House Calls runs every two weeks. Today's column is written by Randy Landenberger, a registered diagnostic cardiac sonographer at Sutter Coast Hospital.
I think there's an echo in here, an echo in here, an echo in hereandhellip;
An echocardiogram, that is. The first thing I'll say about this test is that the name is confusing because "echocardiogram" sounds so much like electrocardiogram (EKG or ECG). Specifically an echo is an ultrasound exam of the heart, and is also known as an echogram or a cardiac ultrasound. Many patients tell me they've had echos on their gallbladder, their neck, or their legs. What they really mean is that they've had ultrasound exams on those areas. Echo refers specifically to the heart.
The ultrasound allows us to look through the muscle walls and
directly inside of the heart to assess the condition of the muscle and
the four valves, the size of the chambers, and the blood flow within the
heart to identify murmurs. This is all done in "real time," meaning
that we're watching it live as it happens. However it does not directly
see the coronary arteries and blockages within those arteries.
Indirectly we can see the effects of arterial blockages, previous heart
attacks (myocardial infarctions - or dead tissue), or heart attacks that
are in progress.
"Doppler" ultrasound is also part of the exam. A "color" window is
laid over the grayscale image of tissue to show us which direction the
blood is flowing. This is typically done over valves to help reveal if
there is any narrowing or leakage. We can then measure that blood flow
to further evaluate the condition. Valves are most often the cause of
"murmurs." The color can also reveal holes in the heart tissue - another
common cause of murmurs and these can be a major contributor in strokes
There are many types of heart disease. First off, there's the kind
you were born with, congenital, and the kind you acquire due to age or
lifestyle. Congenital heart conditions can take myriad forms, from holes
to malformed valves, chambers and vessels. Acquired heart disease
includes ischemia (lack of blood and oxygen to the heart muscle due to
blockage in the coronary arteries), valves that are clogged and narrowed
(stenotic), or leaking (regurgitation or insufficiency), tissue that
has died and/or scarred, thickening of the heart muscle from
hypertension (atherosclerosis or peripheral artery disease) or
hereditary - a condition called hypertrophy. There are a variety of
"cardiomyopathies" or heart "muscle" diseases that may have been
acquired from general infections, septic conditions, drug or alcohol
abuse, or just a bad draw of luck (idiopathic, or unknown source).
Typically an exam lasts about 30 minutes from the time the tech first
puts the probe to your chest. The time to initially interview the
patient and put all information into the ultrasound machine, and the
time to close it all out and create a report, can extend the time to an
hour. Usually patient are lying on their left side. When the exam is
done in the Echo Lab, a special bed with a hinged drop section under the
chest allows the tech to move and manipulate the probe under the
patient to obtain the best images. A support behind the patient makes it
much more comfortable to be in that position for a long period.
The quality of these studies varies widely. Some patients have what
we call a "glass chest," meaning we can see all the structures clearly.
Many patients are less than clear, but we can still obtain the
information needed by the physician to make a diagnosis and the proper
treatment. The challenge for the echocardiographer is that the heart is
surrounded by your ribs and lungs and the limitations of ultrasound are
that it does not penetrate through bones or lungs. The image produced by
ultrasound is a two-dimensional slice on the monitor screen. Yes, there
is 3-D imaging - but that's another story and not practical for
To overcome these obstacles, we obtain images from three different
angles. For the first set, the probe is placed to the left of the
sternum, about midway up the chest wall. The second set of images are
taken from near the bottom of your ribs on your left side. The third set
of images are taken from just below the sternum, at the top of your
Some patients are sensitive to touch, or have conditions which make
the positioning uncomfortable, or are unable to lie still for an
extended period of time. Conversely, many patients fall asleep during
If you're a patient scheduled to have an echo and you experience back
problems or neuropathies, ask your physician about pain relievers or
anxiety medications before your appointment.
Here at Sutter Coast, I make the room and experience as comfortable
as possible. The room is warm, the lights are low, and I have a great
selection of music to transport you to dreamland for half an hour. For
some patients it's like an echo spa, and others prefer the rock 'n' roll
emporium, or sono-country.
Of course nearly every patient wants to know the results. "What did
you see?" "Any problems?" "Am I okay, will I live?" Sorry, but the tech
can't discuss the results. The exam has been digitally recorded for a
qualified physician to "read," or interpret. That physician will send
the report to your doctor who ordered the test.
Email suggestions for future House Calls columns to Beth Liles at
Sutter Coast Hospital, email@example.com