What is 2D Echo Test -The Beginners Guide

My father died in May 2019 due to cardiac arrest at the age of 73 years, a couple of years ago he had done his 2D Echo test and found that he had a few blockages and valvular problems and the doctor said if the operation will be the open heart which due to age is not advised and told to take precaution. Only if the 2D Echo test was done earlier it might have been a different story altogether.

You have been told that in regards to diabetes and blood test that one should be doing a blood test to check if diabetes is thereafter the age of 40 years, one should also take the same precaution in regards to the heart conditions and 2D Echo test.

What that will do is one you can detect the problem at an early stage and if an operation is required it can be done at an early age and have a better chance of survival and a long life too.

What is 2D Echo Test?

2D Echo or 2D Echocardiography is a non-invasive method to investigate and evaluate the function and condition of any section of the heart by creating various images of the parts of the heart which need to be investigated by using sound vibration which assists in checking any blockage, damage, and blood flow rate. The 2D Echo test is routinely used for diagnosis, management, and follow-up of patients suspected of heart diseases.

Inge Edler (1911-2001), a Swedish physician, is known as the “Father of Echocardiography” since he was the first to use ultrasonic pulse-echo imaging to diagnose heart problems.

Mainly 2D Echo is used in heart-related diseases but now the field has expanded and it is also into pediatrics like fetal echocardiography.

Why 2D Echo test is done?                                 

The build-up of fatty plaques in your arteries can damage the blood vessels and heart. This build-up causes narrowed or blocked blood vessels, leading to heart attack, chest pain, or stroke.

The symptoms of heart disease are as follows:

1. Chest pain, chest tightness, chest discomfort (angina), and chest pressure.
2. Shortness of breath, palpitations
3. Numbness, pain, and weakness or coldness in legs or arms if blood vessels in those parts are narrowed or blocked
4. Pain in the jaw, neck, back, throat, or upper abdomen.
5. Sweating, nausea, vomiting, extreme weakness, dizziness, anxiety.

For the above-mentioned symptoms is why 2D echo test is referred. If the symptoms are lasting longer, you are definitely advised to see your physician for a further check-up. These symptoms can be the signs of coronary artery disease, heart attack, arrhythmias, atrial fibrillation, heart valve disease, heart failure, congenital heart defects, heart muscular disease, and pericarditis. This test can detect the above-mentioned diseases and assist the doctor to take further action.

How is 2D Echo Test done?

A 2D Echo test is similar to an ultrasound test. The chest is uncovered and colorless gel is applied to the area and technician instructs the patient to lay on the table on his left side and by using a transducer to move across different or specific parts of the chest to get an image on the computer and can be printed or stored on the hard drive like DVD or memory sticks.

After the test is over the gel is wiped off the patient and he can redress after that. Normally the procedure will be over within half to an hour and this procedure is performed in front of a cardiologist and of a radiologist. This procedure is safe and not painful.

Types of 2D Echo

Mainly there are three types of 2D Echo or echocardiography which are as follow

Transthoracic Echocardiogram:

This is a standard and most commonly used echocardiogram or cardiac ultrasound where the transducer is placed on the chest wall or thorax of the patient and an image is taken through the chest wall. This is highly accurate, non-invasive, and gives a quick assessment of the heart condition.

Transesophageal Echocardiogram:

This is an invasive process wherein a specialized probe containing the transducer and the tip is inserted via the esophagus, this allows the image and Doppler evaluation from the location directly behind the heart.

This is used when the transthoracic images are not at par and to make an assessment a clearer picture is in need. For this procedure, a cardiologist, registered nurse, ultrasound technologist alternatively anesthesiologist is needed in case local anesthesia needs to be observed.

Stress Echocardiogram:

Also known as Stress Echo, A stress echocardiogram uses an ultrasound image of the heart to evaluate the wall motion in response to the physical stress. At first, the image of the heart is taken “at rest” for a baseline of wall motion of the resting heart.

Then the patient is made to walk on a treadmill this is done to increase his heart rate to the targeted heart rate or 85% of the age-predicted maximum heart rate (220 – patient’s age). Then the heart image is taken “at stress” to assess the wall motion at the peak heart rate. Ischemia of one or more coronary arteries could cause wall motion abnormalities, which could indicate coronary heart disease.

Intracardiac Echocardiogram:

Intracardiac Echocardiogram is also known as ICE is a specialized cardiogram where the catheter is used to insert the probe inside the heart to view a 2D structure from within. ICE is more beneficial than transthoracic echocardiography because the operator performing the sterile procedure can also operate the ICE catheter and ICE has no visibility problem which may arise in transthoracic echo.

Intravascular Ultrasound:

Intravascular ultrasound (IVUS) is a specialized cardiography that uses a catheter with an ultrasound probe inside the blood vessels. This is used to measure the size of the blood vessels and to measure the internal diameter of the blood vessels. For example, this can be used for a coronary angiogram to evaluate the narrowing of the coronary artery.

Different Modes of Echocardiography   

How ultrasound crystals are sued to obtain images have different modes which are given below. These modes are the same as all types of echocardiography.

A-Mode:

 A mode is known as Amplitude Mode. A spike or a vertical reflection of a point appears when the ultrasound wave encounters an anatomic boundary. The intensity of returning impulse determines the height of the spike and the time taken to return for the impulse donates the space in between the spikes. This model has become obsolete now.

B-Mode:

Brightness Mode is also known as 2D. Instead of the spiking vertical movements in the A-mode, the ultrasonic signal is employed to create distinct spots whose brightness is dependent on the amplitude. The time delay between pulse transmission and echo return determines the vertical position of each brilliant dot, whereas the horizontal position is governed by the placement of the receiving transducer element.

M-Mode:

M Mode or motion mode is not used frequently in modern echocardiography. This is mainly used to analyze the moving body parts like fetal cardiac imaging.

Strain Rate Imaging:

Strain rate imaging is an ultrasound technique used to detect regional disparities in contraction (dyssynchrony) in conditions such as ischemic heart disease or dyssynchrony caused by Bundle branch block. Strain rate imaging assesses either regional systolic deformation (strain) or the rate of regional deformation (rate of regional deformation) (strain rate). Tissue Doppler or Speckle tracking echocardiography is the method employed.

Three-dimensional echocardiography:

Using a matrix array ultrasonic probe and a proper processing system, three-dimensional echocardiography (sometimes known as four-dimensional echocardiography when the image moves) is now available. This allows for a more complete anatomical evaluation of heart disease, notably valve abnormalities and cardiomyopathies.

The capacity to slice the virtual heart in infinite planes in an anatomically realistic manner and rebuild three-dimensional representations of anatomic components distinguishes it as a unique tool for comprehending congenitally deformed hearts. Real-time three-dimensional echocardiography can be utilized to guide the placement of bioptomes during right ventricular endomyocardial biopsies, catheter-delivered valvular device implantation, and a variety of other intraoperative examinations.

Contrast echocardiography:

The addition of an ultrasonic contrast medium, or imaging agent, to standard ultrasonography, is known as contrast echocardiography or contrast-enhanced ultrasound. The ultrasonic contrast is composed of microscopic microbubbles containing a gas core and a protein shell. This enables the microbubbles to flow through the circulatory system and reflect the ultrasound waves, resulting in a highly reflecting picture.

Contrast-enhanced ultrasonography can be beneficial in a variety of applications. The most typical use is for the augmentation of LV endocardial boundaries in order to measure global and regional systolic function. Contrast may also be utilized to improve visibility of wall thickening during stress echocardiography, to evaluate LV thrombus, or to evaluate various masses in the heart.

What does 2D Echo test show

Following heart conditions can be detected

1. Any underlying heart condition or anomalies
2. Congenital cardiac defects, tumors, and blood clots.
3. Heart valve malfunction.
4. Abnormality in the flow of blood within the heart.

When the 2D echo test shows these results then coronary artery disease, heart attack, arrhythmias, atrial fibrillation, heart valve disease, heart failure, congenital heart defects, heart muscular disease, and pericarditis are the possible diseases that you might be suffering from.

While checking with their doctor many patients ask is 2D echo better than ECG? Though these two are used to monitor the heart, 2D echocardiography uses ultrasound to look for the irregularities in the heart structure whereas ECG looks for the abnormalities in the heart by using electrical impulse using electrodes.

Though ECG can and will provide many clues to many of the diagnoses, an echocardiogram is considered more accurate to detect abnormalities in heart structure and function. There is no special preparation is required for 2D echo and no need to be empty stomach. You can eat and drink as per your normal schedule and even take the prescribed medication if any.

Conclusion:

At the start of the article, I had mentioned my father’s demise, if the test included in regular check-ups with people who are aging so that a person can get an early indication that there is a problem developing which if not taken care of at an early stage of life surgery in later years will be more problematic.

Most people think about doing these tests after their retirement only and by the age of 60 or so doing surgeries are tough on anyone’s health. We should at least educate people that they should take care of their health, especially those people who work 8 to 10 hours sitting at one place and their daily life has very less activity.

As age progress and the family become more stable you would want to enjoy life more and to do so let us consciously take the step to have a healthy life and healthy heart.