How Does Echocardiography Work?

Echocardiography is the sonographic examination of the heart. Doctors also speak of “heart echo”. Ultrasound waves are emitted by the transducer of the sonography device. These waves are either “swallowed” by the body’s tissue or reflected back. The transducer receives the reflected waves and transforms them into electrical impulses that are projected on to a monitor screen. This process happens “live”, so that the cardiologist can examine the heart in acti

Transthoracic Echocardiography (TTE)

In a TEE examination the doctor passes the smartphone-size transducer across the chest wall, varying the angle so as to obtain as clear as possible a picture of the heart structures on the TEE monitor. This form of examination is used as the first-line method of obtaining information about the patient’s heart, such as its size, wall thicknesses, pumping and valve function. The procedures known as Doppler ultrasound and color Doppler deliver additional information about the blood flow velocity and strength in the vessels. Ultrasound is used for diagnosis after acute events such as a myocardial infarction but is also useful for routine examinations.

While conventional echocardiography machines produce only two-dimensional images, the German Heart Center Berlin also uses modern 3D echocardiography, which provides a three-dimensional representation of the heart. This is done by many millimeter-thick two-dimensional ultrasound images being recorded in rapid succession or at the same time, showing the structure in three dimensions.

Transesophageal echocardiography (TEE)

Transesophageal echocardiography involves a small transducer being passed into the patient’s esophagus (windpipe). The patient is first sedated. The advantage of this method is that the transducer moves along below the breastbone and close to the heart and therefore transmits better images. Parts of the heart that are located deep in the thorax can also be visualized. TEE is used, for example, to exclude blood clots, to diagnose inflammation of the heart lining and to examine the heart valves. The German Heart Center Berlin is certified as a training center for this procedure.

Stress Echocardiography

Stress echocardiography is the echocardiographic examination of the patient during exertion. This can be while pedaling a bicycle ergometer or stress can be simulated using a pharmacological agent. The doctor follows this procedure to examine heart wall motion changes during exertion in order to establish whether vessel repair (bypass or dilatation and stent implantation) is indicated. Malfunctioning valves can also be assessed using this method.

Echocardiography with Contrast Medium

For contrast medium echocardiography the patient receives the contrast medium before the examination: a well-tolerated liquid is injected into a vein and reaches the heart together with the blood flow. The contrast can be distinguished from the surrounding blood and enables the doctor to assess the blood flow. This helps to identify malformations and diseases of the heart, for example malfunctioning of the valves or narrowing of the coronary arteries.

Vascular Echocardiography

Echocardiography of vessels is used in the neck area to image the arteries supplying the brain (known as carotid Doppler) and on the arm and leg arteries and the veins, for example in the case of deep vein thrombosis (vein Doppler). Also, vascular echocardiography can be performed (peripheral Doppler) following interventions. In addition to assessing the vessel the device measures blood flow velocity by means of the so-called Doppler effect. Carotid vessel and arm vessel Doppler is applied preoperatively and in the case of narrowed vessels (stenoses). Peripheral Doppler is used to show up stenoses, thrombosis, fistulas and vessel injury.