Heart echo indications, types of examination and methodology

Echo of the heart (Greek “echo” – echo, echo) is an examination of the heart using pulsed ultrasound, which allows to evaluate the structure, size and condition of the heart muscles and valves. This method makes it possible to study the work of the heart in real time, to track changes in the speed and characteristics of the movement of blood in the atria and ventricles.

The principle of ultrasound of the heart is based on the registration of ultrasonic waves reflected from various structures of the organ and blood vessels having different densities. At the same time, a moving image is created on the screen, which can be recorded on a video tape or disk.

The doctor can obtain images of almost any structure of the heart by changing the position or angle of the ultrasonic wave transducer.

The study allows you to see the volumetric image of the organ, make virtual sections, estimate the size of the heart structures, the volume of the chambers, and the wall thickness. Using this method, you can even determine the mass of muscle tissue of the heart, evaluate its contractile function.

This is the only non-invasive (without direct intervention) method that allows you to get complete and reliable information about the severity of various diseases. Thus, a comprehensive analysis and evaluation of the results make it possible to determine the physiological mechanism of heart failure.

Today, without this type of research, adequate diagnosis and management of patients with such a pathology is impossible.

The advantages of the method of heart echo are that it is not associated with the use of x-ray radiation, it is absolutely harmless and painless, which does not prevent it from providing high accuracy. To obtain an image of high quality, a special sensor is introduced into the patient’s esophagus, with which an image is obtained.

The high clarity of such an image allows you to see pathological changes in the smallest cardiac structures. When conducting such studies, it is possible to identify congenital and acquired heart defects, various forms of ischemic disease, hypertension, aneurysmal lesions of the aorta.

You should do an echo of the heart if you are concerned about pain in its area, noise and rhythm disturbance.

Diseases such as cardiomyopathy, hypertension, a history of myocardial infarction, and signs of heart failure are also an indication for this type of research.

In recent years, there has been an increase in the incidence of thrombophlebitis and varicose veins. People suffering from these ailments also need to monitor the work of their heart, because they are fraught with serious complications.

Inflammatory heart diseases (myocarditis, endocarditis, pericarditis, etc.), benign and malignant neoplasms – also require a thorough examination on an echocardiograph.

Types of echocardiography

Options for echocardiographic examination:

    Two-dimensional echocardiography is a real-time image of the heart along the long or short axis.

Two-dimensional echocardiography (B-mode) allows real-time assessment of the size of the heart cavities, the thickness of the walls of the ventricles, the state of the valve apparatus, subvalvular structures, global and local contractility of the ventricles, the presence of cavity thrombosis, etc.

M-mode – a graphic image of the movement of the walls of the heart and valve flaps in time.

The M-mode allowed for the first time in real time to evaluate the size of the heart and the systolic function of the ventricles. At present, it is used as an auxiliary mode for conducting echocardiographic studies mainly for measurements.

In the case when in the parasternal position the cursor of the M-mode is located strictly perpendicular to the image of the heart, the measurements can be carried out with great accuracy.

If the image of the heart and the cursor are angled, all dimensions of the heart chambers will be significantly overestimated and may be misinterpreted. This error occurs with specialists with a short experience.

Therefore, measurements should be made in the B-mode at the end of the diastole if the M-mode cannot be applied. Currently, a number of companies have proposed using the anatomical M-mode, which allows you to change the cursor angle.

On the M-scan graph, the vertical distance is plotted, the horizontal horizontal is time. Depending on the position of the cursor on the screen, you can get a graph of the oscillation of a series of points located along the cursor, elongated in time, i.e. trace their fluctuation in systole and diastole.

Doppler echocardiography – pulsed, continuous-wave, color, color M-mode, energy, tissue color, tissue pulsed, tissue C-mode, etc. – a method that allows you to non-invasively evaluate the parameters of central hemodynamics.

The active application of the technique in medicine can be attributed to the beginning of the 80s. Doppler study implies a high technical skill in conducting two-dimensional research, knowledge of topographic anatomy and hemodynamics of the heart.

In echocardiography, the following Doppler options are used:

  • Pulse Doppler (PW – pulsed wave).
  • Pulse high frequency doppler (HFPW – high frequency pulsed wave).
  • Permanent wave doppler (CW – continuouse wave).
  • Color Doppler
  • Color M-modal Doppler (Color M-mode).
  • Power Doppler
  • High-speed tissue doppler (Tissue Velosity Imaging).
  • Fabric Pulse Doppler (Pulsed Wave Tissue Velosity Imaging).

Pulse Doppler (Pulsed Wave, or PW). The graphic spread of the pulse-wave Doppler reflects the nature of the blood flow at a particular given point, at the installation location of the control volume. The control volume setting point is called the baseline.

The flow rate is plotted vertically on the graph, and time is plotted horizontally. All flows that move to a sensor at a given point are located on the graph above the baseline; all flows that move from the sensor are below the zero line.

In addition to the shape and nature of the blood flow on the graph, you can fix clicks of the opening and closing of valve cusps, additional signals from the chords of the cusps and walls of the heart. Pulse Doppler has a speed limit (not more than 2,5 m / s), so with it you can not register streams that have a high speed.

Pulse high frequency doppler (HFPW – high frequency pulsed wave). Several control volumes are located one after another at different depths. This allows you to register blood flow, the speed of which exceeds 2,5 m / s.
Constant Wave Doppler (CW – Continuous Wave Doppler). Allows to register high-speed streams.

The disadvantage of this method is that all flows along the ray are recorded on the graph.

The CW Doppler technique allows you to calculate the pressure in the cavities of the heart and the great vessels in one or another phase of the cardiac cycle, to calculate the degree of significance of stenosis, etc.

The basic CW equation is the Bernoulli equation, which allows you to calculate the pressure difference or pressure gradient. Using the equation, you can measure the pressure difference between the cameras in the norm and in the presence of pathological, high-speed blood flow.

Color Doppler Color Doppler is an analogue of a pulse Doppler, where the direction and speed of blood flow is mapped in a different color.

So the blood flow to the sensor is usually mapped in red, from the sensor in blue. Turbulent blood flow is mapped by a blue-green-yellow color.

Color M-modal Doppler (Color M-mode). Comparison of the M-modal mode and the color Doppler when holding the cursor through this or that plane allows you to understand the phases of the cardiac cycle and pathological blood flow.

Power Doppler It is used to register low-speed blood flow, therefore, in cardiology, it still does not find active use. When using energy doppler, the direction of blood flow is lost.

Currently, energy doppler is used in combination with contrast agents (leftist and others) to study myocardial perfusion.

Tissue Velocity Imaging The principle of this method is based on mapping the direction of tissue movement in a specific color. Thus, red color indicates movement to the sensor, blue – from the sensor.

By studying the direction of motion of the walls of the left and right ventricles in systole and diastole with the help of TVI, you can detect hidden zones of violation of local contractility. The combination of two-dimensional research in TVI mode with M-modal increases the accuracy of diagnosis.

Tissue Pulse Doppler (Pulsed Wave Tissue Velocity Imaging). Allows you to evaluate graphically the nature of the movement of the walls of the ventricles at a specific point. The systolic component, the early and late diastolic components are distinguished.

This Doppler option allows for myocardial mapping and increases the accuracy of diagnosis in patients with coronary heart disease.

Thus, Doppler techniques allow you to get a large amount of information without the use of invasive research methods.

  • Transesophageal echocardiography (mono-, bi-, and multiplanar). Examination of the heart through the esophagus using special sensors. The information content of the method is very high. Contraindication is the presence of stricture of the esophagus.
  • Stress echocardiography (using physical activity, transesophageal electrostimulation or drug use). It is widely used in patients with coronary heart disease.
  • Three-dimensional and four-dimensional modeling of the heart – computer image analysis and the construction of a three-dimensional image of the heart chambers, valve flaps, blood flow, etc.
  • Intravascular ultrasound – the study of coronary arteries using a special intravascular sensor of small diameter. Invasive ultrasound method. Used in parallel with coronarography.
  • Contrast echocardiography – used to contrast the right chambers of the heart with a suspected defect, or the left chambers of the heart to study myocardial perfusion.

    The information content of the method of contrasting the left chambers of the heart is comparable with myocardial scintigraphy. A positive factor is the absence of radiation exposure to the patient.

    Negative factors are the invasive nature of the method and the high price of the drug (leftist, albunex, etc.).

    Modern echocardiographic instruments

    Currently, the market offers ultrasound devices from the simplest to the most complex with the possibility of three-and four-dimensional modeling. Screening of the heart can be performed on any ultrasound device, in the presence of an appropriate cardiological sensor and B- and M-modes.

    In this case, inexpensive ultrasound scanners can be used. The level of diagnosis and the percentage of error in this case largely depend on the qualifications of the specialist.

    Modern echocardiographic examination should include, in addition to the B and M modes, color doppler, pulse wave doppler and continuous wave doppler.

    In the presence of pathology, only a continuous wave doppler will make it possible to measure high-speed pathological flows, carry out all the necessary calculations and measurements, and evaluate hemodynamics.

    The amount of information received depends on the capabilities of the sensor. Intravascular sensors are used in parallel with angiography, used by cardiac surgeons. Transesophageal transducers can be monoplanar, biplane, and multiplanar.

    Modern technologies (tissue doppler, contrasts) can significantly increase the information content of the study, especially in patients with myocardial pathology. Work programs with echo contrasts are widely developed abroad, however, in our country this direction in ultrasound is not represented enough.

    Indications for ultrasound of the heart

    Echocardiography is recommended as an annual preventive examination for patients with suspected (or already present) heart disease or other abnormalities of the cardiovascular system.

    Echocardiography is also prescribed for:

    • shortness of breath, general weakness, fatigue,
    • tremors in the chest or sudden pains,
    • swelling of the ankles, cooling of the limbs, frequent whitening of the limbs,
    • suspected aneurysm (expansion of the thoracic aorta),
    • suspected presence of tumors and formations in the heart,
    • high blood pressure
    • noise in the heart
    • cyanosis on the skin: both arms and legs, and in the area of ​​the auricles, nose,
    • myocardial infarction
    • assessment of changes in the heart muscle in coronary heart disease, arterial hypertension, atherosclerosis.

    In addition to these categories of patients, ultrasound is recommended for weightlifters, divers, marathon runners in order to make sure that their heart can withstand heavy loads.

    Echocardiography is also performed for those patients who often suffer from bronchitis, tonsillitis, pneumonia for early detection of heart failure. Without fail, an echocardus must be done after previous pathologies:

    • rheumatism;
    • heart defects – acquired and congenital;
    • scleroderma;
    • systemic lupus erythematosus;
    • myocardial infarction;
    • heart rhythm disturbances;
    • swelling;
    • hypertension (in particular, if the patient suffered a hypertensive crisis).
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    There are no absolute contraindications for conducting echocardiography. The study may be difficult in the following categories of patients:

    • Chronic smokers, persons suffering from bronchial asthma / chronic bronchitis and some other diseases of the respiratory system;
    • Women with a significant size of the mammary glands and men with pronounced hairiness of the anterior chest wall;
    • Persons with significant deformities of the chest (rib hump, etc.);
    • Persons with inflammatory diseases of the skin of the anterior chest.

    Pregnancy at any time is not a contraindication for conducting echocardiography; on the contrary, obstetric practice often necessitates an ultrasound of the heart in order to determine the tactics of pregnancy and childbirth.

    How to prepare for the ultrasound procedure of the heart

    If you go to see a specialist about conducting echocardiography, you need to bring the results of previous examinations with you. This will allow you to trace the dynamics of changes that occur with the heart and blood vessels of the patient.

    If a transthoracic echocardiography of the heart is performed, then no additional preparatory measures should be done before such an examination. It is important that the skin of the chest is clean. No need to follow a diet and drinking regimen.

    Regarding food, here it is possible to recommend that patients observe moderation and not overeat: in some cases, this can provoke inaccuracies in the results and their interpretation.

    Before the echocardiography procedure, it is extremely important not to drink alcohol and not to smoke: this changes the indicators and contributes to the change in the diagnostic results. Also, before the echocardiography procedure, you need to avoid emotional overload, intense physical labor.

    All this also adversely affects the results of heart diagnostics using ultrasound radiation. When there is a transesophageal echocardiographic examination, the patient must follow the same recommendations. Another one is added to them – this is avoiding food intake about three hours before the examination.

    If such an examination is carried out for a nursing baby, then it is done in the intervals between breastfeeding.

    How is the survey

    Special preparation for the ultrasound of the heart is not required. The patient is lying on his left side. In this case, the left part of the chest and the apex of the heart come closer. This allows you to better visualize the heart in a four-chamber position during echocardiography.

    For echocardiography, a special sensor is used, which is able to give an ultrasound beam in the form of a sector. This allows you to place the sensor on the intercostal spaces, since the ribs impede the passage of ultrasound.

    There are several main positions that are mandatory when conducting echocardiography. The study begins with an assessment of the state of the aortic orifice in the projection of the long axis of the heart.

    When conducting echocardiography, you can get information about the size of the aortic ring, signs of atherosclerotic lesions, changes in the walls of the aorta and aortic valve dysfunction.

    Also, with echocardiography, the diameter of the left ventricular outflow tract is evaluated. This is important for the diagnosis of subaortic stenosis. Also, from the projection of the long axis of the heart during echocardiography, information is obtained on the movement of the cusps of the mitral valve, interventricular septum and posterior wall of the left ventricle, as well as on the left atrium.

    In this position use the M-mode. M-mode (from the English. Motion) was just the first time used in echocardiography.

    When conducting research in m-mode, time-measured information on the movement of valves and the walls of the heart in one dimension is obtained. Based on the m-mode, echocardiography measures the ejection fraction according to the Teicholz method. This method is not accurate and is suitable only for a rough estimate of the contractility of the myocardium.

    The next position is echocardiography in the projection of the short axis of the heart. At the same time, structures such as the aortic valve can be evaluated – its valves, pulmonary artery and the right ventricular outflow tract, pulmonary valve, left atrium and right ventricle are clearly visible.

    The mouths of the coronary arteries are also visible. To measure the speed of blood flow and direction, use the function of a pulsed Doppler. Thus, in this position, information is obtained about the speed of blood flow through the pulmonary artery and its branches, about the direction, strength and speed of the reverse flows through the valve of the pulmonary artery during regurgitation (returning blood in the opposite direction).

    Also, diastolic pressure in the pulmonary artery is judged by the flow of blood into the diastole through the valve of the pulmonary artery. In the position of the short axis of the heart, one can also evaluate the area of ​​the mitral valve opening and estimate the mass of the myocardium.

    The position most visible to the patient is four-chamber (apical). With echocardiography in a four-chamber position, the sensor is installed in the fourth intercostal space at the level of the apex of the heart.

    Performing echocardiography in a four-chamber position, the volume of the left ventricle is estimated in systole (during contraction) and in diastole (during relaxation). The difference in these volumes is called the stroke volume. If you divide the stroke volume into the end-diastolic volume, you can get a number called the ejection fraction.

    This is a very important indicator that integrally reflects the pumping function of the heart. With an ultrasound of the heart in a four-chamber position, a Doppler study of blood flows through the mitral and tricuspid valves is performed.

    If you slightly identify the position of the sensor, with echocardiography receive a five-chamber position of the heart. In this position, the velocity characteristics of the blood flow in the aorta are measured. To refine the measurement of the cavity of the left ventricle during echocardiography, a two-chamber position is also used, in which the scanning plane is perpendicular to the four-chamber.

    This is due to the fact that in the cross section the cavity of the left ventricle is similar to an oval and the average diameter is derived. Also, the two-chamber position is expert with ultrasound of the heart, if there is a suspicion of mitral valve prolapse.

    Another application of the two-chamber position is the study of the left atrial abalone: ​​the presence of blood clots in it, assessment of the contractility of the left atrial abalone. In some cases, with echocardiography, additional approaches are used – under the sternum and above the sternum.

    The results of the study are recorded in the protocol. Also, with echocardiography, several coefficients are calculated — the cardiac index, the left ventricular mass index — for a more convenient assessment of the function of the heart, depending on the person’s body weight and height.

    Transesophageal echocardiography of the heart

    This study is shown in such cases:

    1. There is a suspicion of bacterial damage to the heart valves (infectious endocarditis).
    2. As a routine examination, if there is an artificial (especially if it is an aortic) valve. Before performing prosthetic valves.
    3. After a stroke, transient disorders of cerebral circulation, especially when there is a permanent form of atrial fibrillation – in order to exclude the embolic nature of these diseases.
    4. Before conducting cardioversion (electropulse stimulation, which gives a chance to normalize the heart rhythm with constant forms of certain types of arrhythmias).
    5. If you suspect a defect in the septum between the atria.
    6. If it is necessary to study the condition and work of the heart, but there are more areas of costal ossification or other pathologies of the chest wall that will not allow ultrasound to “break through” through them.

    You can not conduct an echogram of the heart through the esophagus with:

    • tumors, cramps, diverticulums of the esophagus
    • esophageal varicose veins
    • if there has ever been a case of esophageal perforation, even if it is not a medical oversight, but, for example, an injury or injury by a fish bone
    • instability of the cervical vertebrae
    • large diaphragmatic hernia
    • severe cervical osteochondrosis
    • bleeding from the esophagus, stomach or upper intestines
    • pronounced gag reflex
    • damage to radiation therapy of the esophagus.

    Preparation and technique of transesophageal echocardiography:

    • 4-6 hours before the study, you can not eat, 4 hours you need to stop drinking.
    • Immediately before the study, you need to remove removable dentures, remove the probe from the stomach (if any).
    • The doctor conducting the study irrigates the oropharynx of the test lidocaine to reduce the vomiting reflex and discomfort.
    • The patient is placed on the left side, a mouthpiece is inserted into the mouth, then an endoscope is inserted into the esophagus (a thick probe with optical fiber).
    • Through the endoscope, ultrasonic waves are fed and received.
    • All ongoing echocardiography is removed on video.
    • The procedure takes 15-20 minutes

    How acquired defects are visible on ultrasound

    Acquired heart defects are also perfectly visualized on the monitor. So, for example, a narrowing of the mitral valve often occurs (and it is located between the LV and the left atrium and does not allow blood to be transferred from the ventricle to the atrium).

    Ultrasound shows a narrowing of the valve leaflet and its abnormal structure. The walls of the right ventricle and left atrium are hypertrophied. Valve flaps do not fully close. The aortic valve allows the normal flow of blood from the LV in the direction of the aorta.

    With stenosis of such a valve on ultrasound, you can see how the hole during systole is slightly narrowed. The thickness of the walls of the atrium and ventricle is slightly enlarged.

    Other cardiovascular pathologies are visible on an ultrasound scan of the heart as follows.

    1. With myocardial infarction, you can see how the area of ​​the heart is necrotic (that is, dead). Reductions in those areas are not noticeable.
    2. If the patient is diagnosed with pericarditis, then there is free flu >

    Ultrasound of the heart of a child (standard children’s echocardiography) is the most modern research method in cardiology. During the ECHO CT of the child, the doctor observes the work of the heart in real time, can examine all the structures of the heart of the child in the process.

    It is an ultrasound of the heart that confirms or eliminates the presence of many diseases of the cardiovascular system. It is often very important not to miss precious time for treatment, so that a small pathology does not have time to develop into a serious disease.

    Quickly and competently performed echocardiography allows you to detect the problem in time and keep your baby healthy.

    Indications for ultrasound of the heart of the child:

    • If the pediatrician, upon examination, having heard the heart of your baby, finds noise, then he will direct you to echocardiography (ultrasound of the heart).
    • If you yourself feel a trembling over the area of ​​the heart of the child – consult a specialist.
    • If the child complains of aching, pulling, stitching pains in the heart area – it is better to play it safe and do an echocardiography.
    • If the baby does not suck well, the baby may need echocardiography (here you must first eliminate the problems with improper attachment to the chest – consult a pediatrician about this). You should also pay attention to the color of the skin around the child’s mouth. Usually, with heart problems with crying and sucking, infants have a bluish nasolabial triangle. This is a fairly characteristic symptom.
    • If from time to time you feel that your child’s hands and feet become cool for no apparent reason, then you should be wary.
    • If the child loses consciousness (even during strong physical exertion), an echocardiography should be done and the possibility of cardiovascular diseases excluded.
    • Fatigue, excessive sweating, insufficient weight gain for age – all these things can be caused by heart problems and echocardiography is prescribed.
    • Frequent pneumonia in a child can also occur due to heart disease.
    • If your family has relatives with severe cardiac abnormalities, a child should be given ECHO at least once a year in order to stop the development of hereditary diseases in time if they occur.
    • According to the standards adopted in our country, every child at the age of 1 year should receive a consultation with a cardiologist as part of a routine medical examination, before doing this ECHO CT and ECG (electrocardiogram).

    Just like you during pregnancy, a part of the body (chest) will be smeared with a gel and driven through it with a sensor. A child may even move, fidget, speak during the ECHO KG of the heart, and this will not affect the examination results.

    Preliminary preparation for ultrasound of the heart is not needed. Echocardiography will take approximately 15 minutes. The results of an echocardiogram require decoding by a qualified doctor.

    It is advisable to show the cardiologist along with the results of an ultrasound of the heart also a fresh blood, urine and cardiogram results. The procedure is painless!

    ECHO KG is done both for serious indications, as prescribed by a doctor, and for reinsurance already in the first hours and days of a baby’s life. Experts believe that the method of echocardiography is completely safe, because unlike an X-ray study, it uses not radiation, but mechanical wave vibrations.

    The ultrasound procedure of the heart does not require special preparation and can be performed, if necessary, several times a day. The only thing that needs to be done if the child already understands what is happening to him, calm him down, set him up in a positive way. And in no case should he discuss with his doctor his illness and their possible consequences!

    What affects the quality of the study

    There are three main factors that interfere with obtaining high-quality results during ultrasound of the heart.

      Anatomical features of the patient.

    Not every patient can conduct an echocardiographic study in the proper volume. Access with transthoracic echoes (through the chest) is limited by intercostal spaces, the presence of adipose tissue, lungs, the state of adjacent tissues and the position of the heart in the chest.

    Thus, the state of all these structures can form serious obstacles in the study: for example, chest deformity, obesity and pulmonary emphysema. There is a solution to this problem. This is an MRI of the heart or transesophageal echo. It all depends on the purpose of the study.

    The experience of the doctor who conducts the study is much more important than the class of equipment on which he works. Experience can be divided into 2 categories:

    • Technical skills, that is, how correctly a specialist can bring out the heart in standard positions for making measurements and how correctly he will follow the rules of measurements.
    • The experience of the operator as a clinician. Ideally, the study is conducted by a cardiologist. A specialist in the treatment of heart disease will focus more specifically on those aspects that directly affect the course of the disease.
  • Class of equipment. Everything is clear here. The higher the class, the more accurately and voluminously the study is performed. The presence of certain diseases can be diagnosed only with a good resolution of the ultrasound apparatus.

    As an example, myocardial non-compactness is a type of cardiomyopathy. The presence of tissue doppler simplifies and makes more reliable the diagnosis of myocardial dysfunctions, constrictive pericarditis and the work of the left atrial ear.

    The strain function allows a more accurate assessment of segmental contractile activity of the myocardium. Despite the fact that the class of the device provides additional diagnostic capabilities, we must not forget that in the end the person interprets the received data.

    Explanation of results

    The resulting heart ultrasound protocol contains many abbreviations that only doctors can understand. For this reason, a person who does not have a special education will feel certain difficulties when trying to decipher the results of an echo kg examination.

    It is possible without special difficulties only to assess the norm of dimensions. It is worth paying attention that the norms differ for women and men. The same principle applies to children. For this reason, it is necessary to entrust the decoding of the results of the study to the attending physician.

    Only an experienced specialist will be able to evaluate the data provided and make a conclusion about the presence of a disease.

    At the same time, he will definitely take into account the state of human health, his age, gender, as well as the purpose of the examination. After that, an exact or presumptive diagnosis is made. According to the recommendations of doctors, even a healthy person needs to have an ultrasound of the heart at least twice a year.

    The price of research allows you to do this. This is necessary in order to avoid the occurrence of diseases of the cardiovascular system. Echocardiography is also performed when ailments occur, as well as during treatment to monitor effectiveness.

    Please note that modern diagnostic research methods, such as echo kg, provide the opportunity to detect the disease in the early stages, which helps to prescribe an effective treatment. Your life will be full and long.

    With echocardiography, individual heart structures and features of blood flow in the heart and in large vessels leaving the heart are evaluated. Structural images evaluated by echocardiography, their diagnostic significance:

    1. Pericardium: structural features, the presence of fluid in the pericardial cavity (important for the diagnosis of pericarditis).
    2. Images of heart chambers: right and left atrium, right and left ventricle:
      • the thickness of the walls of the heart (increases with hypertrophy of a certain chamber, often the left ventricle),
      • the size of the cavity of the heart chamber (an increase indicates dilation),
      • features of the contractile function of the walls of the atria or ventricles (impaired contractility is noted with a heart attack, when in the necrosis zone the myocardium loses contractility),
      • the presence of blood clots (formed more often in the right atrium with atrial fibrillation),
      • the presence of a heart tumor – myxomas (mainly localized in the left atrium, less often in the right, very rarely in the ventricles).
    3. Heart valves:
      • leaf structure
      • the presence of stenosis (narrowing) of the valve,
      • size of the functioning opening (mitral stenosis with narrowing of the mitral valve,
      • aortic stenosis – with narrowing of the aortic valve, respectively),
      • mitral valve prolapse – “sagging” of the valve cusps into the cavity of the left ventricle, assess the degree of prolapse,
      • loose closure of valve flaps, in which the ejected blood partially returns back to the heart cavity (insufficiency of the mitral or aortic valve),
      • the presence of vegetation on valve flaps (a sign of infectious endocarditis).
    4. Aorta:
      • narrowing of the aortic site (coarctation of the aorta),
      • the presence of an aneurysm (expansion of the aorta or protrusion of it in the form of a bag).
    5. Partitions of the chambers of the heart, interventricular and interatrial:
      • defects in the septum (characteristic of congenital heart defects, heart injuries).

    Hemodynamic characteristics (especially blood flow), their significance for the diagnosis of diseases:

    1. The movement of blood through the valves of the heart (diagnosis of valve stenosis and the degree of regurgitation – reverse blood flow through the valve).
    2. Blood flow in the chambers of the heart:
      • ejection fraction or cardiac output – the ratio of the volume of blood that is ejected into the aorta during contraction of the left ventricle to the amount of blood remaining in the ventricle (shows the effectiveness of heart contractions, a decrease in the rate is typical for heart failure),
      • final systolic volume
      • final diastolic volume
      • shock volume.
    3. Assessment of blood flow velocity in the aorta, identification of its coarctation.

    Analysis of indicators shows the state of the parameters of the right and left ventricles, as well as the partitions between them.

    Analysis of indicators of the left ventricle:

    • Myocardial mass index (normal for women 71-78 g per square meter, for men – 73-90 g per square meter).
    • Myocardial mass (normal 93-140 g for women, 137-180 g for men).
    • The volume of the ventricle at rest: in women 60-130 ml, in men – 66-190 ml).
    • The wall thickness when working outside the cuts is not more than 1,2 cm.

    Analysis of indicators of the right ventricle:

    • Size index (0,78 to 1,3 cm per square meter).
    • Wall thickness (strictly 5 mm).
    • Size 0,76-1,2 cm at rest.

    Recommendations of specialists

    Depending on the specific pathology identified during the examination, repeated ecocardioscopy is prescribed after 3 months, or after 1 year, or as prescribed by the attending physician.

    It is considered appropriate to perform an ultrasound of the heart in the first year of a child’s life, since this study allows you to identify most of the congenital malformations, so that you can timely correct them and prevent serious consequences.

    If the child in the first year of life had an open oval window, then repeated echocardioscopy is necessary every six months until the oval window is completely closed or before a decision is made on the surgical treatment of pathology.

    Children of school age, as well as adults who do not have heart disease, are recommended to undergo an examination once every five years. Patients with mitral valve prolapse need to undergo an echocardioscopy once every 1 years or annually in the presence of increased physical exertion: heavy physical labor, sports, etc.

    Once a year, heart defects in adults are monitored by ultrasound without indications for surgery. After heart surgery or myocardial infarction, an ultrasound scan is performed several times during the first year, from the second year – 1 time per year.

    People suffering from hypertension and ischemic disease are advised to undergo echocardioscopy once a year, paying special attention to myocardial hypertrophy, ejection fraction and valve function.

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  • Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.