•Test that uses sound waves to create a moving picture of the heart.
•During this test, high-frequency sound waves, called ultrasound,
provide pictures of the heart's valves and chambers.
• This allows the technician, called a sonographer, to evaluate the
pumping action of the heart.
•Echo is often combined with Doppler ultrasound and color Doppler
to evaluate blood flow across the heart's valves.
•Size of the heart
An echocardiogram allows doctors to monitor:
•Abnormal heart valves
•The pumping function of the heart for people with heart failure
•Damage to the heart muscle in patients who have had heart attacks
•The source of a blood clot or emboli after a stroke
•Congenital heart disease
•An instrument that transmits high-frequency sound waves called a
transducer is placed on the ribs near the breast bone and directed
toward the heart.
•The transducer picks up the echoes of the sound waves and
transmits them as electrical impulses. The echocardiography
machine converts these impulses into moving pictures of the heart.
TYPES OF ECHOCARDIOGRAM DESCRIPTION
•Painless test similar to X-ray, but
without the radiation
•Transducer is placed on the chest and
transmits high frequency sound waves
(ultrasound). These sound waves bounce
off the heart structures, producing
images and sounds that can be used to
detect heart damage and disease.
•Transducer to be inserted down the
throat into the esophagus
•Because the esophagus is located close to
the heart, clear images of the heart
structures can be obtained without the
interference of the lungs and chest.
•Stress echocardiogram •Performed while the person exercises on
a treadmill or stationary bicycle.
• Used to visualize the motion of the
heart's walls and pumping action when
the heart is stressed
•Is performed just prior and just after the
•Reveals a lack of blood flow
•Gives information about the heart's structures and blood flow
•The major limitation is that it is often difficult to obtain good quality
images in patients who have broad chests, are obese, or are suffering
from chronic lung disease (such as emphysema)
SAFETY: The echo test is very safe. There are no known risks from the
ultrasound waves. 7
•Is “radiographic visualization of coronary vessels after
injection of radiopaque contrast medium.”
TYPES •Heart (coronary angiogram)
•Lungs ( pulmonary angiogram)
•Brain (cerebral angiogram)
•Commonly used to check the condition of blood
•An Angiogram uses x-rays and a special dye
(contrast) to take pictures of the arteries in heart
•Can be used to show blockages in your arteries.
• Shows a clear picture of the blood vessels. Useful in
• Reveals aneurysms (a bulge on an artery caused by a
blood vessel wall becoming weaker).
• Gives good view of the carotid artery and its branches in
the neck and head.
• The test is used to show if the arteries of the heart have
•Before taking an X-ray, a liquid dye is injected into the blood vessels.
The catheter is inserted into the groin, or occasionally the arm.
•Before inserting into an artery, the surrounding area is numbed with a
•A short, thin wire with a rounded tip is then carefully inserted into the
artery using a needle.
•It is guided with the help of fluoroscopy (X-ray images) to the spot
where the dye is needed.
•The needle is then removed and a vascular sheath inserted around the
wire. A catheter may then be inserted along the guide wire.
•When the catheter is in the correct position, the wire is pulled out and
dye is inserted through the catheter.
•Now the blood vessels can be checked on a screen, or on a series of
rapidly recorded X-rays.
•Cardiac catheterization carries a slightly increased risk when
compared with other heart tests.
•Safe when performed by an experienced team.
•Generally the risk of serious complications ranges from 1 in 1,000 to 1 in
•Risks of the procedure include the following:
•Trauma to the artery causing a hematoma
•Low blood pressure
•Allergic reaction to contrast medium
•Angioplasty is the technique of mechanically widening a narrowed
or obstructed blood vessel
Carotid angioplasty & stenting; CAS
•The inflated balloon crushes the fatty
deposits, opening up the blood vessel
for improved flow, and the balloon is
then deflated and withdrawn.
•An empty and collapsed balloon on a
guide wire, known as a balloon catheter
is passed into the narrowed locations &
then inflated to a fixed size
•Surgical cut in groin
•A catheter is inserted through the cut into an artery
•Catheter is guided up to the blockage in your carotid artery.
•Live x-ray pictures are used to see artery. This kind of x-ray is called
•A guide wire is passed through the catheter to the blockage.
•Another catheter with a very small balloon on the end is pushed
over the guide wire and into the blockage.
• Then the balloon is blown up. The balloon presses against the inside
wall of artery.
•This opens the artery and restores proper blood flow.
•A stent (a wire mesh tube) may also be placed in the blocked area.
It expands when the balloon is blown up.
•The stent is left in place to help keep the artery open.
• The balloon is then removed.
•Useful in condition of atherosclerosis
Angioplasty with or without stenting may be used to treat:
• Persistent chest pain (angina) that medicines do not control
•Clears blockage in a coronary artery during or after a heart attack
•Some patients who have many blockages or blockages in certain
locations may need a coronary bypass (heart surgery).
•Seizures (this is rare)
•Stroke (this is rare)
•Stress causes normal coronary arteries to dilate,
while the blood flow in a blocked coronary
artery is reduced. This reduced blood flow may
decrease the movement of the affected wall (as
seen by echo), or have reduced isotope uptake
in a nuclear scan
•Agents that are commonly used in pharmacologic stress testing
include dipyridamole, dobutamine
•A chemical or pharmacological stress test combines an intravenous
medication with an imaging technique (isotope imaging or
echocardiography) to evaluate the LV.
•Medication serves the purpose of increasing the heart load instead
of using exercise
•notify your physician if you have a
history of asthma, bronchitis or
•Diabetics, particularly those who use
insulin, will need special instructions
•Caution about asthma: The use of
Inhibitor) is generally avoided in
patients with asthma.
•Gives an idea about the patient's exercise tolerance
•pharmacologic or chemical stress test is performed in situations of
severe arthritis, prior injury, reduced exercise tolerance or in patients
who are unable to increase the heart rate
•The imaging portion of the test is identical to that used during Stress
•An intravenous line is started in the arm, the blood pressure is
checked and an EKG recorded. The EKG is also constantly monitored
on the screen.
•If Stress Echo is being performed, an echocardiogram is obtained
before and immediately after administration of the stress producing
• In cases of stress isotope testing, the resting images may be obtained
before or approximately two hours after the stress
•The stress-producing medication is given intravenously, as per
•In cases of dipyridamole, the medication is
usually given over four minutes, through
the IV line. A drop in the diastolic (lower
number) blood pressure is generally
awaited before administration of the
•If a patient is able to perform mild
exercise, he or she may be asked to walk
on a treadmill for a minute or so after the
injection of dipyridamole.
•In cases of dobutamine, drug is given as a continuous drip with a
gradual increase in the rate (at three minute intervals). The patient's
heart rate accelerates and the isotope is given when 85% of the target
heart rate is achieved.
•The patient is exposed to a very small amount of radiation and the
risk is minimal.
•Also, the stress medicine like Dobutamine can be immediately
stopped if there are problems
•The effects of dipyridamole (which can occasionally cause nausea or
a headache can be reversed by aminophylline (an anti-asthma
RISK AND SAFETY
•Technical problems can occur when a patient is markedly
overweight. Some men may demonstrate an inferior wall
abnormality because of a prominent diaphragm
• Patients who have a left bundle branch block on their EKG may also
have a false abnormal test.
Pharmacotheraphy,A pathophysiological approach;T.Dipiro;Edition 7
The goal of cardiac testing is to help stratify patients thought to be
at risk for symptomatic coronary artery disease, specifically for
short-term complications such at myocardial infarction (MI) or
sudden cardiac death.