Echocardiography

It is a unique technique as it is not an invasive procedure for anatomical and functional evaluation of heart and it is completely safe and risk-free. It involves imaging the reflections of ultrasonic sound waves. It has eco varieties such as 2-dimensional, M mode, Doppler (spectral and color) and types such as transesophageal, stress echocardiography. A routine electrocardiogram evaluation includes 3 stages: 2-dimensional, spectral and color Doppler electrocardiogram. After a gel is applied to the chest of the patient while lying on the bed on the left side or on supine position, tomographic images of the heart are taken from different cross-sections by means of a probe. After electrocardiogram, information is obtained regarding the status of pumping functionality of heart, the structure and functionality of valves and structural abnormalities of heart.

The flows in the heart create red, blue and green color (flowing towards the probe is red, flowing away from the probe is blue and flow jets are green) based on their movements according to the probe in Doppler echocardiogram. It is important for identifying the existence and the criticality of leakage and stenosis of heart valves as well as diagnosing congenital heart defects and heart muscle diseases. Hacettepe University Cardiology Department provides service with a total of 5 echocardiograph instruments, one of which is reserved for use in catheterization laboratory. The echocardiograms of patients who have scheduled appointment from the normal outpatient clinic are performed in Echo unit of outpatient clinic of cardiology from 09:00 to 12:00 while the echocardiograms of patients who received examination in the outpatient clinic of academic staff are performed in Echo unit which is located in Cardiology on floor Z. A usual echo test takes about 20-30 minutes and is performed in a few different ways:

1. Transthoracic echocardiography
It is the method which is applied as the routine. This noninvasive test involves applying gel on the chest of patient who is in lying position and it is performed with a probe.
You do not need to make a special preparation before coming to your appointment.
The result is given directly after the test.

2. Transesophageal echocardiography
This test has been developed in order to obtain a better image of the heart sections that cannot be evaluated by means of a routine echo. Similar to endoscopy, a preliminary preparation which includes topical anesthesia and, sometimes sedative medication is carried out and passing down the probe with a transducer mounted at its tip by means of swallowing and various cross-sectional images of the heart are taken by progressing into the esophagus (gullet) and sometimes into the stomach.

It is particularly preferred in the event of a suspect from structural heart abnormalities (congenital heart defect: ASD, VSD, etc.) or thrombus (blood clog) in heart chambers as well as in case of infective endocarditis. Furthermore, it is extremely valuable in diagnosing aortic dissection and it offers the advantage of applicability in intensive care, by the bed and during an operation. Transesophageal echocardiogram is performed by an experienced team 5 days a week in Hacettepe Cardiology. It takes about 15-20 minutes.

Considerations about transesophageal echocardiography
Transesophageal echocardiography is a test method which provides opportunity for a closer and clearer evaluation of heart chambers thanks to the electrocardiogram method which is inserted into the esophagus by means of swallowing.

As nausea can occur during swallowing the probe during the procedure, you should keep an empty stomach starting from at least 6-8 hours before the procedure, in order to prevent vomiting and gastric contents from leaking into trachea.

Your threat will be locally anesthetized in order to reduce your nausea feeling before starting echocardiogram. As the effect of this medication lasts for 2-3 hours, you should not eat or drink anything for 2-3 hours after the procedure in order to eliminate the risk of failure in swallowing food and aspirating it into the trachea.

If you have removable dental prosthetics, please take these off before the procedure as these can be aspirated into your trachea otherwise.
If you cannot breathe from your nose or you have an esophageal disease, make sure that you definitely inform your physician before the procedure.

Transesophageal echocardiography is a test which is completed in a short period of time. The procedure can easily be performed with your help. It allows your physician to obtain better information about your disease as it offers clearer images compared to echocardiography performed on the chest wall. Dental injury, mild bleeding in the throat, esophageal injury particularly by patients with esophageal diseases, difficulty in breathing by patients who cannot breathe from the nose and aspiration of vomited gastric contents into the trachea in the event of not arriving with empty stomach are the adverse effects that can occur during the procedure. As it has been explained above, the majority of these can be minimized with measures.

You should keep an empty stomach starting from at least 6-8 hours before the procedure.
Make sure that you bring along the contents of your prescription which has been given to you, if any.
Please remember to bring along the report of echocardiogram taken from your chest wall and your file.

3. Stress echocardiography

This echocardiography type is based on identification of abnormal contraction in the ischemic areas
It is generally performed with medication (dobutamin) in Hacettepe Cardiology. The advantages of stress echocardiography over cardiac stress test are: enhanced accuracy, no radiation exposure, reasonable pricing, providing information on cardiac hemodynamic and valvular functions changing with exercise. Furthermore, this method is preferred in the events that ECG cannot be evaluated.

Echocardiography laboratory provides important information for valvular heart diseases, ischemic heart disease, pericardial diseases, cardiac masses, diseases of primary blood vessels, pulmonary diseases and congenital heart defects.