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

or TIA's.

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

everyday exams.

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

the exam.

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,