atria at approximately the same speed and in the same direction. Turbulent flow implies the presence of vortices in it, leading to multidirectional movement of its layers and blood particles. Turbulence is usually created in places where there is a drop in blood pressure - for example, with valve stenosis, with valve failure, in shunts.
Fig. 4.10. Doppler echocardiography of the aortic root of a healthy person in a pulse-wave mode. Explanation in the text
On the picture 4.10 demonstrates a Doppler study in a pulsed-wave mode of blood flow in the aortic root of a healthy person. The control volume of the Doppler cursor is at the level of the aortic valve cusps, the cursor is positioned parallel to the long axis of the aorta. The Doppler image is presented as a spectrum of velocities directed downward from the zero line, which corresponds to the direction of blood flow away from the sensor located at the apex of the heart. The release of blood into the aorta occurs in the LV systole of the heart, its beginning coincides with the S wave, and the end - with the end of the T wave of a synchronously recorded ECG.
The spectrum of blood flow velocities in the aorta in its outlines resembles a triangle with a peak (maximum velocity) slightly shifted towards the beginning of systole. In the pulmonary artery (PA), the peak of blood flow is located almost in the middle of the pancreatic systole. Most of the spectrum is occupied by the clearly visible in Fig. 4.10 the so-called dark spot, reflecting the presence of the laminar nature of the central part of the blood flow in the aorta, and only along the edges of the spectrum there is turbulence.
For comparison, Fig. 4.11 an example of a Doppler echocardiogram in a pulse-wave mode of blood flow through a normally functioning mechanical aortic valve prosthesis is presented.
Fig. 4.11. Doppler echocardiography in a pulse-wave mode of a patient with a normally functioning mechanical aortic valve prosthesis. Explanation in the text
There is always a small pressure drop on prosthetic valves, which causes moderate acceleration and turbulence in the blood flow. Figure 4.11 clearly shows that the control volume of the Doppler, as well as in Fig. 4.10, installed at the level of the aortic valve (in this case, artificial). It is clearly seen that the maximum (peak) blood flow rate in the aorta in this patient is much higher, and the "dark spot" is much less, turbulent blood flow prevails. In addition, the Doppler spectrum of velocities above the isoline is clearly distinguishable - this is a retrograde flow towards the apex of the LV, which is a slight regurgitation, which is usually found on artificial heart valves.
The blood flow on the atrioventricular valves is completely different. Figure 4.12 shows the Doppler spectrum of blood flow velocities on the mitral valve.
Fig. 4.12. Doppler echocardiography of the transmitral blood flow of a healthy person in a pulse-wave mode. Explanation in the text
In this case, the control volume mark is set slightly above the closing point of the mitral valve leaflets. The flux is represented by a two-peak spectrum directed above the zero line towards the sensor. The flow is predominantly laminar. The shape of the velocity spectrum of the flow resembles the movement of the anterior cusp of the mitral valve in the M-mode, which is explained by the same processes:
the first peak in flow, called peak E, is the flow of blood through the mitral valve during the rapid filling phase, the second peak, peak A, is blood flow during atrial systole. Normally, peak E is greater than peak A; in diastolic dysfunction due to impaired active relaxation of the LV, increased rigidity, etc., the E / A ratio at some stage becomes less than 1. This sign is widely used to study the diastolic function of the left ventricle of the heart. The blood flow through the right atrioventricular opening has a similar shape to the transmitral one.
The flow velocity can be calculated from laminar flow. For this, the so-called integral of the linear blood flow velocity for one cardiac cycle is calculated, which is the area occupied by the Doppler spectrum of the linear flow velocities. Since the shape of the spectrum of flow velocities in the aorta is close to triangular, its area can be considered equal to the product of the peak velocity and the period of expulsion of blood from the LV, divided by two. In modern ultrasonic devices there is a device (joystick or trackball) that makes it possible to trace the speed spectrum, after which its area is calculated automatically. Determination of the shock ejection of blood into the aorta using a pulse-wave Doppler is important, because the magnitude of the stroke volume measured in this way is less dependent on the magnitude of mitral and aortic regurgitation.
To calculate the volumetric blood flow velocity, the integral of its linear velocity should be multiplied by the cross-sectional area of the anatomical formation in which it is measured. The most reasonable is the calculation of the SV of the blood by the blood flow in the outflow tract of the left ventricle of the heart, since it has been shown that the diameter and, consequently, the area of the LV outflow tract during systole changes little. In modern ultrasound diagnostic systems, it is possible to accurately determine the diameter of the outflow tract from the LV in the B- or M-mode (either at the level of the fibrous ring of the aortic valve, or from the place of transition of the membranous part of the interventricular septum to the base of the anterior cusp of the mitral valve) with its subsequent introduction into the formula in the program for calculating shock ejection by ultrasonic doppler:
UO =? S ml,
where is the integral of the linear velocity of blood ejection into the aorta in one cardiac cycle in cm / s, S is the area of the outflow tract of the left ventricle of the heart.
With the help of pulse-wave Doppler echocardiography, valvular stenosis and valve insufficiency are diagnosed, and the degree of valve insufficiency can be determined. To calculate the pressure drop (gradient) across a stenotic valve, it is most often necessary to use a constant-wave Doppler. This is due to the fact that very high blood flow velocities occur at the stenotic holes, which are too high for a pulse-wave sensor.
The pressure gradient is calculated using a simplified Bernoulli equation:
dP = 4V 2,
where dP is the pressure gradient across the stenotic valve in mm Hg, Y is the linear flow rate in cm / s distal to the stenosis. If the peak linear velocity value is entered into the formula, the peak (largest) pressure gradient is calculated if the linear velocity integral is the average. Doppler echocardiography also makes it possible to determine the area of the stenotic opening.
Fig. 4.13. Doppler echocardiography of blood flow in the left ventricle in color scanning mode. Explanation in the text
If a turbulent flow and / or high-velocity flows appear in the raster area, this is manifested by the appearance of uneven mosaic coloration of the flow. Colored Doppler echocardiography provides an excellent indication of the flow within the chambers and the degree of valvular insufficiency.
Figure 4.13 (and also see the insert) shows a color scan of flows in the left ventricle of the heart.
The blue color of the flow reflects movement from the sensor, i.e. ejection of blood into the aorta from the LV. In the second photo shown in Fig. 4.13, the blood flow in the raster is colored red, therefore, the blood moves towards the sensor, to the apex of the LV - this is the normal transmitral flow. It is clearly seen that the flows are laminar almost everywhere.
Figure 4.14 (and also see the insert) shows two examples of determining the degree of insufficiency of atrioventricular valves using color Doppler scanning.
On the left side of Fig. 4.14 shows an example of a color Doppler echocardiogram of a patient with mitral regurgitation. It can be seen that the color Doppler raster is installed on the mitral valve and above the left atrium. A stream of blood is clearly visible, encoded in a color Doppler scan in the form of a mosaic pattern. This indicates the presence of high velocities and turbulence in the regurgitation flow. On the right in Fig. 4.14 shows a picture of tricuspid valve insufficiency, revealed by color Doppler scanning, mosaicism of the color signal is clearly visible.
Fig. 4.14. Determination of the degree of regurgitation on the atrioventricular valves using color Doppler echocardiography. Explanation in the text
Currently, there are several options for determining the degree of valvular insufficiency. The simplest of these is to measure the length of the regurgitation stream relative to anatomical landmarks. So, the degree of insufficiency of atrioventricular valves can be determined as follows: the stream ends immediately behind the valve cusps (mitral or tricuspid) - I degree, extends 2 cm below the cusps - II degree, to the middle of the atrium - III degree, to the entire atrium - IV degree. The degree of insufficiency of the aortic valve can be calculated in the same way: the stream of regurgitation reaches the middle of the leaflets of the mitral valve - I degree, the stream of aortic regurgitation reaches the end of the leaflets of the mitral valve -
II degree, the stream of regurgitation reaches the papillary muscles -
III degree, the jet extends to the entire ventricle - IV degree of aortic insufficiency.
These are the most primitive, but widely used in practice, methods of calculating the degree of valvular insufficiency. The stream of regurgitation, being sufficiently long, can be thin and, therefore, hemodynamically insignificant, can deviate in the heart chamber to the side and, being hemodynamically significant, not reach the anatomical structures that determine its severe degree. Therefore, there are many other options for assessing the severity of valvular insufficiency.
Ultrasonic research techniques (ultrasound) of the heart are constantly being improved. Transesophageal echocardiography, which was mentioned above, is becoming more widespread. An even smaller sensor is used for intravascular ultrasound. At the same time, apparently, intracoronary determination of the consistency of an atherosclerotic plaque, its area, the severity of calcification, etc. are the only lifetime method of assessing her condition. Methods for obtaining a three-dimensional image of the heart using ultrasound have been developed.
The ability of ultrasonic Doppler to determine the speed and direction of flows in the cavities of the heart and in large vessels made it possible to apply physical formulas and calculate with acceptable accuracy the volumetric parameters of blood flow and pressure drops at the sites of stenosis, as well as the degree of valve insufficiency.
It is becoming a daily practice to use stress tests with simultaneous visualization of heart structures using ultrasound. Stress echocardiography used mainly for the diagnosis of coronary heart disease. The method is based on the fact that in response to ischemia, the myocardium responds with a decrease in contractility and impaired relaxation of the affected area, which occur earlier than changes in the electrocardiogram. The most commonly used loading agent is dobutamine, which increases myocardial oxygen demand. At the same time, at low doses of dobutamine, myocardial contractility increases and its hibernated areas (if any) begin to contract. This is the basis for the identification of zones of viable myocardium using dobutamine stress echocardiography in B-mode. Indications for stress echocardiography with dobutamine are: clinically unclear cases with uninformative electrocardiographic stress test, impossibility of exercise test due to damage to the patient's locomotor apparatus, ECG changes that exclude the diagnosis of transient ischemia (blockade of the left branches of the His bundle, Wolf syndrome -Parkinson-White, ST segment displacement due to severe left ventricular hypertrophy), risk stratification in patients with myocardial infarction, localization of the ischemic basin, identification of viable myocardium, determination of the hemodynamic significance of aortic stenosis with low LV contractility, detection of the appearance or aggravation of mitral regurgitation under stress.
Stress tests with simultaneous visualization of heart structures using ultrasound are becoming common. Stress echocardiography is used primarily to diagnose coronary artery disease. Most often, intravenous dobutamine is used as a loading agent, which increases the oxygen demand of the myocardium, which, in the presence of stenosis of the coronary arteries, causes its ischemia. The myocardial ischemia responds by a decrease in local contractility in the area of the stenotic vessel, which is detected using echocardiography.
Guide to Cardiology: Textbook in 3 volumes / Ed. G.I. Storozhakova, A.A. Gorbachenkov. - 2008 .-- T. 1. - 672 p. : ill.
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Cardiovascular pathology Are serious diseases that often require urgent treatment and timely diagnosis. Therefore, in cardiology, methods such as ultrasound of the heart, echocardiography or electrocardiogram are used.
Each technique has its own subtleties and nuances. For example, an ultrasound of the heart allows you to see the structure of an organ in a two-dimensional image, and with an ECG, you can see the frequency and amplitude of heart contractions.
How is the ECG performed?
Often, during the initial examination, an ECG is assigned to the patient along with clinical analyzes. In general, ECG and EchoCG help to identify the slightest irregularities in the work of the heart, which can occur in the presence of arrhythmias, tachycardia, brachycardia, changes in heart rate. What does the ECG show?
Automatism of heart contraction, starting from passing impulses and ending with the contraction of the heart muscle;
Impulse transmission to the myocardium;
Excitation, which consists in the response of the myocardium to an artificially provoked impulse;
Contraction of the heart muscles;
The tonicity of the heart during the period of muscle contraction.
Electrocardiography usually does not take long. How is the ECG performed? The patient is exposed to the waist and special high-precision sensors are attached to the heart area. The sensors are also attached to the arms and legs. The device turns on and its readings are recorded on the tape. The resulting curved line is then deciphered by the attending physician.
This analysis can detect abnormalities in the heart rhythm, such as arrhythmias or tachycardias. You can also detect impulse disturbances, detect signs of coronary heart disease, or diagnose myocardial infarction.
Features of the EchoCG
How is echocardiography performed? The echo that occurs during the work of the heart can show if there are anatomical defects in the organ. Often, deviations occur with heart defects, myocardial infarction, cardiomyopathies of various origins, and ischemic heart disease.
Violation of echogenicity may indicate the presence of thrombosis in the vessels, benign and malignant tumors of the cardiac system, aneurysm, infectious pathologies such as pericarditis, endocarditis and myocarditis.
How is echocardiography performed? When examining the skin in the area of the heart, the physician applies a special gel. After that, a sensor is used, which is held over this area. The readings from the sensor are transmitted to a specialized monitor, which projects the detected changes in the heart.
When studying pathology on the basis of analysis, the doctor uses a special attachment in his work, which is connected to the echo apparatus. After completing the diagnostic procedures, a clinical diagnostician gives an opinion, with which you can go for a consultation with a cardiologist.
It is worth saying that in cardiological diagnostics, ECG and EchoCG are not prescribed separately, but are used in combination, which in turn allows you to get a more accurate and reliable clinical picture of the disease.
Ultrasound examination of the heart
An ultrasound examination of the heart helps to understand whether there are morphological changes in the organ and surrounding tissues. This is a simple, effective and painless way to help you understand if the patient has any pathology.
Ultrasound detects both primary and secondary pathologies of the cardiovascular system. Usually cardiologists use it to monitor the patient's condition after surgery.
The procedure is simple. The patient undresses to the waist and the doctor making the diagnosis applies a special gel to the heart area. The sensor is pressed against the heart and an ultrasonic pulse is sent, with the help of which a two-dimensional image of the organ and surrounding tissues is produced on the computer screen. What is assessed using ultrasound?
Morphological structure of blood vessels and the organ itself;
The condition of the heart valves and leaflets;
Uniformity and echogenicity;
The presence of mitral valve prolapse;
Regurgitation or reverse blood flow;
The thickness of the walls of the heart;
Physiological condition of the aorta and large vessels surrounding the heart;
The presence of plaques arising against the background of atherosclerosis;
Benign and malignant neoplasms.
Can ultrasound replace ECG or Echocardiography? It is worth saying that all these methods show different sides of the cardiovascular system. The ECG allows you to assess the rhythm and heart rate, and ultrasound more accurately reveals morphological structural changes. After carrying out all the diagnostic measures, the cardiologist can prescribe therapeutic or surgical treatment, depending on the pathology identified.
This article is for informational purposes only, please consult your doctor for details! Ask your doctor about contraindications and side effects.
Today, one of the main methods for diagnosing heart disease is echocardiography (EchoCG). This is a non-invasive study that does not have a negative effect on the body, and therefore can be performed on patients of all age categories, including children from birth.
This article will discuss what echocardiography is, why it is performed, what types of this procedure exist, what may become a contraindication to its implementation and how it is necessary to prepare for it.
The essence and purpose of echocardiography
Echocardiography or echocardiography is a non-invasive examination of the heart using ultrasound. The echocardiograph transducer emits a special high-frequency sound that passes through the heart tissue, is reflected from them, and then is recorded by the same transducer. The information is transmitted to the computer, which processes the received data and displays them on the monitor in the form of an image.
Echocardiography is considered a highly informative research method, since it makes it possible to assess the morphological and functional state of the heart. Using this procedure, it is possible to determine the size of the heart and the thickness of the myocardium, check their integrity and structure, determine the size of the cavities of the ventricles and atria, find out whether the contractility of the heart muscle is normal, learn about the state of the heart valve apparatus, examine the aorta and pulmonary artery. Also, this procedure allows you to check the level of pressure in the structures of the heart, to find out the direction and speed of blood movement in the heart chambers and to find out the state of the outer shell of the heart muscle.
This cardiological examination allows diagnosing both congenital and acquired heart defects, finding out about the presence of free fluid in the heart bag, detecting blood clots, changes in the size of chambers, thickening or thinning of their walls, detecting tumors and any disturbances in the direction and speed of blood flow.
Echocardiography has a number of advantages over other types of cardiac examination.
First of all, it is an absolutely painless and non-invasive procedure that does not cause any discomfort in the patient. It is performed as a normal ultrasound scan. No injections or any other similar manipulations are performed before the procedure.
In addition, the procedure is completely safe for patients of any age group. It can be carried out for children, adolescents, and pregnant women, since ultrasound does not have any negative effect on the fetus.
Echocardiography is notable for its availability, since the equipment for its conduct is present in almost any medical institution. The cost of echocardiography is much lower compared to MRI.
And the most important advantage of this type of examination is excellent informational content, which will allow the doctor to obtain the maximum necessary information and choose the right therapy.
Indications and contraindications for echocardiography
Echocardiography can be recommended for patients both if the doctor suspects they have any cardiovascular pathology, and during therapy, in order to evaluate the effectiveness of the drugs used.
The indications for echocardiography are:
- Suspicion of the presence of congenital or acquired heart disease, including with a hereditary predisposition to this disease.
- Frequent dizziness, fainting, shortness of breath and swelling.
- Complaints about the "sinking" heart, about "interruptions" in its work.
- Pain behind the sternum, especially if they radiate to the area of the left shoulder blade or the left half of the neck.
- Myocardial infarction, diagnosis of angina pectoris and cardiomyopathy, suspected heart tumor.
- Preventive examination of patients who often experience emotional and physical stress.
- Changes in the ECG and chest x-ray, requiring clarification of the morphological changes in the heart.
Separately, it is worth mentioning in which cases echocardiography is recommended for expectant mothers. Echocardiography for pregnant women should be performed if:
- The expectant mother has pain in the precordial region.
- The patient has congenital or acquired heart defects.
- Weight gain has ceased or there has been a sharp weight loss.
- There were unmotivated edema of the lower extremities and shortness of breath with a slight load of antiepileptic nature.
- Violation of hemodynamics during pregnancy.
It should be noted that there are practically no absolute contraindications to echocardiography. At the same time, certain types of this research are not recommended in certain situations, which will be discussed below.
Types of echocardiography
Today there are several types of echocardiography. What kind of research to carry out, in each case, the cardiologist decides.
At the moment, this type of echocardiography is rarely used alone, because it is considered less informative than others. No image of the heart is generated during the procedure. The data is displayed on the screen in the form of a graph. With the help of M-echocardiography, the doctor can volume the cavities of the heart and assess their functional activity.
During B-echocardiography, data from all structures of the heart are fed into a computer and displayed on a monitor in the form of a black and white image. The doctor is able to determine the size of the heart, find out the volume of each of its chambers, the thickness of the walls, assess the mobility of the valve cusps and how the ventricles contract.
As a rule, this study is carried out simultaneously with B-echocardiography. It allows you to track blood flow in large vessels, and on the valves of the heart, to identify reverse blood flow and its degree, which may indicate the formation of pathological processes.
This study makes it possible to more clearly visualize the internal structures of the heart. The patient is injected intravenously with a special contrast agent, after which the procedure is carried out as usual. This procedure allows you to examine the inner surface of the heart chambers. Contraindication for this study is individual contrast intolerance and chronic renal failure.
To diagnose hidden pathologies of the heart, which appear exclusively during physical exertion, a special type of study is used - stress echocardiography. It makes it possible to identify diseases in the early stages that do not remind of themselves if the patient is at rest. Stress echocardiography is recommended to assess the state of the vessels and their patency, to find out how high the risk of complications is before performing surgical interventions on the heart and blood vessels. ... Also, the procedure is performed in order to determine how effective the therapy of coronary heart disease is and to determine the further prognosis for this disease.
There are several contraindications to stress echocardiography. It should not be performed on patients suffering from respiratory, renal, hepatic or severe heart failure. It is also contraindicated in myocardial infarction, aortic aneurysm and a history of thromboembolism.
This is a special type of examination, during which the ultrasound-generating transducer is lowered through the oropharynx through the esophagus to the required depth. Since the transducer is very small, it passes through the esophagus without problems. However, such research is considered quite complex and is carried out exclusively in specialized medical centers. In addition, there are special indications for him. In particular, a transesophageal study is performed when a standard transthoracic study does not allow assessing the state of the heart and its structures. In particular, when doubts arise about the correct functioning of a previously prosthetic heart valve, if there is a suspicion of aortic aneurysm and atrial septal defect, as well as if the patient has been diagnosed with endocarditis of an infectious nature and the doctor suspects an aortic root abscess.
At the same time, this type of study has contraindications from the upper part of the digestive tract, namely, with any tumor formations of the esophagus, bleeding from the upper parts of the gastrointestinal tract, the presence of a large diaphragmatic hernia or enlargement of the veins of the esophagus. A transesophageal examination should not be carried out in patients with severe osteochondrosis of the cervical spine, with instability of the cervical vertebrae, or a history of esophageal perforation. Diagnostics can be complicated in patients with thyroid diseases.
Echo KG preparation
As a rule, when performing one- and two-dimensional echocardiography, as well as Doppler echocardiography, there is no need for any special preparation. In the event that a transesophageal study is prescribed, there are a number of limitations.
So, the last meal should be no later than six hours before the procedure. Drinking is also not recommended. Immediately before carrying out the manipulation, the dentures should be removed.
On the eve of a transesophageal study, persons with a labile nervous system are advised to take a mild sedative. After the procedure, the patient will need some time to recover, so you should not overload yourself with work until the end of the day. You should also refrain from driving.
For transthoracic echocardiography, the patient is positioned on the left side. When a person lies in this position, there is a convergence of the apex of the heart and the left side of the chest. This makes it possible to provide the most accurate visualization of the heart - as a result, all four of its chambers are visible on the monitor at once.
The doctor applies a gel to the sensor, which improves the contact of the electrode with the body. After that, the sensor is alternately installed first in the jugular fossa, then in the zone of the fifth intercostal space, where the apical impulse of the heart can be monitored as clearly as possible, and then under the xiphoid process.
Of course, every doctor strives to ensure that the research results are as accurate as possible. It should be noted that how informative the procedure will be depends on three main factors.
First of all, the anatomical features of the patient should be taken into account. Obesity, chest deformity and other similar factors are major barriers to ultrasound. As a result, the resulting image may be blurry and it will not be possible to interpret it properly. In order to clarify the diagnosis, doctors in such cases offer a transesophageal examination or MRI.
The quality of the equipment should also be taken into account. Of course, more modern equipment will provide the doctor with more opportunities to obtain sufficient information about the patient's heart.
Finally, the competence of the examiner should be considered. In this case, not only his technical skills are important (the ability to position the patient in the correct position and place the sensor at the desired point), but also the ability to analyze the data obtained.
When conducting stress echocardiography, the patient is first given a conventional echocardiogram, and then special sensors are applied, which record indicators during physical activity. For this purpose, bicycle ergometers, treadmill test, transesophageal electrical stimulation or medication are used. At the same time, the initial load is minimal, and then it is gradually increased, controlling the indicators of blood pressure and pulse. If the patient's state of health worsens, the examination is stopped.
All this time, an electrocardiogram is continuously performed, which makes it possible to respond quickly in the event of any extreme situations. During exercise, the patient may feel dizziness, increased heart rate, and discomfort in the region of the heart. After the termination of the load, the pulse slows down. Sometimes, in order for the heart to completely normalize, other medications are required. In this case, the patient's condition is carefully monitored until complete recovery.
Typically, the entire procedure takes about an hour.
Transesophageal echocardiography begins with irrigation of the patient's oral cavity and pharynx with lidocaine solution. This is to reduce the gag reflex during the insertion of the endoscope. After that, the patient is asked to lie on his left side, a mouthpiece is inserted into his mouth and an endoscope is inserted through which ultrasound will be received and delivered.
Decoding the results
The doctor who performed the study interprets the results of the echocardiography. He either transfers the received data to the attending physician, or gives it directly to the patient.
It should be borne in mind that a diagnosis cannot be made based solely on the result of echocardiography. The data obtained are compared with other information available to the attending physician: data from analyzes and other laboratory studies, as well as the patient's clinical symptoms. It is impossible to consider echocardiography as a completely independent diagnostic method.
Where to get echocardiography
Standard echocardiography is performed both in public health facilities (clinics and hospitals) and in private medical centers. To make an appointment for an examination, you must provide a referral from your attending physician or cardiologist.
More specific types of echocardiography - transesophageal examination or stress echocardiography - can only be done in specialized medical institutions, since they require special equipment and personnel who have received special training.
Echocardiography in children
As noted above, the indisputable advantages of echocardiography are non-invasiveness, painlessness and complete safety of this method of cardiological research. Manipulation is not associated with radiation exposure, does not provoke any complications. Therefore, if there are appropriate indications, the study can be recommended not only for adults, but also for children.
Diagnostics will help to timely detect congenital pathology in young children, which, in turn, will make it possible to choose the most effective treatment. As a result, the child will be able to lead an absolutely fulfilling life in the future.
The indications for echocardiography in a child are:
- Heart murmurs.
- Shortness of breath, either on exertion or at rest.
- Cyanosis of the lips, zone of the nasolabial triangle, fingertips.
- Decreased or complete lack of appetite, too slow weight gain.
- Complaints of constant weakness and fatigue, sudden fainting.
- Complaints about frequent headache.
- Discomfort in the chest.
- Decrease or increase in blood pressure indicators.
- The appearance of edema on the limbs.
Taking into account the fact that the method is safe, it is possible to perform echocardiography in babies more than once in order to track the development of the disease or to evaluate how effective the treatment is. In the event that any pathological changes have been identified, a study is carried out at least once every twelve months.
Preparation and conduct of the procedure for children
Like adult patients, children do not need any prior preparation. It is advisable that the child does not eat anything for three hours before the study, because with a full stomach, the diaphragm is high, which can distort the result.
Parents should take with them the results of the electrocardiogram taken the day before, as well as the results of previous studies. Without fail, the baby should be psychologically prepared for the procedure, explaining that no one is going to hurt him.
In order to carry out the procedure, the baby is stripped to the waist and laid on the left side on the couch. After that, moving the sensor along the chest, the doctor examines the resulting image.
There are models of echocardiographs that can be used to study the fetus in the uterus. In this case, neither the mother nor the unborn child will be harmed. As a rule, fetal echocardiography (prenatal or fetal echocardiography) is performed between 18 and 22 weeks of pregnancy. Its main goal is the timely detection of congenital heart disease in the fetus. The study makes it possible to check the intracardiac blood flow of a child in the mother's womb and provide dynamic observation until his birth. As a result, the obstetrician-gynecologist can plan the delivery and cardiologists can start treating the baby immediately after birth.
Fetal echocardiography is performed if the patient's close relatives have congenital heart disease, some diseases of a pregnant woman, in which the likelihood of congenital malformations in the fetus increases (diabetes mellitus, systemic connective tissue diseases, epilepsy). For prophylactic purposes, fetal echocardiography is performed if the mother took antibiotics or anticonvulsants in the first trimester. Diagnostics is also carried out when the mother is over 35 years old. Also, the indication is the deviations revealed during the ultrasound examination for a period of twenty weeks.
Medvedeva Larisa Anatolievna
Specialty: therapist, nephrologist .
Overall experience: 18 years .
Place of work: Novorossiysk, medical center "Nefros" .
Education: 1994-2000 Stavropol State Medical Academy .
- 2014 - "Therapy" full-time refresher courses on the basis of the State Budgetary Educational Institution of Higher Professional Education "Kuban State Medical University".
- 2014 - "Nephrology" full-time refresher courses at the State Budgetary Educational Institution of Higher Professional Education "Stavropol State Medical University".
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Echocardiogram of the heart, showing the atria and ventricles.
Echocardiography (Greek ἠχώ - echo, echo + καρδία - heart + γράφω - to write, depict) - an ultrasound method aimed at studying morphological and functional changes in the heart and its valve apparatus. It is based on capturing ultrasonic signals reflected from the structures of the heart. [one]
Since the advent of technical capabilities for the production of ultrasound devices, they have been used in medical imaging, including for imaging the heart and its valve apparatus. This is how a separate area of ultrasound diagnostics arose - echocardiography.
The principle of the method is based on the ability of ultrasound to be reflected when interacting with media of different acoustic density. The reflected signal is recorded and an image is formed from it.
This method allows you to establish the state of soft tissues, to determine the thickness of the walls of the heart, the state of the valve apparatus, the volume of the cavities of the heart, the contractile activity of the myocardium, to see the work of the heart in real time, to trace the speed and characteristics of blood movement in the atria and ventricles of the heart.
To carry out the manipulation, you need an ultrasound machine It consists of 3 main blocks:
- Ultrasound emitter and receiver
- Signal interpretation unit
- Information input-output means
Echocardiography (EchoCG) is indicated for ischemic heart disease, pain of unknown nature in the region of the heart, congenital or acquired heart defects. The reason for its conduct may be a change in the electrocardiogram, heart murmurs, violation of its rhythm, hypertension, the presence of signs of heart failure.
It is especially important to conduct echocardiography for diagnostic purposes in childhood, since various complaints may arise in the process of intensive growth and development in a child.
- people with complaints of shortness of breath
- cases of loss of consciousness
- feeling of rapid heartbeat or "interruptions" in the work of the heart, pain in the heart, etc.
- heart murmur
There are no absolute contraindications to EchoCG. The study can be difficult in the following categories of patients:
- Chronic smokers, persons suffering from bronchial asthma / chronic bronchitis and some other diseases of the respiratory system
- Women with a significant size of mammary glands and men with pronounced hair growth of the anterior chest wall
- Persons with significant chest deformities (rib hump, etc.)
- Persons with inflammatory diseases of the skin of the anterior chest
- Persons with mental illness, increased gag reflex and / or esophageal disease (for transesophageal echocardiography only)
- M. K. Rybakova, M. N. Alekhin, V. V. Mitkov, "A Practical Guide to Ultrasound Diagnostics, Echocardiography", Vidar Publishing House, Moscow, 2008, 512 pp., ISBN 978-5-88429-100-3 ...