Transthoracic Echocardiogram (TTE)

TTE, one of the safest and non-invasive procedures for the heart, is performed superficially using a transducer that produces ultrasound waves. It is a method for visualizing the heart's chambers, valves, blood vessels, and blood flow, aiding in the diagnosis of various heart conditions. Whenever you are advised to get an echocardiogram, it usually means a transthoracic echocardiogram.

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It is a comprehensive test for diagnosing and managing various heart conditions, as it assesses the structure and function of the heart by capturing dynamic images of the heart.

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Let us delve into the transthoracic echocardiogram and why it is the most commonly done test.

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What is a TTE?

Transthoracic means via the chest. High-frequency ultrasound waves are an essential tool for diagnosing and managing various heart conditions, as they enable the assessment of the heart's structure and function by capturing dynamic images.

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Why is an echocardiogram recommended?

An echocardiogram is useful for:-

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Diagnosing heart conditions

• Evaluating heart structure
  
  • It helps us to see the size and shape of the heart chambers, the thickness of the walls, and the condition of the heart valves.

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• Assessing heart function
  
  • It assesses how well blood is being pumped to the body by the heart, the amount ejected with each heartbeat, and the efficiency of the blood flow.

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• Identifying valvular defects
  
  • It helps identify abnormalities in the valves, such as backflow (Regurgitation) or narrowing (stenosis) of the valve.

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• Detecting congenital abnormalities
  
  • It detects heart defects that may be present at the time of birth

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• Other issues
  
  • It can even help detect conditions such as heart failure, pericarditis, tumors, or clots in or around the heart.

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Monitoring heart health

• TTE tracks the progress of the disease and the effectiveness of the treatment being given.

• It assesses the risk potential of individuals with metabolic diseases or lifestyle diseases, such as diabetes or hypertension. 

• It helps a doctor by providing information about the structure and function of the heart to decide upon the prognosis of the disease.

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Non-invasive and safe

• It is a safe and non-invasive option for repeated use because it does not use radiation. It is a reassuring choice for heart health monitoring.

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Symptoms of heart disease that require an echocardiogram:-

• Chest pain during exertion is possibly due to coronary artery disease.

• Shortness of breath when lying down or during exertion suggests heart failure or valve problems.

• Palpitations, irregular heartbeats, or fluttering sensations.

• Dizziness or fainting occurs due to reduced blood flow to the brain.

• Fatigue with minimal activity could indicate a heart problem.

• Murmurs, unusual heart sounds during the heartbeat, suggest heart valve problems.

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How to perform a transthoracic echocardiogram

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Before the test

TTE is a simple test and requires no special preparations

• You can pursue your routine activities and continue the medicines prescribed.

• Wear loose, comfortable clothes, or may be asked to change into a hospital gown.

• The test usually takes between 30 and 60 minutes and requires no recovery time.

• The patient must arrive at the appointment early.

• Routine details, such as name, age, date, history, and chief complaints, are noted and recorded.

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Setting up the machine and the patient

• The ultrasound machine should be positioned on the right side of the patient, allowing for scanning with the right hand and easy control with the left hand.

• The patient is asked to lie on his back or left side, as this position brings the heart closer to the chest wall, allowing for clearer images.

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Using the transducer (probe)

• The transducer is a handheld probe that uses the piezoelectric effect to convert electrical energy into high-frequency sound waves.

• These waves travel through the chest and bounce off the heart structures, returning as echoes to the probe. The machine creates images from these echoes.

• Phased array probes are used for cardiac imaging due to their small size.

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Imaging modes

• B-mode 2-D Black and white structural images.

• M-mode motion over time (heart valve movement).

• Doppler blood flow analysis
  
  • Colour Doppler shows flow direction.
  • Power Doppler detects low-velocity flows.
  • Pulse or continuous Doppler measures flow speed.

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Image controls

• Depth-adjust zoom helps visualise structures at different depths.

• Gain- adjusts brightness to enhance visibility.

• Freeze or pause  is used to capture the image.

• Measurements and measurement markers are used to quantify the heart structure and functions.

• Save captures, stills, or videos for record-keeping and diagnosis.

During the test

1. Electrodes are attached to the chest to monitor the heart's electrical activity.

2. The patient is then asked to lie on his back or the left side, as this position brings the heart closer to the chest wall. In this position, clear images can be taken.

3. A water-based gel is applied to the chest to facilitate the easy movement of the transducer and the transmission of ultrasound waves.

4.The sonographer, a trained professional who operates the ultrasound machine, moves the transducer over the chest to capture the necessary images.

5. As the probe is moved across the chest, sound waves produced bounce off the heart structures. They are picked up by the transducer, converted to images, and displayed on the monitor.

6. The sonographer then takes images of the heart from various angles, such as the long axis, short axis, apical region, and subcostal region.

7. The test typically takes 30 to 40 minutes to complete.

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After the test

Soon after the test is finished, the patient can resume their normal activities, unless advised otherwise.

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Abnormalities in the captured images are interpreted by a cardiologist, who then provides a detailed report of the heart's structure and function.

1. Heart structure: A transthoracic echocardiogram reveals abnormalities in the heart chambers, valves, and surrounding blood vessels.

2. Heart function: TTE evaluates how well the heart pumps blood. A key matrix for it is the ejection fraction EF, which should be between 50% and 70%

3. Heart valve problems are detected if the valves are leaky and regurgitate blood backwards or if they are narrow (stenosis)

4. Identifies the

• The heart muscles are damaged after a heart attack.

• Abnormal  growth inside or outside the heart.

• The presence of fluid in the outer lining of the heart.

• Blood clots in the heart.

• Hole between the chambers of the heart (septal defects).

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Benefits of an echo test:-

An echocardiogram is crucial in diagnosing congenital heart diseases, heart valve disease, and cardiomyopathy, and it also plays a significant role in monitoring the progression of heart disease, evaluating the effectiveness of medications or surgeries, and assessing the heart's pumping ability and blood flow.

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1. Monitoring the progression of a heart disease.

2. Evaluation of the treatment regarding effectiveness in medications or after surgeries.

3. Helps in assessing the heart's pumping ability and blood flow.

4. Identifying abnormalities in heart valve motion.

5. Guiding and monitoring treatment decisions and patient responses.

6. Detecting early complications like heart failure or stroke.

7. Assessing damage to heart muscles after a heart attack.

8. Determining a patient’s risk of developing heart disease or its complications.

9. The test is non-invasive and safe.

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Risks of an echo test

• Echocardiography has no known risks and is considered a safe test. It is because it uses sound waves.

• Patients hardly ever experience irritation due to the gel. 

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Conclusion

You may be advised to undergo an echocardiogram by the doctor if you have any heart-related disease that requires attention, or if you have a family history of heart disease. Evaluation by TTE helps in diagnosing it early. Echo involves a small transducer (probe), which sends out sound waves. It is placed on the chest, turned, tilted, and rotated. It sends the sound waves through the chest wall into the heart, which bounce back to create images displayed on the screen. For individuals who seek comprehensive cardiac care and state-of-the-art facilities, Gauze is a one-stop destination.