Heart Failure Echocardiogram

Heart failure, also known as congestive heart failure, occurs when the heart is unable to pump blood. It means that the body does not receive oxygen-rich blood, which is necessary for proper function. If left untreated, it can be a life-threatening situation. One of the key diagnostic tools doctors use for heart failure is an echocardiogram.

‍

Some individuals experience symptoms such as shortness of breath, leg swelling, or chest heaviness. Your heart may be under strain and worsening. The fluid can accumulate in the lungs and other parts of the body, impacting your daily activities. In advanced cases, you may even require a heart transplant.

‍

In this blog, we will explore what heart failure is, how it presents, and how an echocardiogram guides its diagnosis and treatment.

‍

What is heart failure?

It occurs due to damaged or stiffened heart muscles. The muscles may get stretched and bigger, making it difficult for the heart to pump blood. Also, the ventricles may become stiff, unable to fill with blood between beats.

‍

Severity of heart failure:-

Class 1 heart failure:- no heart failure symptoms.

Class 2 heart failure:- everyday activities are done without difficulty, but exertion causes shortness of breath.

Category 3 heart failure:- It is difficult to do everyday activities.

Category 4 heart failure:- shortness of breath occurs at rest and is the most severe form of heart failure

Symptoms

Symptoms develop slowly, including:-

• Shortness of breath
• Fatigue and weakness
• Swelling in the legs, ankles, and feet
• Irregular heartbeat
• Reduced ability to exercise
• Coughing
• Swelling in the belly
• Chest pain
• Nausea

‍

Causes

Infections, alcohol, use of recreational drugs, chemotherapy, and genes can damage the heart muscles.

‍

Other conditions that cause damage to the heart and cause heart failure are

• Coronary artery disease
• High blood pressure
• Heart valve disease
• Congenital heart defects
• Arrhythmia

‍

Sudden heart failure may be caused by:-

• Blood clots
• Infections
• Allergic reactions
• Medications

‍

What is an echocardiogram?

An echocardiogram, also known as an echo, is a non-invasive ultrasound test that creates images of the heart. It helps the doctor to assess:-

• Heart size and shape
• Heart valve function
• Blood flow
• Heart muscle health
• Congenital heart defects
• Blood clots and pericardial effusion

‍

Types of Echocardiogram

• Transthoracic echocardiogram(TTE)

It is the most common type of echocardiogram, which is done with a transducer placed on the chest. The transducer sends and receives sound waves from the heart, generating images of the heart.

‍

• Transesophageal echocardiogram (TEE)

The transducer here is inserted down the esophagus under local anesthesia to get clearer images, especially of the back of the heart.

‍

• Stress echocardiogram

It involves imaging of the heart while exercising. It allows us to assess how the heart functions under stress.

‍

Heart Failure and Echocardiogram

Heart failure occurs when the body is not receiving enough blood from the heart for two reasons.

• A reduced ejection fraction, or systolic heart failure (HFrEF), occurs when the heart muscle cannot contract effectively, resulting in the heart pumping out approximately 40% less blood.

• Preserved ejection fraction, also known as diastolic heart failure (HFpEF), occurs when the heart muscles contract strongly; however, the ventricles cannot relax completely, which prevents the release of blood from the heart and reduces the rest of the body’s access to blood.

‍

Echocardiography images are not actual pictures of the heart, but doctors use them to understand its structure and function. The images display the heart's ejection fraction and damage to the heart and ventricles.

‍

Key metrics in echocardiography

Key metrics in echocardiography include.

• Left ventricular ejection factor, LVEF.
• Fractional shortening, FS.
• Fractional area change, FAC.
• Other measurements related to valve function, thickness, and diastolic function.

‍

Left ventricular function

• Left ventricular function is the percentage of blood pumped out of the left ventricle with each beat, and a normal range is between 55% to 70%
• Fractional shortening measures the left ventricular diameter during systole.
• Fractional area change (FAC), another measure of systolic function, is represented as a percentage change in left ventricular area from diastole to systole. Normal FAC is usually 35%
• Global longitudinal strain GLS) is an advanced measure of left ventricular systolic function that assesses myocardial deformation in segments of the left ventricle.

‍

Valve function

• Mitral valve: it measures the area of mitral stenosis and the regurgitant jet in mitral regurgitation
• Aortic valve measurements include the aortic valve area, maximum velocity, and pressure gradient in aortic stenosis and regurgitation.
• Tricuspid and pulmonic valves measure the regurgitant jet area and velocity in cases of regurgitation or stenosis.

‍

Wall thickness and structure

• Left ventricular wall thickness: Measurement of the interventricular septum and posterior wall helps calculate relative wall thickness and assess hypertrophy.
• Left ventricular mass is calculated from wall thickness and left ventricular dimensions.

‍

Diastolic function (how the heart relaxes)

• It measures how long the heart takes to relax
• Pulmonary vein flow helps to assess the atrial pressure and the left ventricle.
• Tissue Doppler Imaging tracks the speed of heart muscle movement and can detect signs of heart relaxation.

‍

Other important measurements

• Cardiac output refers to the volume of blood the heart pumps. It is calculated using the size and blood flow through a specific part of the heart.
• Inferior Vena Cava diameter and movement.

‍

Reporting and interpretation

• A good echocardiogram report includes all views, 2D Doppler, and color images.
• All issues should be explained clearly with comparison to normal values.
• Key findings should be summarized.

‍

Treatment of heart failure

• You may be advised on medicines
  
  • To relieve symptoms
  • To help your heart pump better
  • Oxygen through a mask
• Surgery or other procedures

‍

Surgery may be needed for the condition that causes heart failure, and for heart failure includes

• Coronary artery bypass graft surgery may be needed if the arteries are blocked, causing heart failure. The surgery involves taking a healthy blood vessel from the leg, arm, or chest and connecting it to the blocked artery in the heart.

• Heart valve repair or replacement. Several types of surgeries are performed on the valve, depending on the type needed, which in turn depends on the cause of the disease. Other assisting devices to enable efficient pumping are available, and implantable devices are also being used. A heart transplant may not be the choice for everyone, but a team of professionals is the best guide for it.

• Lifestyle changes, a balanced diet, regular exercise, quitting smoking and alcohol, and stress management are essential steps to a better life.

‍

Limitations of an echocardiogram

Echocardiograms are invaluable assets in imaging, but they may have several limitations.

• Image quality
  
  • Obesity, lung disease, chest wall abnormalities, and previous surgery hinder ultrasound waves, making it difficult to visualize certain structures.
• Interobserver variability
  
  • Measurements and interpretations depend upon the operator’s skill and limitations in detecting certain abnormalities.

‍

Conclusion

When the heart's muscles become too weak or stiff to pump blood to the rest of the body, heart failure occurs. Fluid accumulates in the lungs, leading to shortness of breath. An echocardiogram is a test that checks the heart's structure and function.