Normal vs Abnormal Echocardiogram

Echocardiogram is a vital tool in cardiac imaging, providing valuable insights into the heart's structure and function. However, deviations from normal can cause uncertainty and anxiety to the patient.

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It is natural for anyone to feel concerned about unusual results, but remember that an abnormal echocardiogram is not always a serious problem. Echocardiograms provide detailed information on the heart’s structure and function. When the results indicate abnormality, there can be several causes.

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These causes range from harmless fluctuations to issues that would require medical attention. This blog will guide you in understanding normal versus abnormal echocardiography.

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What is an Echocardiogram?

An echocardiogram is a diagnostic imaging test that utilizes ultrasound waves to produce detailed images of the heart's structure and its function. A hand-held transducer is placed on the chest, sending high-frequency sound waves to capture images of the heart valves and chambers. During the procedure, a transducer emits ultrasound waves at a frequency too high to be heard.

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When the transducer is placed on the chest at a certain location and angle, the sound waves penetrate through the skin and other tissues of the heart. The waves bounce off the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves on the screen. 

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This non-invasive test is commonly used to evaluate:-

• Heart valve problems.

• Assess heart failure.

• Detect congenital abnormalities.

• Investigate symptoms like chest pain and shortness of breath.

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Assessment of echocardiogram results is vital for early diagnosis of heart conditions, which, along with other tests, enables timely and appropriate treatment to improve patient outcomes.

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Why is an echocardiogram advised for a patient?

An echocardiogram is a part of routine examination and is usually advised for patients whose symptoms include:-

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• Chest pain.

• Shortness of breath.

• Lightheadedness.

• Dizziness.

• Fainting.

• Fatigue.

• A heart murmur or a change in heart sounds.

Types of echocardiograms

• Transthoracic echocardiogram (TTE). It is the most common type of echo. A small probe is placed on the front of the chest and moved around to get pictures of the beating heart.

• Transesophageal echocardiogram (TEE). The echo probe is placed on the end of a flexible tube that goes down the throat, into the oesophagus, to get details of the heart that a surface echocardiogram cannot pick up. 

• A stress echocardiogram is the surface echo that determines how much blood flows through the heart muscle before and after exercise.

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What to expect during an echocardiogram?

An echo is done in a hospital by a trained technician. No special preparation is required, and the procedure usually takes 30 to 60 minutes to complete. The procedure is conducted in a dark room, allowing technicians to view the monitor. You will be asked to remove your clothing from the waist up and put on a hospital gown.

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The technician places sticky patches called electrodes on the chest to monitor your heart rhythm through an ECG. A small device called a transducer is placed against the chest over the heart, causing it to move back and forth.

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The transducer picks up and sends out sound waves, which travel to the test monitor and show pictures of your heart. For most of the procedure, you lie on the left side; you may need to lie on your back and hold your breath for a few seconds.

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Understanding the basics of echocardiography

• Echocardiography is a non-invasive imaging technique.

• It uses high-frequency ultrasound waves to examine cardiac structures and their function.

• It provides real-time images of the heart for evaluating its size, shape, and motion.

• Echocardiography is performed using different modalities.

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• 2D echocardiography

It provides a detailed view of the heart's structure and dynamic images. In transthoracic echocardiography, images are obtained by an ultrasound probe that is moved along the patient's chest. In transoesophageal echocardiography, images are obtained by inserting a probe into the oesophagus for a closer look at the heart.

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• Doppler echocardiography

It measures the velocity and direction of blood flow within the heart and blood vessels. It utilizes the principle of the Doppler effect, which states that a change in frequency occurs due to the relative motion between the ultrasound waves and the moving blood cells. The Doppler effect helps to analyse the severity of valvular regurgitation or stenosis and detect abnormalities in patient blood flow patterns.

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Components of Echocardiography

An echocardiogram (or “echo”) gives a detailed picture of how your heart is working.

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Heart chambers' size and function

The heart has four chambers. The two on top are the atria, and the two on the bottom are the ventricles. 

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An echo checks:

• The size of the chamber.

• How well they are pumping blood.

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Ejection fraction (EF) is the amount of blood the left ventricle pumps out with each beat. A healthy EF is about 60%; numbers lower than 40% signal heart failure. It tells us how the heart relaxes and fills with blood. It is called the diastolic function. If the heart is stiff or filling poorly, it indicates early heart failure.

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Proper opening and closing of heart valves

The heart has four valves that control blood flow:

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• Mitral Valve is between the left atrium and the left ventricle.

• Aortic valve is the valve between the left ventricle and the aorta.

• Tricuspid valve is between the right atrium and the right ventricle.

• The pulmonary valve is between the right ventricle and the pulmonary artery.

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The echo checks for regurgitation (leaky valves), narrowing (stenosis), or damage from infections, age, and other diseases. The mitral valve may be prolapsed, tight, or leaky. It makes the heart work harder and causes symptoms of shortness of breath.

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Other important structures

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The Echo checks:

• Left Atrium, if enlarged, indicates longstanding heart problems.

• The aorta (large artery) may be thickened. 

• The pericardium (lining of the heart) has any extra fluid (pericardial effusion) or inflammation (pericarditis) in the sac around it. 

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Congenital abnormalities 

Echocardiography can be used to detect small holes in the heart.

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• Atrial septal defect (A hole between the upper chambers).

• Ventricular septal defect (a hole between the lower chambers).

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These create shunts where blood flows in the wrong direction.

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Serious conditions

• Aneurysms are bulges or weak spots in the heart wall or the aorta that could rupture.

• Tumours.

• Pericardial effusion, which causes breathing difficulties.

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Interpreting Normal and Abnormal Results

To interpret echocardiogram results, we should be able to distinguish between normal and abnormal findings.

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Normal results

They indicate that the cardiac structure and functions are within the expected range for a healthy individual.

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The findings include:-

• Normal chamber size of all cardiac chambers, i.e, left ventricle, left atrium, right atrium, and right ventricle.

• Normal wall motion should show normal contraction and relaxation and indicate normal myocardial function.

• The cardiac valve should open and close properly and show no signs of regurgitation (backflow) or stenosis (narrowing).

• The blood flow through the heart and major vessels should be in the expected direction and velocity.

• There should be no visible defects or abnormalities, such as septal defects or masses, in the heart.

Abnormal findings

Abnormal findings in the echocardiogram report suggest structural or functional abnormalities in the heart.

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They may be:-

• Increased dimensions of cardiac chambers, which may indicate heart failure, cardiomyopathy, or valvular disorders.

• Abnormal wall motion: Hypokinesis (reduced contraction), akinesis (absence of contraction) indicates damage to the heart or ischemia.

• Valvular abnormalities, such as leakage (regurgitation) or narrowing (stenosis), alter blood flow, causing symptoms or complications.

• Abnormal blood flow patterns indicate the presence of abnormalities, such as shunts (abnormal connections) or obstructions.

• Structural defects, presence of mass or tumours, and defects between various chambers of the heart can be detected through echocardiography.

• The abnormalities in the echocardiogram should be clinically correlated with the patient's symptoms, medical history, and other diagnostic tests to arrive at a correct diagnosis.

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What does abnormal mean?

Abnormality occurs when the heart appears or functions differently from what is expected. It could be serious, but it could also be a minor difference with little to no effect on our health.

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Abnormal results could indicate irregular heartbeats and problems with the heart walls; it could also be a reaction to medication or low electrolyte levels in the body. Other common examples include blood flow issues or excess fluid around the heart, which may indicate that the heart is enlarged or its walls are thicker.

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What does an Echocardiogram Show?

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Indications for the test

• Heart failure (or pump weakness).

• Valve diseases like infective endocarditis.

• Heart muscle disease (cardiomyopathy).

• Blood clots in the vessels of the heart or lungs.

• Fluid accumulation or inflammation in the lining around the heart.

• Congenital heart abnormalities.

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Size, thickness, and movement of heart muscles

The echo determines the size of the heart chambers and how thick the heart walls are. It observes how the heart moves as it beats, squeezing blood and then relaxing to fill with blood.

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Ejection fraction

It measures how well the right and left ventricles work and how much blood they pump with each heartbeat. Ejection fraction (EF) is the percentage of blood pumped out of the filled left ventricle when the heart contracts.

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Normal ejection fraction is between 50% and 70%, which means the left ventricles pump out 50% and 70% of their total volume. The borderline ejection fraction is between 40% and 49%.

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The ejection fraction for the right ventricle cannot be calculated with a transthoracic echocardiography because of the heart's position in the chest. For this reason, it is written as normal or reduced.

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The heart valves

Echo gives a detailed description of the shape, movement, and function of the heart's valves. Valves are flap-like tissues that regulate the flow of blood through the heart.

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Normal valves open freely and close completely with every heartbeat. An echocardiogram report describes the appearance and function of each of these valves.

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• Aortic valve. 

• Mitral valve.

• Tricuspid valve.

• Pulmonic valve. 

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Regurgitation refers to leaky valves. Stenosis means they are too stiff. Some regurgitation and stenosis of each of these main valves is normal, but moderate to severe cases require further investigation and treatment.

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Other echocardiogram findings

The echocardiogram report should include structures in and around the heart.

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like the:

• large arteries and veins.

• lining of the heart (pericardium).

• Presence or absence of any abnormalities like blood clots.

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The Echo report also comments on:

• Size and appearance of main blood vessels(aorta, pulmonary artery, and inferior vena cava).

• Pressure in the pulmonary arteries, blood vessels supplying the lungs.

• Presence or absence of fluid in the sac surrounding the heart (pericardial effusion).

• Whether there is pleural effusion (fluid in the bases of either or both lungs, which can be a sign of heart failure).

• Congenital abnormalities.

• Presence or absence of blood clots in heart chambers or any abnormal growth.

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Echocardiography reveals a wide range of abnormalities, some of which are minor and others require simple monitoring. However, some can be serious problems related to the heart or its structures that should be identified as early as possible before they can develop into potentially debilitating or life-threatening conditions.

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Conclusion

An echocardiogram (cardiac ultrasound) is a test that utilizes high-frequency sound waves to produce detailed images of the heart. It provides detailed information about the size, shape, movement, and pumping strength of the heart; the functions of the heart valves regarding leakage, narrowing, or blockage; and abnormalities in the pericardium, heart chambers, and blood vessels.

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Symptoms of heart disease or a family history of heart disease require heart monitoring. Gauze combines clinical expertise with technological advancements, enabling you to unlock the potential of echocardiography and achieve better cardiac health outcomes.