Heart ultrasound( echocardiography) - Causes, symptoms and treatment. MF.

What is echocardiography?

A physician may not always be able to accurately diagnose on the basis of a single clinical examination, as during the auscultation( listening) of the chest and heart area he can only suspect a disease. But in order to confirm or deny this suspicion, echocardiography is prescribed.

Echocardiography is an instrumental research method that allows you to visualize the heart and evaluate its structural features and basic hemodynamic parameters. Its essence consists in the use of ultrasonic waves, capable of reflecting from the tissues of the organism with different acoustic densities. Apparatus for the study includes a source of ultrasound, which, reflected from the heart tissue, is converted into electrical impulses. These electrical signals are processed by a computer and fed to the monitor of the device as a specific image. Echography allows you to get a two-dimensional image of the heart in real time.

This is a graphic representation of the heart on the monitor of the device.

Study is performed through the front wall of the chest in the projection of the heart. In cases where this is not possible due to technical difficulties( severe obesity in the patient, trauma to the chest), the sensor is inserted through the esophagus and is in close proximity to the atria and ventricles. This kind of echocardiography is called transesophageal ultrasound of the heart .

also stresses the stress echocardiography , which, when performing certain stress tests( with the use of medications or physical exertion), allows assessing the contractility of various parts of the myocardium to the load on the heart and after it. Especially relevant is the use of this method in conjunction with other instrumental examinations for the diagnosis of coronary heart disease.

There is a method supplementing ultrasound of the heart, based on the effect of Doppler - the ability of ultrasound to change the frequency depending on the speed of the object( in this case, the echo - signal is reflected from the moving blood cells).With , an ultrasound of the heart with the doppler produces a color image of the blood flow in the atria and ventricles.

ultrasound of the heart with doppler( dopplerography, ultrasound, CDC).Fetus. A heart.

Directly, echocardiography allows you to visualize the heart, see its anatomical features, determine the size, increase or decrease the chambers of the heart( atria and ventricles), assess myocardial contractility and the presence of postinfarct scars, and Doppler helps the doctor see the movement of blood in the heart( hemodynamics) and determine if there iswhether violations in the correct flow of blood in the heart cavities( for example, regurgitation - reverse the return of blood).

Indications for ultrasound of the heart

Why is echocardiography necessary? The method of ultrasonic cardiography is widely widespread in cardiology and cardiac surgery due to its availability and non-invasiveness( the absence of mechanical penetration into the organs and tissues of the body).

Indications for heart ultrasound are:

1. Routine examination:
- newborns - necessary for diagnosis of congenital anomalies or heart defects;
- adolescents - is carried out to identify functional abnormalities in the heart, because in the period of intensive growth of the musculoskeletal system, the growth of the heart may be delayed, in connection with which the load on the cardiovascular system increases;
- pregnant women - is conducted to evaluate the activity of the cardiovascular system with the subsequent decision of the issue of the possibility of independent delivery( if necessary, for example, with previously unhealed heart and large vessels)
- athletes - to analyze the structural and functional changes that arisein the heart of persons professionally engaged in sports
2. Diagnosis of endocardial diseases( inner shell) and heart valves:
- bacterial endocarditis, as well aspain that can lead to its development - tonsillitis, rheumatic fever, scarlet fever, intravenous drug use, bacteremia;
- congenital and acquired heart defects;
- thrombi in the heart cavities
3. Diagnosis of myocardial diseases( cardiac muscle):
- myocarditis;
- ischemic heart disease( CHD), including myocardial infarction;
- rhythm and conduction disorders( cardiac arrhythmias);
- cardiomyopathy( endocrine, toxic, alcoholic origin);
- heart tumor
4. Diagnosis of pericardial( cardiac, cardiac) heart diseases:
- pericarditis
5. Arterial hypertension
6. Chronic heart failure
7. Malformations or pathological conditions of large vessels( aortic aneurysm).
8. Evaluation of the state of the heart and cardiac activity after drug therapy of the above diseases
9. Evaluation of the state of heart valves and the state of the heart muscle as a whole after surgery( prosthetics or restoration of valves, the establishment of an artificial pacemaker, cardiosurgical treatment of myocardial infarction, etc.).

Contraindications for echocardiography

There are no contraindications for carrying out an ultrasound examination of the heart. There are technical difficulties when carrying out ultrasound of the heart is impossible for the following reasons: the patient has a high degree of obesity, severe chest injuries, the patient has severe chronic obstructive pulmonary disease with increased airiness of the lung tissue( because of which the heart is covered with light and not accessiblefor penetration of ultrasound).

Preparation for ultrasound of the heart

Special preparation of ultrasound of the heart does not require. The patient on the eve of the procedure can observe the usual daily routine. Unlike the research of other organs, there is no need to perform an examination on an empty stomach or change the drinking regime.

How is echocardiography performed?

As a rule, the procedure is performed in a polyclinic( outpatient), if the patient has not been sent beforehand by a doctor to a hospital with a therapeutic and diagnostic purpose. It should be noted that the ultrasound of the heart has nothing to do with radioactive radiation, it is completely safe and harmless, and therefore can be used repeatedly.

At the appointed time, the patient comes to the clinic and the nurse invites him to the ultrasound diagnosis room. Further, the researcher is placed on the couch in the supine position on the back or on the left side( depending on the doctor's recommendations), the doctor applies a transparent gel( the conductor providing the best passage of ultrasound through the skin) to the chest skin in the projection of the heart and "slides" the sensor over the skinin various points of access to the heart. The access points on the chest are parallel to the sternum on the left, above the breastbone in the jugular fossa region, under the breastbone is closer to the left hypochondrium, in the region of the apex of the heart under the left nipple.

The received data are processed by the computer and displayed on the monitor in the form of a graphic image and heart rate indicators, then the doctor analyzes all this and issues his conclusion.

In the process of research, the overwhelming majority of people have no unpleasant sensations. The entire process takes 20 - 30 minutes, after which the patient is given a conclusion, and he can go home( unless, of course, there are serious heart diseases requiring immediate hospitalization).This conclusion must be given to your doctor. Decoding of the results of ultrasound of the heart

Of course, it is difficult for a patient who does not have medical education to understand the written in the conclusion. But still, let's try to sort out at least some of the basic heart rate indicators obtained by ultrasound. The normal values ​​of these indicators may vary depending on the equipment in this or that medical institution. So, they are:

- the root of the aorta is 20-40 mm.
- right ventricle - 7-23 mm;
- right atrium - 27-45 mm;
- left atrium - 19-40 mm;
- left ventricle: BWW( terminal diastolic volume, volume of blood in the relaxed ventricle at the time of diastole) - 65-123 ml;CDR( terminal diastolic size) - 46-57 mm;CSR( terminal systolic size, ventricular size at the time of ejection of blood into the aorta - systole) 31-43 mm;
- the thickness of the interventricular septum is 7-11 mm;
- pulmonary trunk( diameter) - 16-25 mm;
- ejection fraction( EF) - 55-60%;
- stroke volume( VO) - volume of blood ejected by the left ventricle into the aorta for one cardiac contraction;
- the number and mobility of valve flaps, their thickening, narrowing or divergence are also estimated;presence or absence of regurgitation( reverse transfer of blood to the atrium);general contractility of the myocardium and the presence of zones of akinesia and hypokinesia( absence or reduction of myocardial contractions in certain areas);condition of the pericardium( presence or absence of effusion in the pericardial cavity - the cavity between the heart muscle and the outer shell of the heart, pericardium).

Changes in indicators occur in various diseases. Thus, changes in the root of the aorta may indicate atherosclerosis of the aorta or its aneurysm;augmentation of the atrial and / or ventricular cavities on the presence of dilated cardiomyopathy, chronic heart failure, heart valves failure with regurgitation.

Thickening of the heart muscle( myocardial hypertrophy) is characteristic of arterial hypertension;reduction in myocardial contractility, or in some areas for acute myocardial infarction or the formation of postinfarction cicatrix.

The ejection fraction and shock volume allows to assess the overall performance of the heart, can be reduced in many pathological processes in the cardiovascular system. Changes in valve flaps, different directions of their movement, constriction or expansion may indicate the presence of heart defects in the patient( stenosis of atrioventricular apertures or failure of valves).

In any case, only a doctor in the course of a full-time examination will decide whether there are irregularities in the work of the heart, whether they are comparable to clinical symptoms, whether additional diagnostic methods are required, whether treatment is needed and where - in a hospital or polyclinic at the place of residence. Self-analysis of the conclusion of an ultrasound of the heart without the participation of a doctor is fraught with a threat to health and life, if it is a serious disease according to the results of the survey.

Are there any complications in cardiac ultrasound?

Due to the safety of the procedure, there are no complications for echocardiography. The only drawback is the occurrence of an allergic reaction at the site of application on the skin of the gel - a conductor in persons predisposed to allergies. But this is very rare and does not have any significant clinical value, since the benefit of the study exceeds the risk of allergy development.

Doctor therapist Sazykina O.Yu.