Cardiac and Peripheral Evaluation

Testing facilities available: Cardiac investigations

• ECG
• Echocardiogram
• Exercise stress echocardiogram
• Exercise stress test (ECG)

What is an Echocardiogram?

An echocardiogram is a test in which ultrasound is used to examine the heart. In addition to providing single-dimension images, known as M-mode echo that allows accurate measurement of the heart chambers, the echocardiogram also offers far more sophisticated and advanced imaging. This is known as two- dimensional (2-D) Echo and is capable of displaying a cross-sectional “slice” of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right ventricle.

An echocardiogram can be obtained in a physician’s office or in the hospital. For a resting echocardiogram no special preparation is necessary. Clothing from the upper body is removed and covered by a gown or sheet to keep you comfortable and maintain the privacy of females. The patient then lies on an examination table or a hospital bed.

Sticky electrodes are attached to the chest and connected to wires. These help to record the electrocardiogram (ECG) during the echocardiography test. The ECG helps in the timing of various cardiac events (filling and emptying of chambers). A colourless gel is then applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes recordings from different parts of the chest to obtain several views of the heart. You may be asked to move from your back and to your left side, so the heart sits closer to the chest wall.

Instructions may also be given for you to breathe slowly or to hold your breath. This helps in obtaining higher quality pictures. The images are constantly viewed on the monitor. Images and measurements are stored digitally for permanent record of the examination and are reviewed by the physician prior to completion of the final report.

Echocardiography is an invaluable tool in providing the doctor with important information about the following:

• Chamber size of the heart, including the dimension or volume of the cavity and the thickness of the walls.
• The appearance of the walls which may help identify certain types of heart disease that predominantly involve the heart muscle.
• Blood flow (direction and velocity).
• Pumping function of the heart can be assessed by echocardiography. This measure is known as an ejection fraction or EF. A normal EF is around 55 to 65%.
• Valve Function: Echocardiography identifies the structure, thickness and movement of each heart valve.
• Echocardiography is useful in the diagnosis of fluid in the pericardium (the sac that surrounds the heart).

Other diagnoses made by echocardiography include congenital heart diseases, blood clots or tumours within the heart, active infection of the heart valves and abnormal elevation of pressure within the lungs.

Echocardiography is extremely safe. There are no known risks from the clinical use of ultrasound during this type of testing. A brief examination in an uncomplicated case may be done within 20-30 minutes. However, it may take up to 45mins when there are multiple problems or when there are technical problems (for example, patients with lung disease, obesity, restlessness, and significant shortness of breath may be more difficult to image).