Echo decryption. Ultrasound of the heart (Echo-KG) - types, indications and contraindications, preparation, indicators and norm, interpretation of results, price

Echocardiography of the heart (ultrasound of the heart) is an absolutely harmless and effective method for a complete examination of the condition and work of the patient's heart.

To conduct an echocardiogram of the heart, a device operating on the principle of an ultrasound scanner is used.

During diagnostics, this device is installed in different parts of the chest, which allows you to examine the heart, its valves and large vessels with the greatest accuracy.

A study using ultrasonic waves, unlike an ECG (during which electrical impulses generated by the heart are recorded), allows you to visually analyze the mechanical activity of the heart and evaluate its morphological characteristics.

The entire structure of this important organ is traced on the monitor using a detailed and clear image. Evaluation of functional changes is carried out on the basis of an analysis of the rate of contractions of the heart, muscle tone and valve function.

Echocardiography is used to determine the diagnosis, as well as to prescribe the correct treatment for the identified pathology. This method is popular due to its informativeness and safety.

With the help of ECHOCG, any anomalies that may occur in the work and structure of the heart of patients of any age are detected in a timely manner. Since in our time there are very often violations in the work of the cardiovascular system, regardless of the age of the person, if necessary, the echocardiography procedure can be performed for the following groups:

• newborn babies;
• children of any age;
• pregnant women;
• young and old people.

Patients who have had a myocardial infarction should be examined with an echocardiogram so that a specialist can check the work of their heart and identify areas with insufficient functionality. In the study, it can also reveal violations in the structure of the organ that caused the onset of the disease.

People who are professionally involved in sports are constantly required to undergo a lot of various examinations. All procedures are performed for preventive purposes for the timely detection and prevention of a disease that is emerging in the body.

So, an echocardiogram of the heart is needed in order to diagnose any changes in the characteristics of the heart muscle in time, which can significantly affect sports.

Recently, many pregnant women have been prescribed fetal heart echocardiography. E heart chocardiography during pregnancy completely painless and completely safe for both the mother and the baby in her womb. There are the following indications for an echocardiogram:

• the age of the pregnant woman;
• transferred infectious diseases during childbearing;
• the presence of diabetes in the mother;
• violations in the development of the fetus, noted on a planned ultrasound;
• congenital heart disease in the mother or previously born children;
• other genetic diseases.

What can an echocardiogram of the heart detect?

When conducting an echocardiographic examination, the specialist receives a visualization of the heart and blood vessels in real time.

During such a scan, they evaluate the following parameters:

• the size of the chambers of the heart and the pressure in them;
• the presence or absence of changes in the myocardium;
• wall thickness of the heart;
• the functionality of the heart valves;
• the state of large vessels of the heart;
• speed and direction of intracardiac blood flow.

In addition, this method measures the pressure in the pulmonary artery and determines the activity of the heart during its contraction.

Based on the analyzes performed, a summary of the morphological and functional characteristics of the heart is summarized. If necessary, based on the results of the study, the cardiologist chooses the most effective treatment tactics.

Types of echocardiography

One-dimensional or M-echocardiography

Due to the advent of more advanced technologies, this type of examination is now extremely rare.

A one-dimensional echogram of the heart allows you to obtain accurate information about the size of the atria and the functional activity of the ventricles. The entire record of the examination of the structures of the heart is displayed on the computer screen in the form of a graphic image.

B-echocardiography (two-dimensional)

Using this diagnostic method, a specialist evaluates the state of the structure and functionality of the heart in real time. The ultrasonic beam, moving in a specific plane, registers successive signals received from the objects of study.

Based on a series of conditional messages, a gray-white moving image of the heart is formed on the monitor, allowing measurements of the required parameters.

Doppler echocardiography

Echocardiography with Doppler Analysis is carried out to monitor the direction and speed of blood flow in the ventricles, atria and large vessels. Most often used in a study combined with one of the previously considered diagnostic methods.

On the computer screen, depending on the detected changes in the direction, the blood flow is depicted as blue or red lines.

Contrast echocardiography

For this type of echocardiographic diagnosis, a special radiopaque substance is used, which is injected into the patient's blood.

The use of this technique allows you to better visualize the structure of the organ under study and get clearer scan results on the screen.

Stress echocardiography

Stress echocardiography is used to detect narrowing in the coronary arteries, analyze vascular patency, diagnose underlying heart pathology, and determine other symptoms of diseases that are absent in a patient who is usually at rest during examination.

When performing this type of diagnosis, the patient is affected by physical and drug stress.

Echocardiography method

When performing an echocardiographic examination, two techniques can be used: transthoracic and transesophageal.

Each of them differs from each other by the method of implementation and the degree of execution.

Transthoracic echocardiography

This type of ultrasound is considered the oldest and therefore the most common. The transthoracic heart disease detection technique is performed through the chest using an ultrasound transducer pressed against the patient's body in the region of the heart.

The results of the signals are displayed on the screen of the echocardiograph, which are converted into multiple versions of the image of the heart. As a rule, the person who undergoes such an examination is on the couch in the supine or side position.

Transesophageal echocardiography of the heart

Despite the great popularity of the transthoracic echocardiography technique, some cases of patient examination require a more thorough approach.

Such a need arises due to the occurrence of acoustic interference in the human body or the impossibility of achieving optimal penetration of ultrasound into some parts of the diagnosed organ.

Meanwhile, the transesophageal technique, despite the technical difficulties of its implementation, allows: to better examine the heart for the presence of tumors and blood clots, to detect pathologies of prosthetic valves in a timely manner, to detect congenital malformations, and so on.

An echocardiographic examination is performed on an outpatient basis and involves some preparation for its implementation.

A few hours before undergoing such a procedure performed using the transesophageal technique, the patient must refrain from drinking water and food.

In order to avoid any distortion of the survey results, it is forbidden to take coffee or any products that contain caffeine (strong tea, chocolate, Coca-Cola type carbonated drinks) the day before participation in the study.

The same restriction applies to cardiac drugs, including nitroglycerin, or belonging to the group of beta-blockers. Although this point should be discussed with your doctor.

If there is a gastric tube in the body or dentures, it is required to remove them immediately before echocardiography.

Indications for the procedure

The attending physician prescribes an echocardiographic examination to the patient if the patient has:

• murmurs in the heart;
• changes in the electrocardiogram;
• congenital or acquired defect;
• an increase in the size of structures or the organ itself;
• modified aorta;
• all types of arrhythmia;
• suspicion of the presence of neoplasms and other various anomalies.

Carrying out such a diagnosis is necessary for people who have had a heart attack and suffering from coronary disease, arterial hypertension and cardiomyopathy. Athletes who regularly experience increased stress on the heart are recommended to systematically undergo such a procedure.

For children who are at the stage of active growth and physical development, doctors prescribe echocardiography, especially if congenital heart disease is suspected.

Such a diagnosis is in a number of other causes of perinatal mortality. Therefore, pregnant women are often prescribed a completely safe ECHOCG procedure, as a result of which the unborn child is examined for cardiac pathologies.

Contraindications for echocardiography

In general, echocardiological examination is a completely harmless procedure.

However, due to some anatomical features of patients (deformity of the chest, rather pronounced hairline of the male chest, obesity, inflammatory skin lesions in the heart area, large size of the mammary glands of women), it may be difficult to sufficiently penetrate ultrasound through transthoracic echocardiography.

Meanwhile, patients who have been diagnosed with a stomach ulcer or acute gastritis, or those who suffer from the presence of tumors of any severity, should not undergo ultrasound of the heart by inserting a probe through the esophagus.

Heart echocardiogram results

The specialist conducting the examination is engaged in deciphering its results, which are drawn up on a special form and transferred to the attending physician. All indicators of ultrasonic radiation of the heart can fluctuate within certain ranges.

Heart echocardiogram norms

The table shows the normal values ​​obtained during cardiac echocardiography.

Adults have stable values ​​of these values. In children, the normal size of heart structures varies with age.

Quite well-known is the term electrocardiogram of the heart. But about echocardioscopy heard, perhaps, not everyone. Let us consider this type of heart examination in more detail, paying attention to the nuances of indications and limitations, the preparation and process of conducting, as well as the effectiveness and cost of the procedure.

What is echocardioscopy?

Echocardioscopy (EchoCS) also called echocardiography (EcoCG) or simply ultrasound examination of the entire cardiac system. This method is quite informative, as it allows not only to detect an enlarged heart, but also to examine all its components (septums, ventricles and vessels) in more detail and carefully.

By examining the cardiac region using the EchoCS method, you can determine:

• The state of the heart muscle;
• Valve performance;
• Blood pressure in the cavities of the heart and their dimensions;
• The thickness of the heart walls;
• Blood movement.

This research method provides an opportunity to detect heart defects regardless of origin (congenital or acquired), changes in the valves, the presence of blood clots, as well as a violation of the ability to carry out a cycle of certain movements.

We will apply this method both in good and healthy state of health, and in various heart diseases, as well as in case of need to measure the pressure of the pulmonary artery.

Kinds

Echocardioscopy can be divided into different methods. Basically, an ultrasound examination of the heart is performed externally through the chest area.

Types of methods for conducting a study of the heart:

Advantages

When detecting diseases of the heart area, primarily defects of this organ, EchoCS is of paramount importance in terms of its characteristics.

Advantages:

• Modernity(carried out on high-precision and modern equipment with the least error);
• Safety(there is no radiation, pain and side effects, so EchoKS during pregnancy is absolutely harmless for both the expectant mother and her baby);
• informative(no analysis will show how the heart and its components work so accurately as this method).

EchoCS is performed only in specialized clinics and costs an order of magnitude higher due to its performance than a conventional electrocardiogram of the heart. It is carried out both before and after treatment in order to trace the dynamics and therapeutic effect of the treatment.

Indications for carrying out

At the slightest suspicion of pain in the heart, you should contact a specialist cardiologist, who, as a result of the examination, directs you to undergo other types of research.

The need to undergo echocardiography arises in such circumstances:

1. The presence of murmurs in the heart and a violation of the rhythm of its work during normal listening to the chest;
2. Pain in the region of the heart;
3. Suspicion of heart disease or a high risk of its development due to genetic predisposition;
4. Increased blood pressure in the patient, which directly affects the work of the heart;
5. Manifestations of heart failure, such as enlargement of the liver and hyperedema of the extremities;
6. Frequent dizziness and a feeling of weakness, increased physical activity and the presence of shortness of breath;
7. After injury or heart surgery;
8. Oncological neoplasms, especially in the region of the heart.

• Referral to such extensive cardiac diagnostics issued by a cardiologist. Deviations in the functioning of the organ and its increased size can be detected with a conventional chest x-ray.
• During childbearing such a study is prescribed if a woman has high blood sugar or one of her blood relatives had a heart disease.
• Conducting echocardiography in a newborn occurs when the baby gains little weight at a monthly examination.

Contraindications

In general, echocardioscopy of the heart is an absolutely safe procedure.

Contraindications can only arise when performing the transesophageal type of this method. This is primarily due to the anatomical features (obesity, chest injury, tumors in the esophagus, large breasts in women) of the patient or the presence of disorders in the organs of the gastrointestinal tract (ulcer, acute gastritis), since this method is carried out through the esophagus.

There are no contraindications for other types of EchoKs.

Preparation for the procedure

There is no special preparation for conducting a heart examination using the EchoCS method. For babies, it is carried out during sleep, while feeding should occur an hour before the procedure. Adults who have a rapid pulse or high blood pressure should take medications that a cardiologist will advise in order to relieve these symptoms and not get an error in the study.

When conducting a transesophageal examination of the heart, it is worth preparing as for a conventional gastroscopy. That is, do not eat or drink a few hours before the procedure, and a few days before the study, control your diet and exclude from it those foods that can irritate the walls of the stomach.

About that, read here.

Carrying out algorithm

Echocardioscopy is done only on an outpatient basis in those medical institutions that have special equipment and qualified personnel to conduct such a study.

The procedure is carried out in this way:

1. The patient exposes himself to the waist so that the entire chest area is available for examination and lies down on the couch.
2. A special gel is applied to the skin so that the sensor does not come into contact with air and the waves transmit readings to the monitor better.
3. A special sensor transmits the main readings to the EchoKS device in real time for a maximum of 40 minutes.

At the same time, the position of the sensor, like the Doppler, is periodically changed in order to capture a large area for research. After a few minutes, the diagnostician issues a conclusion to the patient, which is necessary for the presentation and appointment of treatment by a cardiologist.

Conducting a transalimentary method for diagnosing the heart occurs using general or local anesthesia. It is carried out in a special room, very similar to the gastroscopy room. In this case, the patient lies on his side, and the internal sensor displays all the data on the monitor. Also, within a few minutes, the patient is given a conclusion.

Deciphering the results

Only a specialist cardiologist can correctly read and interpret the results of echocardioscopy studies. Self-assessment will not give a person an understanding of the full picture and the presence of diseases. Assessment of EchoCS indicators is an important component of the study in order to correctly prescribe therapy, so it is better to entrust this to a specialist.

In this case, the doctor can both decipher the results and answer all the questions of the patient. It rarely happens that indicators that deviate from the norm are recorded in the study protocol under other items. This directly indicates that the device is not of sufficient quality.

Accurate results are obtained only on high-quality equipment in specialized clinics. And only accurate indicators will help the doctor diagnose diseases and prescribe appropriate treatment.

Depending on the purpose of the study, the age and general condition of the patient, the examination may show results that differ slightly from each other.

The EchoCS procedure of the heart shows:

Deciphering the indicators is carried out by comparing them with normal indicators. So for a comprehensive and comprehensive assessment of the main organ in the human body, different indicators are used.

EchoCS issues a conclusion on the following parameters:

• The opening diameter of the valves, as well as the area of ​​​​their openings
• Antero-posterior size of the cavities of the heart, pressure in them
• MZHP thickness
• Left ventricular stroke volume, cardiac impulse and cardiac output
• Peak diastolic filling rates
• Max line speed
• Pressure gradient between cardiac cavities
• Fluid in the pericardial cavity

The accuracy of these indicators entirely depends on the equipment, as well as the qualifications of the doctor.

Normal performance

After the end of the examination procedure by the EchoCS method, the doctor issues a protocol with his conclusion.

In the table below you can see the indicators within the normal range:

It should also be borne in mind that age indicators can have different values.

What influences the results?

Sometimes these data can be distorted, when This may be due to the following factors: too large a mass of a person, a modification of the chest, the lack of professionalism of a diagnostician, a discrepancy between the equipment and high quality.

EchoCS can be performed in public institutions or private clinics for an additional fee.

Specific and some research methods of EchoCS are done only in specialized institutions on high-precision and high-quality equipment in order to avoid errors in indicators.

Establishing an accurate diagnosis and prescribing the correct therapy entirely depends on the accuracy and effectiveness of the examination.

Cost of the procedure

• Few government agencies have special equipment for conducting research using the EchoCS method. Those who have the appropriate material and technical base (state cardiodispensaries) carry out the procedure according to the directions of the district cardiologist at the place of residence. In this case, the procedure may have a minimum cost (up to 300 rubles) or be carried out free of charge.
• In most cases such examinations are carried out on a commercial basis in private clinics. The cost of the procedure varies from 2200 rubles to 4000 rubles. It all depends on the pricing policy of the institution itself and the availability of modern and high-precision equipment in it. At the same time, the cost of an EchoCS examination in large cities is usually higher than in other settlements.

Summing up the above, we can say with confidence that the EchoCS method is accurate, effective, informative both at the initial stages and in the post-therapeutic period. The method is absolutely safe and is carried out both for newborns and adults. And the venue entirely depends on the preferences and financial capabilities of the person.

The heart, as the main human organ, needs timely diagnosis and treatment, so trust only specialists.

Before prescribing treatment for any disease, the doctor must diagnose and identify this disease. This also applies to diseases of the heart and cardiovascular system. Some of these diseases may be asymptomatic, so their presence cannot be detected. But even in the case of obvious signs, diagnostic procedures are necessary, since for effective treatment you need to know the cause of the problem.

To identify diseases of the heart and cardiovascular system, two methods are most often used: echocardiography and ECG.

Both of these methods are accurate, but if cardiac pathologies are suspected, ECHO is usually used.

Echocardiography in a simpler sense is an ultrasound of the heart. By means of ECHO, the following features can be determined:

ECHO methods:

• Transthoracic (echocardiography is performed through the surface of the patient's body).
• Transesophageal.
• Stress-ECHO (the procedure is performed with a load on the heart muscle, which allows you to identify pathologies that are hidden).

Since such a study accurately characterizes cardiac activity, it is used very often. It can be performed even on newborns.

Is the reason for the ECHO:

ECHO should be performed only in a medical institution, and should be carried out by a person who has the knowledge necessary to decipher the data.

Such a study has a number of advantages. These are the safety of ECHO (the same as when performing an ECG), the absence of discomfort for the patient and side effects, the accuracy of the results. There are no contraindications for cardiac echocardiography, only stress ECHO is performed with slight restrictions.

What diseases are diagnosed using this method?

ECHO can determine the condition of the heart valves. Also, such a study allows you to study the structural features of the organ. Thus, among the diseases that can be detected by this method, we can name the following:

• Heart failure.
• Stenosis.
• Prolapse.
• Heart attack.
• Aneurysms.
• Heart disease.

Vasospasm (angina pectoris)

Thanks to additional diagnostic methods, you can find out how the valve apparatus functions.

It is impossible to identify the causes of chest pain with the help of an ECHO of the heart. Also, this method does not report on the state of the vessels, does not detect arrhythmia and blockade.

Despite its safety and lack of contraindications, it cannot be considered that echocardiography alone is sufficient to be sure that there are no heart problems. Diagnostic methods should be chosen by the doctor, and only he should evaluate the results of the studies.

Execution features

Patients who are prescribed ECHO are interested in how this procedure is done. It is simple and does not require preparation. To obtain the most accurate information, the patient is placed on the left side.

It is with this arrangement of a person that the heart is closest to the chest, and the picture becomes more accurate.

The data is captured by a sensor. The ultrasound beams from this transducer are able to study the chambers of the heart. When examining, it is important that the beam is of the correct shape and directed to the gap between the ribs. The ribs become an obstacle to the procedure and make it not effective enough.

The examination begins with an examination of the aorta and the study of its condition to identify pathologies. After that, the ventricles and atria are studied, then the contractile properties of the heart muscle are assessed.

To carry out this study, special knowledge and experience are required, therefore only doctors do echocardiography. They also decipher the data obtained and, on the basis of this analysis, establish a diagnosis. Further treatment is prescribed.

The patient before this procedure, as well as before the ECG, does not need to take any action. There is no need to follow a diet, and there is no need to stop taking medications.

What influences the results?

Distortions in the results in this study of the heart may occur due to the anatomical features of the patient. For a group of people, diagnosis in this way is very difficult.

These include people suffering from obesity, patients with an incorrect arrangement of organs inside the body or the structure of the chest.

Echocardiography for them is carried out by the transesophageal method, or another method is chosen: ECG or MRI.

Another factor that affects the accuracy of the work is the competence of the doctor who conducted the research. If he does not have enough experience or knowledge to carry out the procedure correctly, the results may not be correct. Therefore, it is so important that the diagnosis is carried out by a specialist.

The equipment used for echocardiography also has an impact. The same can be said about any other diagnostic method: ECG or MRI. The serviceability of devices, the quality of their manufacture, modernity - all this matters for accurate results.

Clinics where this service is provided.

• Indications for the procedure
• Methods for conducting echocardiography
• Preparation for the procedure
• Advantages of the echocardiography procedure

An echocardiogram is used to study the structure and functioning of the heart muscle. An echo cardiogram is a special research method in which the internal structure of the heart is studied using ultrasound, its work is analyzed. Ultrasound, passing through the walls and colliding with an obstacle, sends an impulse back. In this case, the device displays the presence of one or another obstacle.

A cardiac echocardiogram is an ultrasound examination of the function and structure of the heart.

Indications for the procedure

An echocardiogram is prescribed if the following symptoms and indications are present:

• in the process of examining a patient by a cardiologist, noises are detected when listening;
• when analyzing the electrocardiogram (ECG), there are obvious observable changes;
• if the patient's body temperature rises in the absence of any signs and symptoms of the disease;
• the patient himself clearly feels any interruptions in the work of the heart, breathing goes astray, the heartbeat quickens and slows down;
• when analyzing a radiograph, there are changes in the size or shape of the heart muscle, its position, the size of the vessels extending from the heart;
• patients suffering from high blood pressure, which can lead to disruption of the heart;
• if close relatives have any disturbances in the work of the heart itself, heart defects;
• with emerging dizziness, fainting, the presence of pain in the chest;
• after suffering heart disease.

After a past heart attack, it is very important to carry out the “Echo” procedure, since it is necessary to assess how the work of the heart has changed after the death of individual tissues and cells.

Heart echo is recommended for athletes, those people who are engaged in enhanced physical exercise, as well as those who are associated with frequent and severe stressful and emotional situations.

For children, an echocardiogram is performed in the same cases as for adults, and also without fail in the presence of congenital heart defects.

EchoCG is absolutely harmless. It allows you to assess any violations that have appeared in the work of the heart, to monitor the state of blood flow inside the heart and near it.

Echocardiography is also done during pregnancy. EchoCG is mandatory for the following categories of pregnant women:

• if close relatives had any heart defects or defects;
• if during pregnancy there was a miscarriage before;
• if a woman is observed on the issue of diabetes;
• if antibodies to rubella are detected in a biochemical blood test or the disease has passed in childhood;
• if the woman took any antibiotics in the first trimesters of pregnancy.

A fetal echocardiogram is usually done between 18 and 22 weeks of gestation. Echo cardiogram can be prescribed for children at almost all ages with the available indications.

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Methods for conducting echocardiography

The echocardiogram procedure itself can be carried out by various methods:

1. Cardiography in one dimension is to record the readings of cardiac activity in the form of a regular graph. This method is used extremely rarely, it allows you to evaluate the size and shape of the heart and its chambers, to analyze the work of the heart in the process of its contraction.
2. Two-dimensional cardiography consists of a static recording of the work of the heart, displayed in grayscale. On it you can see the process of cardiac contraction and closing of the heart valves. This method allows you to assess the condition of the walls of the heart, the condition and operation of the heart valves, detect tumors, thrombosis.
3. Doppler echocardiography consists in determining the rate and direction of blood flow to and from the heart, the patency of blood through the vessels. This method is very popular, because it allows you to determine exactly the direction of blood movement, which is very important, since it should only move in one direction. When analyzing the rate of passage of blood through the vessels, one can judge the state of the vessels themselves, their openness or the degree of narrowing.

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Preparation for the procedure

The use of all of the above methods is possible only if the patient does not have any acoustic and mechanical barriers, i.e. there are no additional devices that help the work of internal organs. In the presence of such devices, the patient needs to conduct a transalimentary echocardiogram. In this case, the patient is forced to swallow a special sensor, with the help of which the internal state of the heart muscle and blood vessels, the state of the walls of the heart are examined, visible violations and the presence of any changes, tumors are detected.

However, this procedure is contraindicated in patients suffering from various diseases of the digestive system, accompanied by bleeding and inflammation.

• if there is a possibility of bacterial infection of the heart valve;
• if there is an artificial valve, then it is necessary to check it from time to time;
• if there is suspicion of a violation of the atrial septum.

Often, a method such as a stress echocardiogram is also used. This method helps to examine the behavior and changes in the work of the heart muscle when it is affected by any stressful situations or under the influence of drugs. It reveals hidden disorders of the functioning of the heart muscle, which can only appear in certain situations. In this case, a two-dimensional Echocardiogram is made in the presence of highly professional doctors who, using various medications, physical activity, cause a certain stress on the patient's body, thereby analyzing the work of the heart at rest and in a stressful situation.

A stress echocardiogram is indicated in the following cases:

• to confirm the diagnosis of coronary heart disease;
• to monitor the degree of influence of vasoconstriction on the work and condition of the heart muscle;
• to determine the degree of effectiveness of the applied drug treatment.

The choice of a specific method for studying the work of the heart is determined by the attending cardiologist, depending on the condition and symptoms of the patient.

Echocardiography is a subspecies of ultrasound diagnostics, which allows you to visualize the pathology of the heart, blood circulation between its departments, the frequency and nature of contractions in various pathologies. This method is included in the list of the most common and informative cardiological studies.

With the help of ultrasound of the heart, it is possible to diagnose and observe the course of cardiomyopathy of various etiologies, inflammatory processes in the heart, anomalies in the structure of valves, stenosis of large vessels, etc.

The essence of Echo KG of the heart

Echocardiography of the heart is performed using a complex of special equipment, which contains:

• ultrasonic sensor;
• a sensor that receives reflected waves;
• a converter of analog data into digital form, which shows the organ under study on the monitor.

The diagnostic method is based on the property of tissues to reflect high-frequency ultrasound. The change in wave parameters depends on the density of the heart structures located under the signal. The study of the chest in different planes allows you to build a model of the organ and determine the volume, linear dimensions, density and shape of its chambers and large vessels suitable for it.

Depending on the indications, ultrasound of the heart is performed in several ways:

1. Transthoracic. Transthoracic echocardiography is performed with an external transducer placed on the surface of the chest. This method is the most common, because. makes it possible to estimate the size of the organ and its cavities without inserting the sensor inside and additional load.
2. Transesophageal. In this study, the inspection is performed by a tubular sensor, which is inserted into the esophagus. Transesophageal ultrasound provides the most accurate data on the deep structures of the heart (mitral valve, atrial septum, etc.). It is carried out with suspicion of damage to the valvular system, aneurysm and abscess of the aorta, septal defects between the atria.
3. Intravascular. Intravascular ultrasound is performed during cardiac catheterization, it consists in introducing a sensor through peripheral arteries or veins into the heart cavities and large vessels. This procedure is performed primarily not to examine the heart cavities, but to look for blood clots or other obstructions to blood flow.
4. Stress cardiography. A stress study is performed in the presence of a drug or physical activity that stimulates the activity of the heart. For this, sports exercises (running, exercise bikes) or medications (Adenosine, Dobutamine, etc.) can be used. Stress echocardiography allows assessing the function of the valvular system, the movement of the walls and the completeness of the filling of the chambers against the background of a growing load.

In some cases, microbubble contrast agents are used to study blood flow through the heart cavities and vessels.

There are 4 types of ultrasound cardiography:

1. One-dimensional echocardiography. A one-dimensional study (ultrasound in M-mode) involves the intersection of the structures of the heart with one ultrasound wave. The time (abscissa) and distance from the studied structures to the receiving sensor (y-axis) are recorded on the screen of the device. In M-mode, you can set the size of the cavities and the thickness of the walls of the heart.
2. 2D ultrasound. Study in B-mode allows you to study the structure and movement of the body in two projections. With two-dimensional ultrasound, it is possible to obtain data on myocardial contractility, the volume and linear dimensions of the chambers, the thickness of the walls of the cavities, the valve apparatus and subvalvular structures. In some cases, in B-mode it is impossible to accurately establish the border of the endocardium and exclude space-occupying formations.
3. Three-dimensional echocardiography. Three-dimensional ultrasound is performed using a special sensor that receives a signal in several directions of the examined volume. 3D ultrasound allows you to get a three-dimensional model of the heart and its movement. In comparison with the M- and B-modes, a three-dimensional study more accurately reflects the structure and function of the organ, the volume and ejection fraction of the ventricles, but is longer and more demanding for the correctness of the heart rhythm.
4. Echocardiography method with Doppler analysis. Doppler echocardiography allows you to determine the speed of direct blood flow in the heart cavities, the presence of backflow of blood and the diameters of the valves and aorta. The blood flow velocity is directly proportional to the change in the frequency of the received wave. The information obtained can be useful for diagnosing congenital malformations and diseases that lead to ventricular filling disorders.

The most common diagnostic method in cardiology is two-dimensional transthoracic ultrasound cardiography.

Indications and contraindications for

ECHO of the heart is prescribed for prophylactic purposes in the diagnosis and monitoring of the course of heart diseases, as well as for monitoring the patient after surgery for the implantation of artificial valves and after other surgical interventions.

Indications for ultrasound cardiography are:

• arterial hypertension;
• suspicion of congenital and acquired valve pathologies;
• hereditary predisposition to heart defects;
• pulmonary embolism and myocardial infarction in history (study of myocardial contractility after necrosis of a part of functional cells and monitoring of the condition during preventive examinations);
• diagnosis of coronary heart disease, assessment of contractility and filling of the left ventricle in angina pectoris;
• differential diagnosis of aneurysm and pseudoaneurysm;
• atypical location and volume of the heart, a change in the shape and size of its large vessels, the presence of volumetric neoplasms on the radiograph;
• establishing the type of cardiomyopathy;
• the presence of noise during auscultation (listening) of the organ;
• rheumatism;
• endocrine and other pathologies that provoke secondary myocardial dysfunction.

• frequent dizziness and fainting;
• chronic headaches;
• severe shortness of breath during physical and emotional stress;
• cyanosis (cyanosis) of the skin around the lips, nose, ears, manifested or aggravated by physical exertion;
• swelling of the lower extremities;
• chest pain (mainly retrosternal pain radiating to the neck, left shoulder, shoulder blade and arm);
• feeling of a sinking heart, interruptions in the heart rhythm;
• fast fatiguability.

In some cases, an echogram is prescribed in connection with pregnancy. Women who are pregnant or planning to conceive are advised to undergo an ultrasound of the heart for the following indications:

• diabetes;
• high titers of antibodies to Rubella virus or rubella suffered during gestation;
• the presence of heart defects in close relatives;
• taking antibiotics, antiepileptic drugs and other presumably embryotoxic drugs before 16 weeks of gestation;
• miscarriage (spontaneous miscarriages and premature births in history).

EchoCG is assigned to both the most pregnant woman and the fetus. The study is performed transabdominally at 18-22 weeks of gestation.

Preventive ultrasound cardiography, which is performed in the absence of symptoms of heart disease, is recommended at the following intervals:

• adults and children who are not on the cardiological register - 1 time in 1-2 years;
• people who are actively involved in sports, and those whose professional activities are associated with great physical exertion - annually;
• elderly people (over 60 years old) - 1-2 times a year;
• patients registered with a cardiologist for implants or asymptomatic cardiovascular pathologies - 2-3 times a year.

Transthoracic ultrasound CG has no absolute contraindications. A relative contraindication to examination through the sternum can only be an allergy to the gel, which provides acoustic contact between the transducer and the skin.

Contraindications to stress cardiography are the following diseases:

• aortic aneurysm;
• thromboembolism of the pulmonary artery and other large vessels;
• severe insufficiency of the function of the excretory, cardiovascular and respiratory systems;
• myocardial infarction (in the early stages).

Conducting transesophageal ultrasound CG is contraindicated in such pathologies as:

• varicose veins of the esophagus;
• protrusion (diverticulum) and neoplasms of the esophageal wall;
• violation of the integrity of the esophagus in history;
• large diaphragmatic hernia;
• severe osteochondrosis, displacement and instability of the cervical vertebrae;
• radiation inflammation of the esophageal mucosa;
• bleeding in the gastrointestinal tract;
• strong gag reflex.

Preparing and conducting a survey

Conducting transthoracic echocardiography and echocardiography with Doppler analysis does not require special training. However, there are a few general rules that must be followed before starting the study:

• do not drink caffeinated and alcoholic drinks during the day before the procedure;
• do not smoke for at least 2-3 hours before the study;
• warn the attending physician and the diagnostician about the constantly taken medicines;
• if necessary, skip taking medications that affect cardiac activity on the day of the procedure;
• do not exert yourself physically for several hours before the examination;
• sit and relax for 15-20 minutes before cardiography.

Before conducting a transesophageal ultrasound, you must refuse to eat and drink 4-8 ​​hours before the procedure. If the patient has a probe or removable dental implants, these devices should be removed prior to cardiography.

The prohibition on the use of food and liquid is also valid for intravascular examination, which is carried out simultaneously with coronary angiography or open surgery.

During transthoracic ultrasound, the patient lies on the left side. This position of the body allows you to simultaneously examine all the chambers of the heart, providing maximum convergence of the apex (the narrowed part of the organ formed by the left ventricle) and the left side of the chest.

With a standard EchoCG, the diagnostician applies a medical gel to the device's sensor, which improves the contact of the electrodes with the skin. The sensor is installed alternately in several main positions: the jugular fossa, in the region of the V intercostal space with a shift of 1-1.5 cm to the left, under the xiphoid process (at the upper point between the lower ribs). During the procedure, the patient must follow the instructions of the doctor (inhale smoothly, hold the breath, change position if necessary, etc.).

The obtained data on the distortion of the ultrasonic wave is digitized and visualized on the screen. The echocardiogram is presented as a sector of a circle.

Stress cardiography consists of two stages:

1. At the first stage, a standard transthoracic ultrasound is performed and the filling of the heart chambers, rhythm and other parameters are assessed.
2. At the second stage, ultrasonic sensors are attached to the chest, which record changes in the activity and structure of the heart during exercise and continuously transmit data to a computer. After that, the patient is injected with stimulating medications or is invited to work out on simulators. With good tolerance of the minimum load, it is recommended to increase the speed of running or pedaling, and if you feel worse and have a sharp increase in pressure, stop.

With transesophageal ultrasound of the heart, medical preparation for the procedure is required. To eliminate the gag reflex and relieve discomfort when the sensor moves, it is recommended to irrigate the pharynx with a solution of Lidocaine (10%), and to calm and reduce the secretion of saliva and gastric juice, the introduction of Relanium (2 ml) and Atropine (1 ml of a 0.1% solution).

After medical preparation for the procedure, the patient lies on his left side, as in transthoracic ultrasound. The doctor lubricates the endoscope with medical gel and inserts it into the patient's throat without applying excessive force. To advance the endoscope into the esophagus, the patient should make several swallowing movements.

With intravascular ultrasound, an ultrasonic transducer is inserted directly into the lumen of the arteries under X-ray control.

The duration of the EchoCG procedure is 10-40 minutes, depending on the mode and method of its implementation. To prevent complications after transesophageal and intravascular ultrasound, the patient stays in the hospital for several hours.

Principles for decoding results

With Echo KG of the heart, the following indicators are determined:

• dimensions of the organ, its inner, muscular and outer shell, atria and ventricles at the moment of tension and relaxation;
• ejection fraction of blood;
• thickness and structure of the walls of the heart;
• the size of the aortic orifices and valves;
• frequency and rhythm of beats;
• the volume of fluid and the presence of adhesions in the pericardium (heart sac).

Doppler ultrasound allows you to explore the completeness and speed of blood flow, the structure of blood vessels and the degree of their stenosis.

The accuracy of ECHO results can be affected by:

• anatomical features of the patient (age, gender, amount of fat mass, chest deformities, lung pathology, etc.);
• equipment quality;
• the experience of the doctor conducting the diagnosis (the ability to install the sensor at the right points depending on the characteristics of the patient, analyze the data and determine the affected areas).

The following results may indicate pathology of the heart:

1. Deceleration of the arterial valve opening and its closure in the stress phase (systole) in combination with an increased ejection fraction of the right ventricle is indicative of pulmonary hypertension. High systolic pressure and a thickened wall of the right ventricle may indicate the same disease.
2. An increase in the size of the ventricle and atrial wall, shunting of blood from the aorta indicate a patent ductus arteriosus, which is a congenital defect.
3. Thickening of the atria and the presence of a breakdown in the wall between them are signs of atrial septal defect.
4. An increase in the volume of the heart cavity and thickening of the walls, the presence of an ejection from the left to the right ventricle indicate a congenital pathology (gap) of the interventricular septum.
5. A decrease in the opening between the ventricle and the atrium, thickening of the mitral valve are signs of stenosis.
6. Thickening of the walls of the left chambers of the heart, weakened compression of the valve leaflets in the systolic phase indicate prolapse. An additional sign is the presence of reverse blood flow (regurgitation). Against the background of insufficient ejection of blood into the vessels, heart failure develops.
7. The weakening of contractions in the area of ​​​​the heart muscle indicates a previous heart attack and the formation of a post-infarction scar.
8. The presence of ruptures, branches and other pathological formations on the heart valves is a sign of endocarditis.
9. Insufficiency of contractile function, an increase in the volume of the chambers and a decrease in the ejection fraction of the left ventricle to 50% or less indicate myocarditis.
10. Exceeding the normal volume (30 ml) of fluid in the pericardium (hydropericardium) may indicate exudative pericarditis, trauma, tumors, vascular rupture, and other diseases.

Also, on ultrasound of the heart, pericardial adhesions, blood clots, necrosis zones, scars and other pathological formations can be detected.

The results of the study are evaluated by the doctor who performs the procedure and the cardiologist who observes the patient. Deviations from the norm in ultrasound are not a sufficient diagnostic criterion for making a diagnosis: cardiography data must be compared with the patient's complaints, the results of laboratory diagnostics, ECG, CT and the results of other studies.