How to Read an Echocardiogram?

First is the anxiety of getting an echocardiogram, followed by the stress of understanding the results of the black and white heart images. Reading an echocardiogram report and trying to understand it is an uphill task.

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We simplify the process of reading an echocardiogram report in a step-by-step manner in this blog. 

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More about the echocardiograms you need to know

Ultrasound of the heart is called an echocardiogram (echo). It uses sound waves to create images.

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It creates images of the heart's structure, its pumping ability, and the surrounding blood vessels.

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There are several types of echocardiograms. These are:

• A transthoracic echocardiogram (TTE) is performed by moving a probe over the chest using a water-based gel. It is the standard echo done most commonly.

• A transesophageal echocardiogram (TEE) is done by inserting a small tube into the oesophagus down the throat to get detailed and clear images of the heart.

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Why is an echo needed?

After the preliminary investigation of blood tests and ECG, you may be advised to undergo an echocardiogram. When an echo is advised, the health care provider wants to rule out certain common abnormalities such as:-

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• Heart failure or weakness of the heart in pumping blood

• Valve Diseases caused by infections such as infective endocarditis

• Heart muscle disease (cardiomyopathy)

• Evidence of a blood clot in the heart or lungs

• Evidence of a heart attack

• Fluid or inflammation in the lining around the heart

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Components of the 2-D echo report:-

Patient information and details such as name, gender, and test date

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Image views are obtained from different angles and consist of parasternal, apical, subcostal, and suprasternal views. They display the heart and its chambers from various angles.

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• Ejection fraction (EF) is a measure of the heart's pumping efficiency and indicates how well the heart can pump blood. Usually, EF falls between 50% and 70% for normal adults.

• Valve functions: it assesses mitral, aortic, tricuspid, and pulmonic valves, indicating if there is any leakage (or regurgitation) or stenosis (narrowing of the valves).

• Chamber sizes: Any of the four chambers of the heart can enlarge in size.

• Wall motion abnormalities: it suggests heart muscle damage or ischemia (lack of blood flow).

• Pericardium: It gives signs of any accumulation of fluid (pericardial effusion) or pericarditis (Inflammation) of the lining of the heart

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Red flags and abnormal findings:

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Ejection fraction

It is the percentage of blood that the heart pumps out of its chamber with each beat. Measuring the ejection fraction allows us to know how well the heart is pumping. Ejection fraction between 50% and 70% is considered normal. Ejection fraction below 49% is indicative of an improperly working heart.

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Left ventricular systolic dysfunction (LVSD)

• Of the four chambers in the heart, the left ventricle is the biggest and the strongest as it pumps blood to the rest of the body.

• Systole refers to the heartbeat when the heart pumps blood out. Left ventricular systolic dysfunction indicates that the left ventricle is not able to pump blood as it should. It causes symptoms such as shortness of breath, swelling in the ankles or feet, or fluid accumulation in other parts of the body.

• LVSD occurs due to a heart attack or narrowing of the arteries (Coronary artery disease).

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Left ventricular diastolic dysfunction (LVDD)

• When the heartbeats, one part squeezes or contracts (systole), and the other part relaxes and fills with blood (diastole).

• In left ventricular diastolic dysfunction (LVDD), the left ventricle does not relax properly and does not fill with enough blood to pump out.

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Here, it may be able to squeeze but is not able to pump a sufficient quantity, which causes breathlessness and swelling as in LVSD.

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Mitral valve regurgitation and Aortic valve stenosis:-

The heart has four valves, namely:-

• Aortic

• Mitral

• Tricuspid

• Pulmonic

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Improper opening and closing of these valves causes regurgitation (leakage) or stenosis (narrowing).

• Mitral valve regurgitation. The valve between the left atrium and left ventricle does not close properly, and the blood leaks backward instead of moving forward.
  
  • Mild regurgitation usually is not serious.
  • Severe regurgitation causes the heart to work harder, leading to problems

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• Aortic stenosis: the aortic valve between the left ventricle and aorta narrows, and less blood flows out of the heart, making the heart work harder than normal.

Both regurgitation and stenosis make the heart work harder, which can eventually lead to:-

• Heart failure
• Irregular heartbeat
• Stroke
• Infections

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Left ventricular hypertrophy (LVH)

• The walls of the left ventricle become thick and stiff, more than usual, making it difficult for the heart to pump blood.
• High blood pressure or cardiomyopathy can also be the cause of left ventricular hypertrophy (LVH).

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Pericardial effusion

• When the lining around the heart gets filled with fluid, it is called pericardial effusion. The accumulated fluid exerts pressure, making it harder for the heart to function.

• It may even be caused by pericarditis or inflammation of the sac.

• It leads to chest pain, especially when lying down.

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Patent foramen ovale (PFO)

It is a small flap-like opening between the two upper chambers that usually closes after birth. An echocardiogram may show some blood flowing between the two chambers, a sign of a patent foramen ovale. They are usually symptomless, but they often increase the chance of having a stroke.

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Checklist for TTE report

• Date of procedure
• Reason for test
• image quality
• Rate and rhythm
• Chamber sizes
• Hypertrophy
• Right ventricular function
• Left ventricular systolic function
• Left ventricular diastolic function
• Valves
  
  •  morphology
  •  regurgitation
  •  stenosis
• Atrial or ventricular septal defect
• Pericardium
•  Incidental finding
  
  •  pleural effusion
  •  hepatic masses
  •  aortic dilatation or aneurysm
• unsuspected cardiac abnormalities
• Conclusions with important findings and suggestions for follow-up

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Importance of specialist review

A cardiologist, specifically trained to interpret the results and manage complex heart conditions, must review the results.

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The common symptoms of heart disease that require a referral to a cardiologist are

• Chest pain or discomfort: It feels like squeezing, tightness, or aching in the chest radiating to the arms, back, neck, or jaw.

• Shortness of breath, difficulty breathing when lying down.

• Unexplained fatigue and weakness

• Dizziness or lightheadedness, a feeling as if you are going to faint, is a sign of reduced blood flow to the brain.

• Irregular heartbeat, a racing, fluttering, or pounding sensation in the chest, is called palpitations. A sign of arrhythmia.

• A pain radiating to the jaw, neck, back, or arms.

• Nausea, indigestion, heartburn, cold sweats, persistent coughing, or wheezing may also be warning signs.

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The main reason why patients are referred to cardiologists is

• Established diseases

Usually, older adults have a history of congestive heart failure, heart attack, or atrial fibrillation. Men are at a greater risk than women, but women catch up in postmenopausal age.

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• Risk factors

Multiple risk factors include high blood pressure, cholesterol level, diabetes, and smoking. Obesity, a sedentary lifestyle, and an unhealthy diet also contribute to the risk.

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• Family history

If your parents or siblings have a history of heart disease, and you experience shortness of breath, unexplained dizziness following exertion, a cardiologist's consultation is a must.

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• Pregnancy complications

Gestational diabetes or preeclampsia increases the risk of future cardiac complications, which need to be evaluated.

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Cardiac care plans

• Diet and exercise changes
  
  • The risk of heart disease can be reduced by following a low-fat and low-sodium diet and engaging in 30 minutes of moderate exercise most days of the week.
  • Quitting smoking and limiting alcohol intake

• Medications
  
  • Medications depend on the type and severity of the heart condition. They are added if lifestyle changes fail to accomplish the goal.

• Cardiac procedure
  
  • A surgery is recommended if medications fail to achieve the desired result. Additionally, surgery depends on the condition and extent of the heart damage.

Conclusion

The echocardiogram report is crucial for making informed treatment decisions and accurately diagnosing various cardiac conditions. Sometimes, we need to monitor abnormalities over time, which may require serial echocardiograms to detect changes. However, in other situations, one may be required to undergo a CT or MRI scan.