What are the 5 Abnormalities that can be Found on the Echocardiogram?

An echocardiogram is also known as a heart ultrasound or sonogram. It is a simple, painless test that uses sound waves to create dynamic images of the heart. Doctors can observe how blood flows through the heart chambers and assess the function of the valves and other heart structures.

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You may be asked to undergo this test if you experience unusual symptoms. In 15 to 30 minutes, an echocardiogram can reveal important clues about your heart’s health.

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In this article, we will examine how echocardiograms aid in detecting heart abnormalities and what these abnormal results signify.

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Abnormal symptoms that require attention:-

An echocardiogram is recommended for individuals presenting with heart problems who exhibit the following signs and symptoms:-

• Arrhythmia
• Shortness of breath
• Chest pain
• High blood pressure
• Leg swelling
• Abnormal ECG results
• Unusual sounds between heartbeats 

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What do abnormal results mean?

An abnormal heart finding is when the heart functions differently from what it should. Abnormal results could include irregular heartbeats and problems with the heart walls or blood flow. We need to correlate the abnormalities in the echocardiogram with the patient’s clinical information to reach a correct diagnosis.

• Symptoms
• Medical history
• Other diagnostic tests

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Normal results

Indicate that all parameters of cardiac structure and function are within the expected range. The parameters evaluated include: -

• Normal chamber size.
• Normal wall motion.
• The cardiac valve opens and closes normally.
• Blood flow direction and velocity are normal.
• No defects or abnormalities.
• Ejection fraction is between 50% and 70%.

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Abnormal findings

Abnormal findings in the echocardiogram indicate abnormalities in the heart's structure or function. They may be: -

• Increased dimensions of cardiac chambers.
• Abnormal wall motion.
• Valvular abnormalities.
• Abnormal blood flow patterns.
• Structural defects.
• Ejection fraction is >49%.

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5 Key Abnormalities Found on an Echocardiogram:-

Echocardiograms aid in the early diagnosis of heart diseases, resulting in improved patient outcomes. These are:-

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1. Valve abnormalities

The heart has four valves:-

• Mitral Valve is located between the left atrium and the left ventricle.
• Aortic valve is the valve between the left ventricle and the aorta.
• Tricuspid valve regulates blood flow between the right atrium and the right ventricle.
• Pulmonic valve regulates blood flow between the right ventricle and the pulmonary artery.

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These valves control the flow of blood in one direction. When the valves malfunction, there can be a:-

• Leak of blood backwards, also known as regurgitation
• Narrowing of walls, also known as stenosis.

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Both regurgitation and stenosis cause the heart to work harder to compensate for the increased workload. Initially, it causes symptoms, and early diagnosis can be made by performing an echocardiogram test. The mitral valve may be prolapsed, tight, or leaky. It makes the heart work harder and causes symptoms of shortness of breath. If it is not treated, it causes heart failure.

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2. Chamber size and function abnormalities 

Our heart has four chambers

• Upper auricles  
• Lower ventricles

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The walls of the left ventricle are thickest because it pumps blood to the body.

The heart chambers require the

• Strength 
• Size 

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to pump blood to various parts of the body. If it is enlarged or shrunken, it adds to the strain or damage that affects the blood flow.  We can measure the dimensions of these chambers using an echocardiogram and calculate the ejection fraction, a key indicator of the heart’s performance.

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A low ejection fraction in an echocardiogram shows the reduced pumping ability of the heart.

Cardiomegaly, which indicates an enlarged heart and suggests cardiac overload. Cardiomegaly can happen due to the following reasons:-

• Congenital (since birth) heart defects: the heart muscles become thick and weak
• Damage from a heart attack causes scarring of the muscles and increases the strain on the heart.
• Heart muscle disease (cardiomyopathy) causes the heart muscle to become rigid or thick, making it difficult for the heart to pump blood effectively.
• Presence of fluid (Pericarditis) in the sac around the heart
• Thyroid disorders
• Anaemia (low red blood count)
• Haemochromatosis (Too much iron in the body)
• Cardiac amyloidosis (deposition of proteins in the heart)

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3. Wall motion abnormalities

The heart muscle walls contract, helping to circulate blood, and echocardiography helps visualize these motion patterns in real time.

• Hypokinesis (decreased movement in one segment)
• Dyskinesis: (A bulge during contraction)
• Akinesis (Lack of movement)
• Normokinesis (normal wall movement)

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Wall movement abnormalities make it difficult for the heart to pump blood efficiently. They are a sign of heart disease and increase the risk of heart attack and other cardiovascular events.

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These abnormalities are reversible if the underlying cause is treated by restoring blood flow as early as possible.

The causes include:-

• Coronary artery disease
• Myocardial infarction (heart attack)
• Cardiomyopathy
• Hypertension

4. Myocarditis and pericardial effusion

The pericardium is the outermost layer covering the heart. When the pericardium is filled with fluid, it exerts pressure on the heart, affecting its pumping activity.

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Pericarditis affects the heart's outer lining, causing severe chest pain. Pericardial effusion occurs when > 50ml of abnormal fluid collects around the heart. The most severe form of pericardial effusion is cardiac tamponade (The fluid in the cardiac sac causes compression and prevents the heart from functioning properly).

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Cardiac tamponade causes poor blood flow and reduced oxygen supply to the body. It is life-threatening and requires emergency treatment.

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Causes of pericardial effusion and pericarditis are:-

• Inflammation
• Trauma
• Malignancy (cancer)
• Autoimmune diseases

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5. Intracardiac thrombus and strain abnormalities 

It is not just the structure of the heart that causes complications, but also the formation of blood clots (thrombus) within the heart, which may lead to stroke, pulmonary embolism, and blood clots lodging in the brain, lungs, and other organs.

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A thrombus (clot) can dislodge and settle in any part of the body, causing a stroke. Strain abnormalities are conditions that contribute to the formation of blood clots, also known as thrombi.

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 Some important causes of thrombus formation are:

• Myocardial infarction (heart attack)
• Atrial fibrillation
• Cardiomyopathy
• Valvular heart disease
• Endocarditis (infection of the heart)

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Strain imaging echocardiography provides detailed information about heart function, assessing changes in the heart muscles in the cardiac cycle. Reduced strain indicates a higher probability of dysfunction due to reduced blood flow. It helps to identify future cardiac events.

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Using a Global Longitudinal Strain (GLS) echocardiogram, a highly sensitive method for assessing the heart's function, it detects early heart muscle damage and damage related to chemotherapy.

What happens after an abnormal echocardiogram?

The cardiologist may explain to you the implications of the cardiac abnormalities as viewed in the echocardiogram. He may even advise you to undergo a stress echo, CT, or MRI.

Conclusion

An echocardiogram is a safe and non-invasive test that helps to detect abnormalities in the heart. These, when detected early, provide an opportunity to improve outcomes. Small changes, along with medication, diet, and lifestyle adjustments, can improve patient outcomes in the early stages.